We Can Manage Our Moodsthey Cannot Manage Theirs
When we are not experiencing dementia and find ourselves upset by an experience or situation, we can evaluate, compare, and consider. We can choose to avoid being in a bad mood and we can choose to not inflict it on our companions. For example, if Im late for an appointment and the car ahead of me is driving slower than the speed limit, I might feel irritated and frustrated but I have the skills necessary to change that feeling before it affects my mood. I can tell myself that Im late due to my own lack of planning, that other people cant be expected to hurry to accommodate me, and that its too nice a day to be in a bad mood. I can do that with my memory skills and my rational thinking skills and change the negativity Im beginning to feel back into a positive mood. But when were experiencing dementia, we cant do any of that.
So, with dementia in the picture, people cant help taking everything personally, and they lack the skills to change the moods that result when they feel hurt or betrayed or taken advantage of.But theres more to think about. It gets both worseand better. Theres a third truth which is the key to avoiding combative and aggressive behaviors with dementia. When we are experiencing dementia, we cannot choose our own moods.
How To Deal With A Mean Dementia Patient*
Why is my mom so angry? Why does my husband blow up when I try to explain something?
Why does it feel like having dementia and being mean to family often go hand in hand? There is an answera way to avoid the anger that so often accompanies dementiabut its not a simple one. If it were, far fewer families would be dealing with combativeness and aggression when their loved ones develop dementia or Alzheimers. Like anything complex, this will take some explaining, so Ill write about this issue of anger and meanness with dementia in a series of articles .
The first step to having happier interactions and fewer episodes of aggression or combativeness with someone whos experiencing dementia is to understand why they may begin treating you badly.
Who is Judy Cornish?
Judy Cornish is a former eldercare lawyer and the former owner of Palouse Dementia Care, a dementia care agency that provides in-home dementia care to seniors in northern Idaho. She is the author of Dementia With Dignity and The Dementia Handbook as well as the creator of the DAWN Method of dementia care. Judy believes that with a little training, families can provide excellent dementia care at home with less stress and more companionship.
Talking With A Doctor
After considering the persons symptoms and ordering screening tests, the doctor may offer a preliminary diagnosis or refer the person to a Cognitive Dementia and Memory Service clinic, neurologist, geriatrician or psychiatrist.Some people may be resistant to the idea of visiting a doctor. In some cases, people do not realise, or else they deny, that there is anything wrong with them. This can be due to the brain changes of dementia that interfere with the ability to recognise or appreciate the changes occurring. Others have an insight of the changes, but may be afraid of having their fears confirmed.One of the most effective ways to overcome this problem is to find another reason for a visit to the doctor. Perhaps suggest a check-up for a symptom that the person is willing to acknowledge, such as blood pressure, or suggest a review of a long-term condition or medication.Another way is to suggest that it is time for both of you to have a physical check-up. Any expressed anxiety by the person is an excellent opportunity to suggest a visit to the doctor. Be sure to provide a lot of reassurance. A calm, caring attitude at this time can help overcome the person’s very real worries and fears.Sometimes, your friend or family member may refuse to visit the doctor to ask about their symptoms. You can take a number of actions to get support including:
- talking with other carers who may have had to deal with similar situations
- contacting your local Aged Care Assessment Team
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Facial Expressionstry Not To Frown
They will see and respond to the briefest flash of irritation on our faces. They can sense that we are concerned or worried from the set of our shoulders or slight tension in our stride as we enter the room. They can tell if we are frustrated from the slightest of pauses before we answer them or the merest intonation in a word. They are always reading our emotions.
And so, we must become aware of what we are communicating nonverbally. All of us have a default facial expressionthe one we wear when were deep in thought or concentrating on a task or determined to solve a problem. For most of us thats a frown. But if our companions are experiencing dementia, they wont be able to remind themselves that were deep in thought, or concentratingthey will simply see the frown and take it personally.
If you spend time with someone whos experiencing dementia, ask your friends and family to tell you when they see you frowning. It takes awareness and practice, but you can teach yourself to look happy and at peace when your mind is wandering or occupied elsewhere. Learning just thisto simply put a true smile on your face the moment you enter your loved ones presencewill go far in changing the dementia anger stage back to peaceful, friendly interactions.
How Common Is Dementia
The U.S. Centers for Disease Control and Prevention estimate that 5 million U.S. adults age 65 or older have Alzheimers and related dementia. By 2060, the CDC projects that about 14 million people will have dementia, which is about 3.3% of the population.
Alzheimers disease is the sixth leading cause of death in the U.S. and the fifth leading cause of death in Americans age 65 and older.
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Body Languagestop And Face Them
Next, we have to think about posture. When someone lacks memory skills, it changes how they interpret gesture and posture. Suppose Im making sandwiches for lunch and my husband walks into the kitchen and asks what Im doing. If he isnt experiencing dementia, I dont need to stop and turn around to face him. I can simply direct a brief answer over my shoulder, because if hes not experiencing dementia our previous conversations and exchanges will be there in his mind to temper my lack of attention during this moment.
