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How to deal with agitation and anger in dementia

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January 4th, 2018
Young pair of hands holding pair of hands of an elderly woman

Daily life as a caregiver can be taxing physically and emotionally. Complicating matters, if a loved one has a dementia-related illness, he or she may behave in ways that are confusing and frustrating for you. 

Anger and agitation are two of these behaviors that can be especially frustrating for caregivers. 

Reasons behind it

“The reason someone seems distressed may make no sense to you,” says Tina M. Marrelli, M.S.N., M.A., R.N., author of A Guide for Caregiving: What’s Next? Planning for Safety, Quality, and Compassionate Care for Your Loved One and Yourself (Innovative Caregiving Solutions, L.L.C., 2017). “It is not uncommon, for example, for some people with dementia to develop a fear of water, so they may be upset every time you try to bathe or shower them.”

Sometimes anger and agitation may be due to changes in the brain because of the dementia-related illness. But behavior changes can also stem from personal discomfort. “Someone might not be able to articulate if they are in pain, have constipation, or have symptoms of a urinary tract infection,” Marrelli explains. “That’s why if you notice a behavior change, have your loved one examined by a health care provider.”

Small changes may also be upsetting. “People with dementia need daily structure,” Marrelli says. “They feel stressed if their routine is disrupted.”

Specific situations

If your loved one is refusing to do something, assess the importance of that task. “If they are refusing a bath, think of how dry an older adult’s skin can get and then ask yourself whether they really need a daily shower,” Marrelli says. “In some cases, it’s best to just honor their wishes, or just come up with an alternative like a simple washup outside of the bathroom.”

As a caregiver, you are probably in charge of meals, and you want your loved one to eat well. But suppose he or she has a strong preference for doughnuts and has been insisting on having one every morning. When you try to offer a piece of fruit instead, anger begins. 

“In these types of situations, you could offer fruit before or after the doughnut, or just plan to have something more healthful later in the day,” Marrelli says.

What if they refuse to do something crucial, such as take medication? “Talk to the doctor about this situation,” Marrelli says. “Find out if certain medications can be eliminated or if their regimen can be simplified.”

You may begin to detect patterns in angry behavior or agitation. “It may tend to occur more often in the evening,” Marrelli explains. “This situation is called ‘sundowning.’ Experts aren’t sure why it happens, it could just be the exhaustion of getting through the day. You can be proactive in handling sundowning by establishing a soothing routine for later in the day. Plan a calming activity at the same time every evening. Reduce loud noises, bright lighting, or other stimuli, and be relaxed yourself.”

In the moment

It can be hard to think straight when someone is showing anger toward you. Take a few deep breaths,” Marrelli suggests. “That will alleviate your stress levels so you can think more clearly about ways to solve the problem.”

Redirecting their attention can help diffuse combativeness. “Switch to another topic of conversation or choose a different task to do,” Marrelli suggests. “Bringing up a favorite memory or engaging in an enjoyable activity can be calming. Put on music, a favorite movie, or television show.”

You know what comforts your loved one. “People with dementia sometimes develop a comfort object, such as a stuffed animal or a favorite photo. They may also enjoy talking about favorite memories.” 

Give them control whenever possible. “People with dementia do not necessarily lose their desire to manage their lives and activities,” Marrelli explains. “Can they help with dinner? Help sweep up? Try to find a simple task related to their former career or skills.”

Forgive yourself

“Let yourself be human,” says Melanie P. Merriman, Ph.D., hospice consultant and author of Holding the Net: Caring for My Mother on the Tightrope of Aging (Green Writers Press, 2017). “Emotion often overwhelms reason, even for a hospice care expert like myself. The frustration and uncertainty of caregiving make it hard to keep your cool.”

No matter how adept you become at dealing with a loved one’s anger, there may come a time when it is no longer safe at home. If someone becomes physically violent toward you or the environment, it might be safer to consider other care options.

“There is no foolproof recipe for caring for an aging loved one,” Merriman says. “There is no such thing as perfection. All you can do is simply do your best.”

The Alzheimer’s Association website (alz.org) has a Caregiver Center that offers comprehensive information about other common behaviors exhibited by people with dementia, such as depression, hallucinations, repetition, sleep issues, suspicion, and delusions. You can learn about causes, how to respond to your loved one, and coping strategies. 

The Caregiver Center also provides detailed information about stages of dementia-related illness, where to find care options and support, safety concerns, personal and medical care, and financial and legal planning,


Top five tips from alz.org

When faced with challenging behaviors, the Alzheimer’s Association recommends caregivers keep the following in mind: 

  1. Try not to take behaviors personally.
  2. Remain patient and calm.
  3. Explore pain as a trigger.
  4. Don’t argue or try to convince.
  5. Accept behaviors as a reality of the disease and try to work through it.

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