People with memory loss and confusion sometimes become agitated, angry or violent.  For caregivers these behaviors are difficult at best and occasionally become dangerous.  The following tips are designed to help you avoid and defuse angry outbursts.

1.  REMEMBER ANGER IS A SYMPTOM

• Try not to take angry outbursts personally.
• Remember that anger is often the result of loss of control or frustration.
• Look for early signs of frustration such as fidgeting.  Try to distract the person before violent outbursts occur.

2.  RESPOND CALMLY

• Respond to anger and outbursts in a calm and direct manner.
• Speak in clear, short, easy-to-understand sentences.  Make eye contact.
• Approach the person slowly and from the front.

3.  LOOK FOR PHYSICAL CAUSES

• Check for physical causes such as pain, illness or constipation which may cause frustration and anger.
• Have a medical evaluation.  Find out if the person is taking medications, which may cause anxiety, hallucinations or paranoia. 
• Find out if medications may decrease symptoms.
• Hava a doctor check for impaired vision or hearing which may be increasing confusion.

4.  PLAN FOR QUIET TIMES

• Make sure the person is getting rest and sleep.
• Mix quiet times with other activities.  Try listening to quiet music or reading aloud.

5.  AVOID CONFUSION

• Do the same things, such as eating dinner, taking a walk, at the same time each day.
• Limit choices which cause confusion.

6.  AVOID STRESS

• Avoid situations with a  lot of noise, activity and people.  This can create stress.
• Notice if the person is acting lost, confused or frightened.  Calmly reassure him or her.
• Pay attention to your body language.  The person may become agitated if you are angry or frustrated.
• Plan stressful activities such as bathing and dressing for when the person is rested.
• Allow plenty of time for all activities and give clear, step by step directions.
• Try a daily walk to reduce stress.
• Providing soothing objects such as stuffed animals.

7.  PROVIDE SECURITY

• Provide a safe and secure environment.  Avoid changes in home and caregivers when possible.
• When a change or a move is necessary, include familiar objects in the new home.
• Try to make changes gradually.

8.  ASSESS DANGER

• Make sure the person cannot hurt him or herself.
• Keep sharp objects put away.
• Try moving five steps back from the person to see if that diffuses the anger.
• Avoid physically holding or restraining the person unless absolutely necessary.  This will often make the situation worse.
• If possible, take the person away from upsetting situations.
• Try to distract the person with a favorite food or activity.

9.  KEEP YOURSELF SAFE

• If the person is physically violent, make sure you are safe.  If necessary, stay out of reach or leave to avoid getting hurt.
• Call friends, family, neighbors, or your doctor for help.
• If violent episodes are repeated, devise an emergency plan to keep yourself and the person you are caring for safe.
• If you feel your safety is threatened, call 911 or your local emergency number.

10. EVALUATE EPISODES

• After a violent episode, don't remind or blame the person.  He or she will probably forget what happened. 
• Look at what caused the problem.  See if there is any way to avoid the situation in the future.
• Remember that by responding calmly you can sometimes help avoid outbursts.

5190 S. Valley View Blvd., Ste. 101
Las Vegas, Nevada 89102
(702) 248-2770

Contributed by: Alzheimers Association: So. Nevada Chapter.