However, if hes experiencing dementia, he will by default interpret my posture as dismissive, because for him its our first interaction and for him my posture will speak louder than my words. So, if my husband is experiencing dementia I need to pause and turn to look at himand make eye contactto avoid inadvertently hurting his feelings.
Check Their Advance Care Plan
You should find out if the person has an advance care plan. This document may record their preferences about the care theyd like to receive, including what they want to happen, what they do not want to happen and who they want to speak on their behalf. It may include an advance statement or an advance decision. We have information on planning ahead for patients and their families, which you might find useful.
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Why Is This Happening
Some reasons why a person with dementia might be aggressive include:
- The person might be feeling unheard or misunderstood.
- The person might be feeling threatened or frightened.
- The person might be feeling embarrassed, frustrated or annoyed because they need help to do things they used to do independently.
- The person might be asserting their own wishes when others are trying to make them do something they dont want to do.
- The person might be in pain.
The Rules In Relationships Change With Dementia
If youre spending time with someone whos experiencing dementia, you can avoid the dementia anger stage , but only if you become more aware of whats causing it. When dementia comes into a relationship, the rules change. A relationship including dementia is different from any youve experienced before. You will need to understand the cognitive skills we all normally useand then which ones we continue using when were experiencing dementia.
In my first article in this series , I described our two thinking systems and explained the most frustrating rational thinking losses caused by dementia. I also described our intuitive thinking skillsthose that we continue using. It will be helpful to read that article first if you havent yet.
Who is Judy Cornish?
Judy Cornish is a former eldercare lawyer and the former owner of Palouse Dementia Care, a dementia care agency that provides in-home dementia care to seniors in northern Idaho. She is the author of Dementia With Dignity and The Dementia Handbook as well as the creator of the DAWN Method of dementia care. Judy believes that with a little training, families can provide excellent dementia care at home with less stress and more companionship.
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Understand Why Someone With Dementia Says Mean Things
First, its important to understand why this hurtful behavior is happening.
Dementia is a brain disease that causes parts of the brain to shrink and lose their function, resulting in cognitive impairment.
These different parts control functions like memory, personality, behavior, and speech. Dementia also damages the ability to control impulses, which means actions arent intentional.
Even though its difficult, do your best to remember that they truly dont intend the mean things they say.
These mean comments and hurtful accusations often happen because the person is unable to express whats actually bothering them.
It could be triggered by something in their environment that causes discomfort, pain, fear, anxiety, helplessness, confusion, or frustration.
Working to accept the fact that theyre not doing this on purpose helps reduce stress and makes their behavior easier to manage.
The overall strategy is to take a deep breath, remind yourself that its not personal, take care of immediate discomfort or fear, and try to find the cause behind the behavior.
Next, look for long-term solutions that will help you get the support and rest you need to keep your cool in challenging situations like these.
What Medications Are Available To Manage Dementia
Drugs approved for the most common form of dementia, Alzheimers disease, include:
- Cholinesterase inhibitors, including donepezil , rivastigmine and galantamine .
- NMDA receptor antagonist memantine .
- Anti-amyloid antibody aducanumab .
Healthcare providers use these drugs to treat people with some of the other forms of dementia.
Cholinesterase inhibitors and the NMDA receptor antagonist affect different chemical processes in your brain. Both drug classes have been shown to provide some benefit in improving or stabilizing memory function in some people with dementia.
Cholinesterase inhibitors manage the chemicals in your brain that allow messages to be sent between brain cells, which is needed for proper brain function. Memantine works similarly to cholinesterase inhibitors except it works on a different chemical messenger and helps the nerve cells survive longer.
Aducanumab targets amyloid proteins, which build up into the plaques seen in the brains of people with Alzheimers disease.
Although none of these drugs appear to stop the progression of the underlying disease, they may slow it down.
If other medical conditions are causing dementia or co-exist with dementia, healthcare providers prescribe the appropriate drugs used to treat those specific conditions. These other conditions include sleeping problems, depression, hallucinations and agitation.
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Aggressive Behaviour In Dementia
In the later stages of dementia, some people with dementia will develop what’s known as behavioural and psychological symptoms of dementia .
The symptoms of BPSD can include:
- increased agitation
- aggression
- delusions
- hallucinations
These types of behaviours are very distressing for the carer and for the person with dementia.
It’s very important to ask your doctor to rule out or treat any underlying causes, such as:
- uncontrolled pain
- infection, such as a urinary tract infection
- side effects of medicines
If the person you’re caring for behaves in an aggressive way, try to stay calm and avoid confrontation. You may have to leave the room for a while.
If none of the coping strategies works, an antipsychotic medicine can be prescribed as a short-term treatment. This should be prescribed by a consultant psychiatrist.
