CONTEXTUAL FACTORS IN THE ASSESSMENT AND MANAGEMENT OF AGGRESSION IN DEMENTIA PATIENTS

Aggressive behaviors associated with dementia present serious problems for patients and caregivers. Aggression, which has often been assumed to be an inherent feature of dementia, may actually be adaptive for d ementia patients who have limited skills available to manage an enviro nment that becomes increasingly complex as cognitive deterioration pro gresses. When aggression in dementia patients is examined within a fun ctional analytic framework, it emerges as an adaptive, albeit undesira ble, means of communicating distress or discomfort. Idiographic assess ment of the influence of setting events, environmental antecedents, an d consequences associated with aggression may assist in the developmen t of proactive interventions that modify environmental influences asso ciated with aggressive behavior. Modifying environmental precipitants rather than relying on interventions that attempt to directly eliminat e aggression from the patient's already impoverished behavioral repert oire is presumed to be more humane.