When people living with Alzheimer’s become angry and combative, their caregivers face new challenges that require new strategies. “I realize I am the one who needs to change,” shared a myALZteam member who cares for a loved one with Alzheimer’s disease. “Learn not to take it personally. Don’t engage and argue. I don’t have to be right if I want peace.”

Researchers have identified seven stages of Alzheimer’s disease. At stage 3, mild cognitive impairment, the person can seem more anxious than usual. Once they reach moderate dementia (stage 5), anger and suspicion can become commonplace. Advanced Alzheimer’s, or severe cognitive decline at stage 6, may include angry outbursts and violent behavior related to diminished independence and fear.

Managing emotional outbursts from someone with Alzheimer’s can be tough for caregivers, and it’s hard not to take these sudden changes personally. Remembering that your loved one has a brain disease can help you maintain a level-headed perspective while providing dementia care.

Here are some strategies, including tips from members of myALZteam who’ve found ways to cope with these difficult circumstances.

1. Alleviate Discomfort, Anxiety, and Overwhelm

Sometimes feelings of physical discomfort, anxiety, or overwhelm can manifest as aggression for people with Alzheimer’s.

People with Alzheimer’s can’t always articulate when they’re uncomfortable or in pain. You can first determine if your loved one is hot or cold, hungry or thirsty, constipated, or isn’t getting enough sleep. Resolving these root causes of discomfort may help with the underlying anger.

Feeling anxious or fearful can also be a cause of anger. One caregiver on myALZteam shared, “We see a lot of anxiety in her. We talk quietly and stroke her hands or back and offer reassurance at these times. She often retreats to her bed to relax and process.”

Minimize overstimulation by clearing clutter, reducing loud noises, and avoiding crowds. Narrowing down choices is another way to reduce feelings of overwhelm that stem from decision-making. “Watching her stare at a menu, getting increasingly anxious, was hard to see,” one myALZteam member shared. “I sat beside her until after we ordered and let her help me figure out what I wanted. I would only point to items she usually orders for herself, then order one for each of us.”

Another member explained, “He has difficulty with too many options at restaurants. I often say, ‘You usually like seafood here, like oysters or crab cakes, maybe?’ This typically works fine. Too much choice overwhelms him.”

2. Avoid Needless Arguments

It can be difficult not to engage with a parent, spouse, or other family member who argues with you or accuses you of something you didn’t do. Although this may be easier said than done, try to step back and avoid taking their unkind words personally.

“I learned that arguing a point, however logical in my mind, is utterly fruitless,” said a myALZteam member. “I have so much more peace now that I have learned to say, ‘That’s a good point. Let me think about it.’”

Another explained, “When my husband has a burst of angry words, I simply do not respond. Anything I say will only add fuel to the fire. I may turn my attention to a small task near to hand or leave and go to another room to read (or simply sit and breathe). So far, not responding to the irrational, angry burst seems to work best at tamping down the flames.”

Journaling can be a good outlet for your emotions and a way to practice self-care as a caregiver. Rather than trying to reason or fight with the other person, you can express your feelings without prolonging an argument.

“I choose not to engage, which sometimes makes you feel weak,” said another member. “I journal about it. I do not re-read my pages. I hope one day I can throw the journal away.”

3. Redirect or Distract

In a myALZteam conversation about aggression and Alzheimer’s, one member wrote, “I have learned the art of distraction and therapeutic fibs.”

If you can’t walk away or fix the problem, sometimes a distraction is the next step. “Listen and see why they’re mad. Try to help. If not, redirect them to a happy place,” said one member.

“Let it go. It is not worth the headache. Just guide the conversation in another direction,” suggested another member. “Life is too short, and memories fade away fast. Enjoy the moments you still can have or make.”

You can also redirect using items, activities, or foods that may interest them, like this member who explained, “Redirect with simple snacks, like grapes, carrot sticks, an apple, or banana. You can also use a new catalog or piece of mail.”