For All Family Members
Some of the most common feelings families and caregivers experience are guilt, grief and loss, and anger. Rest assured that you are not alone if you find yourself feeling these, too.
Guilt
It is quite common to feel guiltyâguilty for the way the person with dementia was treated in the past, guilty at feeling embarrassed by their odd behaviour, guilty for lost tempers or guilty for not wanting the responsibility of caring for a person with dementia.
If the person with dementia goes into hospital or residential care you may feel guilty that you have not kept him at home for longer, even though everything that could be done has been done. It is common to feel guilty about past promises such as âIâll always look after you,â when this cannot be met.
Grief and loss
Grief is a response to loss. If someone close develops dementia, we are faced with the loss of the person we used to know and the loss of a relationship. People caring for partners may experience grief at the loss of the future that they had planned to share together.
Grief is a very individual feeling and people will feel grief differently at different times. It will not always become easier with the passing of time.
Anger
It is natural to feel frustrated and angryâangry at having to be a caregiver, angry with others who do not seem to be helping out, angry at the person with dementia for her difficult behaviours and angry at support services.
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We Make Them Angry Without Realizing It
Either dementia makes people so crazy that they feel angry and upset for no reason at all, or there is something causing people to feel angry and combative when they are experiencing dementia. During the past decade I spent a lot of time with people whore experiencing dementia, and I soon realized that the second statement is true, not the first. They were not crazy. I was the problemI was making them angry without realizing it. I had to understand what I was doing wrong and change it if I wanted them to stop being angry and mean to me.
Dementia Behavior: Sleep Problems
While quality sleep tends to decrease as you age, people who have dementia experience more sleep disturbances than other seniors. In fact, sleep problems affect as many as a third of seniors with dementia.
Common sleep issues may include:
- Difficulty getting and staying asleep
- Agitation and restlessness when trying to sleep
- Thinking its daytime when its night, going as far as getting up, getting dressed and wanting to start the day, Hashmi says
Sleep disturbances are hard on patients and caregivers alike, Hashmi says. Its physically and mentally exhausting to be up night after night.
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Struggling To Adapt To Change
For someone in the early stages of dementia, the experience can cause fear. Suddenly, they cant remember people they know or follow what others are saying. They cant remember why they went to the store, and they get lost on the way home.
Because of this, they might crave routine and be afraid to try new experiences. Difficulty adapting to change is also a typical symptom of early dementia.
What Are The Symptoms Of Dementia Towards The End Of Life
Dementia is progressive, which means it gets worse over time. In the last year of life, its likely to have a big impact on the persons abilities including memory, communication and everyday activities. The speed at which someone will get worse will depend on the type of dementia they have and who they are as an individual.
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What Increases The Risk For Dementia
- AgeThe strongest known risk factor for dementia is increasing age, with most cases affecting those of 65 years and older
- Family historyThose who have parents or siblings with dementia are more likely to develop dementia themselves.
- Race/ethnicityOlder African Americans are twice more likely to have dementia than whites. Hispanics 1.5 times more likely to have dementia than whites.
- Poor heart healthHigh blood pressure, high cholesterol, and smoking increase the risk of dementia if not treated properly.
- Traumatic brain injuryHead injuries can increase the risk of dementia, especially if they are severe or occur repeatedly.
Why Does Behaviour Change
There are many reasons why a persons behaviour may be changing. Dementia is a result of changes that take place in the brain and affects the persons memory, mood and behaviour. Sometimes the behaviour may be related to these changes taking place in the brain. In other instances, there may be changes occurring in the persons environment, their health or medication that trigger the behaviour. Perhaps an activity, such as taking a bath, is too difficult or the person may not be feeling physically well. Dementia affects people in different ways. Understanding why someone is behaving in a particular way may help you with some ideas about how to cope.
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Dementia Caregivers Get Impatient Annoyed Frustrated And Even Angry For A Variety Of Reasons Some Of Which Include:
- Things may not be happening as youd like or are out of your control
- Youre feeling overwhelmed in your role of caregiver, or feel like you do not have enough time for other aspects of your life
- Others arent helping out and/or are criticizing your efforts as a caregiver
- Unrealistic expectations of others, including the person who has dementia, and of yourself
- The care receiver may be doing things that are irritating or scary to you
- The care receiver may be angry about something, which can trigger an angry response from you, and the anger of both parties escalates from there
- Resentment of having to care for someone you may not have gotten along with in the past
- Role reversal resentment
- Inaccurate thinking
Its natural to get angry, but its important to mindfully manage what you do with it. One reason is that people who have dementia are sensitive to your moods. If they feel afraid of you, for instance, that could have a negative impact on the caregiving and care-receiving relationship that is ideally rooted in trust.
Another reason to mindfully manage your anger is that if left unchecked it can sometimes result in emotionally or physically harmful interactions with the person who has dementia or others and you want to avoid that at all costs.
The following tips arent a guarantee you wont get angry, but hopefully theyll help you respond in an effective and healthy way.