How to deal with anger with those who have dementia

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The Dementia Caregiver's Little Book of Hope [Kindle Edition]

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Co-written by Nettie Harper, MSRS and Michael Friedman, L.M.S.W.

"Go away, you thief," Margaret screamed when her son knocked on the door of her room. "You stole my money." He opened the door and entered. "Get away!" she screamed again. She was sitting in her easy chair. A cup of coffee was on the table next to her. She grabbed it and threw it at him.

"Mother, it's me, David," he says. "I didn't steal your money. You don't keep money in the room."

"You're lying, you thief. Get away from me." She was looking for something else to throw.

Stung by her words, he felt anger well up in him. He wanted to scream back, but he turned and left the room, closing the door behind him.

His mother has been living with Alzheimer's for almost a decade. Her memory for names and recent events has diminished more and more over time, as has her ability to deal with situations that diverge from her routines. She can no longer manage her finances, shop, cook or keep herself clean.

David is the child who has stepped in to make sure she has everything she needs and spend time with her. Today's outburst stunned and hurt him. He was uncertain what to do.

He is far from alone. Nearly 6 million people in the U.S. have Alzheimer's, many of whom are in theearly stages and can manage without much help. But caregivers of those with more limited functional capacity face difficult challenges virtually every day. Dealing with distrust and anger is one that emerges from time-to-time. What should they do?

David's instinctive reaction to walk away was a good one. Screaming back would have frightened his mother and accomplished nothing. It's even possible that this was a passing moment and that she will forget her suspicions and be herself when he returns to the room.

But if it is not a fleeting experience, what could be happening and what can be done?

It is tempting to think that Margaret's feelings and behavior are the result of Alzheimer's because the condition involves changes in brain function that often make it difficult to contain emotions. But most people with dementia do not behave abusively toward people caring for them, and Margaret and David have had a warm relationship until today. Something must be troubling Margaret today!

It could be that something in the situation itself set her off. Perhaps David's knock on the door startled his mother awake from a nap. Perhaps his voice through the closed door was muffled and merged with something ominous that she was dreaming.

There may be a physical cause. Is she constipated or does she have an impacted bowel? Does she have a urinary tract infection or a toothache? Has she been sleeping enough or possibly too much? Is she having trouble hearing? Has her vision blurred or darkened? Is she taking a new medication? Physical conditions such as these can have a terrible impact on mood and behavior.

It is also possible that her "paranoia" and "irritability," her suspicions and anger, are psychologically rooted. A psychiatric evaluation and non-pharmacological interventions, such as structured activities or psychotherapy, can be helpful for people with co-occurring dementia and psychiatric disorders. Psychiatric medications are sometimes indicated but must be used with extreme caution because of their risks to the physical health of people with dementia.

David's mother's distrustfulness could reflect distress about a change in her physical or social environment. Has she moved? Has the place where she lives been renovated or rearranged? Is someone she cares about sick? Has someone died? Has there been a change in caregivers? Have eating or other routines changed? Changes in environment or routine can both cause confusion and distress in a person with dementia.

David's mother's anger might be justifiable but aimed at the wrong person. Has something been stolen? Has someone been harsh with her? Has someone hit her? Has she been molested? It may seem a long way from being insulted to becoming convinced that your son has stolen your money, but the mind follows its own path.

Sometimes it is fairly easy to figure out what is going on. Sometimes it may seem impossible. But there is always a reason -- a reason other than, "It's the dementia."

Here are some rules of thumb that may help you when faced with anger.

• Never yell back. A shouting match may succeed in winning a frightened silence, but you will not achieve a change of inner feeling.

• Deal with your own emotions about being distrusted by someone you care for and for whom you are doing your best. It can be very hard to take, but it's probably not something that the person with Alzheimer's can control voluntarily.

• Don't try reasoning ("Mother, you don't keep money in your room.") People with or without dementia who are angry and suspicious are almost never moved by reason and logic.

• If conversation is possible, ask questions about the situation and listen attentively to whatever explanation is given -- sensible or not. You may get a clue to what's going on.

• Avoid disrupting the routines of the person and, if there are changes, get back into the routines as soon as possible.

• If there were only one rule of thumb it would be: Be kind.

Managing problem behavior with those who have dementia

Activities directors and other healthcare professionals here is a great dementia resource for caregivers and healthcare professinals.Benevolant Society

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

Inquirer Lifestyle

Alfredo Torres, OTRP, chief occupational therapist of the National Center for Mental Health, has provided a list of behavioral and psychological symptoms of dementia and tips on how caregivers can deal with them.
Anger and Aggression
Assure the angry individual that they’re alright, and that you understand that they can’t help themselves.
Be prepared to receive insults and verbal abuse.
Speak in a well-modulated voice.
Offer food or drink (it is difficult to eat and be angry at the same time).
Sit or stand a little to the side some four to five feet away rather than facing them directly to appear less intimidating
Confusion
Provide a night light to help them see and locate familiar things, prevent falls in the dark and protect against wandering.
Encourage reminiscence.  Gently assist them with keeping facts reasonably accurate and related to the past
Use communication techniques rich in reminders, cues, gestures and physical guide to increase personal awareness.
Provide them personal space filled with familiar things where they can  rest and feel safe and secure.
Ask permission if something must be moved or changed to establish feelings of trust and control.
Hoarding, rummaging behavior
Ignore the behavior if it’s not particularly troublesome or unsafe.
Clean out the person’s collection but leave a few items behind.
Learn the person’s hiding places.
Provide a box or private space that is theirs alone to keep things in.
Sundowner’s syndrome
Set up a rigid daily schedule to reduce their anxiety about what happens next
Alternate activity with programmed rest.
Reduce all stimuli during rest periods.
Prepare the impaired person for special events so they don’t come as a shock.
Suspicion, distrust
Avoid grand gestures and promises that cannot be carried out.
Do not argue about or rationally explain disappearances of the person’s possessions.
Offer to look for items they say  is missing.
Depression
Try to rebuild self-esteem through reminiscence, participation in activities and decisions.
Notice pictures and mementos. Ask about them and listen.
Spend time with them.  Do not ignore quiet, uncomplaining people.
Alert the person’s doctor; medications may help.
How to Facilitate Interaction with an Individual with Dementia
Approach the person slowly from the front, never behind, and give him or her time to get used to your presence.
Maintain eye contact. A gentle touch may help.
Introduce yourself to them daily and call the person by name. Do not ask “Don’t you remember me?”
Treat them like adults and don’t talk down to them.
When possible, attempt all communication in a calm, relaxed and quiet environment using your natural voice. Shouting only agitates them.
Try and talk about feelings rather than arguing over facts.
Invite an individual to an activity using gentle assertion rather than a question that may be easily refused.
Give short simple directions.  Do not overwhelm them with too much information at once.Repeat or rephrase if they don’t understand you right away
Do not rush them. Allow them enough time to answer questions, follow directions and express themselves at a pace they choose and find most comfortable.
Reduce distractions in the environment and tone down radio and TV sets
Too many people in the room can be over-stimulating for them.
If the impaired person seems frustrated and temperamental and you don’t know what he or she wants, try to ask simple questions answerable by “yes” or “no.”