4. Maintain Reassuring Routines

People with Alzheimer’s can get frustrated and confused when their environment or schedule changes. Familiar routines can add structure to their day.

One member shared, “A daily routine for him is to locate his money. He leaves it in the coat he last wore, so I make a point of putting it nearby to avoid ‘who’s taken my money?’”

“Having a routine is key and ensuring all her basic needs are met,” said another. “She’s not hungry. She’s not scared or hot or cold. She needs to be reminded often that she is safe and who she lives with and that we love her.”

Reassuring the other person by explaining where they are, the time of day, and what’s happening next can provide comfort and potentially head off angry outbursts before they occur.

5. Consider Medications

Your loved one’s doctor can advise on whether medication can help deal with anger outbursts and agitation.

“I found a good geriatric psychologist and a good combination of meds that help a lot,” said a myALZteam member.

“My husband used to accuse me of infidelity and used to hide his possessions and money … . I used risperidone (Risperdal) to get us through the worst agitated moments. I couldn’t have done it without medication,” a second member shared.

Risperidone is an example of an antipsychotic drug that is used off-label to treat aggression or agitation in people with Alzheimer’s. Off-label means the medication is used for a different purpose or condition than the one approved by the U.S. Food and Drug Administration (FDA). Other examples include aripiprazole (Abilify) and clozapine (Clozaril).

Brexpiprazole (Rexulti) is an antipsychotic approved by the FDA to treat agitation in people with Alzheimer’s.

Antipsychotic medications should be used with caution and only under specific circumstances because of potential serious health risks.

Along with antipsychotics, doctors may recommend antidepressants for people with Alzheimer’s-related behavioral symptoms. “We took the neurologist’s suggestion and added an antidepressant to my mom’s daily medications,” shared another member. “We had to give her the max dose because of the hitting, which is unacceptable. I realized I needlessly suffered for a few years with the yelling and name-calling. She still has her temper but has improved on the right medication dose. She also seems much happier too! Please don’t suffer needlessly.”

“My mom was very short-tempered and unkind,” another member wrote. “I spoke with her primary care physician, who prescribed a medication that helped calm her while not making her apathetic or tired. This has made a dramatic difference in the relationship between me and my mom.”

All medications have side effects, so discussing the pros and cons with your loved one’s health care provider is essential. You may need to switch medications or adjust the dosage before finding the best treatment.

6. Protect Yourself and Your Loved One

There are times when people with Alzheimer’s can become a danger to themselves and other people. If this happens, do your best to ensure your own safety and that of your loved one.

“He nearly broke my neck because I wouldn’t let him leave the house alone at 11:30 p.m. one night,” a myALZmember shared. “He threatened to beat me to death if I didn’t give him medication I had already given him. He almost broke my wrist when I asked him not to wear his winter coat when it was 95 degrees out … . I can’t believe this is the same man. He has no emotion and doesn’t care if he hurts me.”

“There have been two occasions when I have been frightened by his paranoia and anger, and it taught me to be more prepared should I have to exit quickly. The reality is he does not always know what he is doing … so I have to safeguard myself,” explained another.

It’s worth talking to other family caregivers and your loved one’s health care providers about how to handle any potentially violent or dangerous outbursts so you have a plan of action in place. Health care providers can help advise you on what to do when situations escalate and offer resources for a care facility, assisted living, or homecare if you need more support.

You can also call the Alzheimer’s Association 24-7 helpline at 800-272-3900, chat with a staff member by clicking the Live Chat button, or submit a question through an online form.

You may consider calling 911 if you feel you or the other person is in immediate danger. Be sure to explain that your loved one has Alzheimer’s disease, and that’s the reason for their irrational and aggressive behavior.

Talk With Others Who Understand

On myALZteam — the social network for people with Alzheimer’s disease and dementia caregivers — more than 85,000 members come together to ask questions, give advice, and share stories.

Have you had to navigate angry outbursts from your loved one with Alzheimer’s? What strategies do you use to de-escalate aggressive behavior? Post your thoughts in the comments below, or start a conversation on your Activities feed.