Do Not Get Angry Or Upset
When looking after persons with dementia, practicing self-control is of utter importance. Learn how to breathe in and just relax without taking things personally or getting angry and upset. Remember that dementia patients do not act the way they do out of their own accord. It is the illness that makes them behave the way they do.
What Works Best For Treating Depression And Anxiety In Dementia
- By Stephanie Collier, MD, MPH, Contributor
Its 3 pm on a warm, sunny Saturday. For the past 20 years your mother would dress in her finest clothes and walk to her neighbors house for her weekly bridge game. For the past month, however, she has not been interested in playing bridge. Although she sometimes required prompting , she usually returned from these games cheerful. Her indifference this month is new.
Your mother received the diagnosis of mild Alzheimers disease last year. Although visibly frustrated at times, especially when she cannot think of the right word or find her pocketbook, she seemed to enjoy her routine until recently. You now see her crying in the morning. She is no longer sleeping or eating well, and she becomes scared when you leave her for a moment. You wonder whether she might benefit from medications.
How To Respond To Anger And Aggression In Dementia
Understanding the Causes and Finding Ways to Cope
Some people living with Alzheimer’s disease or other types of dementia remain easy-going. Others develop intense feelings of anger and aggression.
It’s normal to feel surprised, discouraged, hurt, or even angry when someone with dementia lashes out at you for no obvious reason.
It’s important to understand what causes anger in dementia. This will help you learn how to respond and cope in these situations.
This article looks at some of the reasons for anger and aggression in people with dementia. It also offers some coping tips for caregivers.
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Dont Infantilize The Person
Dont talk down to the person or treat them like an infant. This is sometimes called “elderspeak” and it’s got to go.
Have you ever observed how people talk to babies? They might use a high pitched tone and get close to the babys face. While this is appropriate for infants, its not fitting for communicating with adults. Regardless of how much the person with dementia can or cannot understand, treat them with honor and use a respectful tone of voice.
Tips To Help Manage Dementia Sleep Problems
There are ways to help your loved on get a better nights sleep, Hashmi says.
Avoid things that disrupt sleep.
- Limit caffeine, alcohol, and sugar near bedtime.
- Avoid over-the-counter sleep aids. Instead, Hashmi suggests you talk to a doctor about whether melatonin might help your loved one sleep.
- Remove electronics from the bedroom.
Create a routine that supports sleep.
- Make sure your loved one gets enough daytime light to help with circadian rhythms.
- Change into comfortable clothing, signaling nighttime.
- Consider warm milk, a hot shower, relaxing music or reading before bed.
- Pick a bedtime not too late and stick with it every night.
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Tips For Everyday Tasks For People Living With Dementia
Alzheimers disease and related dementias get worse over time. Even simple everyday activities can become difficult to complete. To help cope with changes in memory and thinking, consider strategies that can make daily tasks easier. Try to adopt them early on so you will have more time to adjust. You can:
- Write down to-do lists, appointments, and events in a notebook or calendar.
- Set up automated bill payments and consider asking someone you trust to help manage your finances.
- Have your groceries delivered.
- Manage your medications with a weekly pillbox, a pillbox with reminders , or a medication dispenser.
- Ask your doctor to provide a care plan and write down care directions .
Where To Find Help And Support
Community and voluntary organisations can provide help and support to people affected by a dementia, their family and friends.
This support includes:
- information about services
- carers’ training programmes to make sure family and friends know the best ways to support a person with a dementia
- group support services for people with a dementia and their carers
You can find more information and support services from the following organisations, see also more useful links section:
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Tips For Caregivers: Taking Care Of Yourself
Being a caregiver can be extremely rewarding, but it can also be overwhelming. Caring for a person with Alzheimer’s or a related dementia takes time and effort. It can feel lonely and frustrating. You might even feel angry, which could be a sign you are trying to take on too much. It is important to find time to take care of yourself. Here are some tips that may offer some relief:
- Ask for help when you need it. This could mean asking family members and friends to help or reaching out to for additional care needs.
- Eat nutritious foods, which can help keep you healthy and active for longer.
- Join a caregiver’s support group online or in person. Meeting other caregivers will give you a chance to share stories and ideas and can help keep you from feeling isolated.
- Take breaks each day. Try making a cup of tea or calling a friend.
- Spend time with friends and keep up with hobbies.
- Get exercise as often as you can. Try doing yoga or going for a walk.
- Try practicing meditation. Research suggests that practicing meditation may reduce blood pressure, anxiety and depression, and insomnia.
- Consider seeking help from mental health professionals to help you cope with stress and anxiety. Talk with your doctor about finding treatment.
Hospital Emergencies: What You Can Do
A trip to the emergency room can tire and frighten a person with Alzheimers or other dementia. Here are some ways to cope:
- Ask a friend or family member to go with you or meet you in the ER. He or she can stay with the person while you answer questions.
- Be ready to explain the symptoms and events leading up to the ER visitpossibly more than once to different staff members.
