I’m often asked about ways to provide care for people with dementia who are aggressive and combative. Recently, I was asked to offer suggestions for helping an aggressive dementia patient change clothes. The response I share here specifically addresses that recent question, but the principles of care can be applied to a variety of activities involving people with Alzheimer's disease and related dementias (ADRD).

It’s important to know that behaviors are often simply a form of communication. Therefore, if we can discover the message that underlies the behavior, it will likely lead us to a change in approach that will eliminate or reduce the behavior.

Research shows that, most often, aggressive behaviors occur during activities of daily living (ADLs), and they occur because the person feels violated, threatened, or out of control. The behavior is therefore a defensive reaction with the message behind the aggression being, “I am frightened and need to defend myself.” Or the message could be, “This is the only way I can communicate my need for control or choice because this person isn’t allowing me to be an active, willing participant.”

With this in mind, we should also remember to always gain trust and agreement from the person before starting an activity. Therefore, if the person gives any indication of being scared or resistive, we need to immediately figure out why the person feels this way. It is our responsibility to change our approach to gain trust and agreement. Usually there is an indicator that the person is feeling uncomfortable before the situation becomes physical or combative. Care partners need to observe and respond immediately, instead of pushing through the task.

Here are some general ideas for reducing aggressive behaviors during dressing/undressing. First, ask the person, “Would you like to wear this outfit or that outfit?” Even if they can’t respond, this may give them a feeling of control.

Also, make sure that the person is not cold, overexposed, or uncomfortable. Honor privacy by placing a towel over body areas that are uncovered. Prevent the person from getting cold by turning up the heat. Prevent discomfort by making sure the person is seated comfortably during the dressing/undressing session.

Finally, make sure that the person is in agreement with the clothes being removed for changing. Otherwise, the person may feel violated or threatened. If you did not give your agreement and someone took your clothes off, wouldn’t you fight? That’s a normal, defensive reaction. Therefore, make sure to first establish a supportive, trusting relationship with the individual. Then ask the person for their permission to have their clothes removed. It is also vital to empower and facilitate the person to assist in the process as much as possible, as this will decrease feelings of powerlessness and feel less threatening.

I hope this information proves helpful to all caregivers who are committed to helping make life better for people with Alzheimer’s disease and related dementias.