- Tell ER staff that the person has dementia. Explain how best to talk with the person.
- Comfort the person. Stay calm and positive. How you are feeling will get absorbed by others.
- Be patient. It could be a long wait if the reason for your visit is not life-threatening.
- Recognize that results from the lab take time.
- Realize that just because you do not see staff at work does not mean they are not working.
- Be aware that emergency room staff have limited training in Alzheimers disease and related dementias, so try to help them better understand the person.
- Encourage hospital staff to see the person as an individual and not just another patient with dementia who is confused and disoriented from the disease.
- Do not assume the person will be admitted to the hospital.
- If the person must stay overnight in the hospital, try to have a friend or family member stay with him or her.
Do not leave the emergency room without a plan. If you are sent home, make sure you understand all instructions for follow-up care.
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Caregiving In The Middle Stages Of Alzheimers Or Dementia
As your loved ones Alzheimers disease or dementia symptoms progress, theyll require more and more careand youll need more and more support as their caregiver. Your loved one will gradually experience more extensive memory loss, may become lost in familiar settings, no longer be able to drive, and fail to recognize friends and family. Their confusion and rambling speech can make communicating more of a challenge and they may experience disturbing mood and behavior changes along with sleep problems.
Youll need to take on more responsibilities as your loved one loses independence, provide more assistance with the activities of daily living, and find ways of coping with each new challenge. Balancing these tasks with your other responsibilities requires attention, planning, and lots of support.
Ask for help. You cannot do it all alone. Its important to reach out to other family members, friends, or volunteer organizations to help with the daily burden of caregiving. Schedule frequent breaks throughout the day to pursue your hobbies and interests and stay on top of your own health needs. This is not being neglectful or disloyal to your loved one. Caregivers who take regular time away not only provide better care, they also find more satisfaction in their caretaking roles.
Take Courses Or Read Guides
People can attend courses in person or do ones online that cover topics ranging from the early signs of Alzheimers to behavioral changes and financial planning.
People can find more information about caregiving by visiting the Alzheimers Association webpage or by reading this for caregivers from the National Institute on Aging .
These more comprehensive guides include step-by-step tips on how to help someone bathe, eat, and more.
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Planning For The Future
- Talk to the person with dementia to make sure that they have a current up-to-date will that reflects their wishes.
- Encourage the person with dementia to set up a Lasting Power of Attorney so that a responsible person can make decisions on their behalf when they are no longer able to.
- Talk to the person with dementia about making an advance decision to refuse certain types of medical treatment in certain situations. It will only be used when the person with dementia has lost the capacity to make or communicate the decision in the future.
- If the person youre caring for has already lost the ability to make or communicate decisions but doesnt have an LPA, you can apply to the Court of Protection who can make decisions on behalf of that person or appoint someone else to do so.
If the person you care for drives, the law requires them to tell DVLA about their diagnosis. A diagnosis of dementia doesn’t automatically mean someone has to stop driving straight away what matters is that they can drive safely.
Who Are These Medications For And What Are The Benefits
These medications are prescribed for people with mild to moderate Alzheimers disease. Studies show that between 40 70% of people taking the drugs benefit from them with symptoms improving temporarily for between 6-12 months.
The impact of taking cholinesterase inhibitor medications can include: reduced anxiety, improvements in memory and concentration daily activities such as personal care, dressing and shopping.
Trials to determine if these drugs also bring benefits for behavioural changes such as agitation or aggression are inconclusive, with mixed results. Unfortunately the impact of these medications gradually reduces with symptoms then gradually worsening.
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Hospital Visits During Covid
Due to COVID-19, hospitals continue to update appointment and visitor policies to comply with state department of health guidelines to protect the health and safety of patients, visitors and employees. For example, visitors may be required to wear a face mask or cloth face covering. Or, they may not be allowed to accompany patients in clinics, hospital departments or the emergency room, with exceptions in certain cases. Before you plan a visit, call or check the hospitals website for information on their policies. Get the latest public health information on the coronavirus at coronavirus.gov.
Treatment For Mild To Moderate Alzheimers
Treating the symptoms of Alzheimers can provide people with comfort, dignity, and independence for a longer period of time and can encourage and assist their caregivers as well. Galantamine, rivastigmine, and donepezil are cholinesterase inhibitors that are prescribed for mild to moderate Alzheimers symptoms. These drugs may help reduce or control some cognitive and behavioral symptoms.
Scientists do not yet fully understand how cholinesterase inhibitors work to treat Alzheimers disease, but research indicates that they prevent the breakdown of acetylcholine, a brain chemical believed to be important for memory and thinking. As Alzheimers progresses, the brain produces less and less acetylcholine, so these medicines may eventually lose their effect. Because cholinesterase inhibitors work in a similar way, switching from one to another may not produce significantly different results, but a person living with Alzheimers may respond better to one drug versus another.
Before prescribing aducanumab, doctors may require PET scans or an analysis of cerebrospinal fluid to evaluate whether amyloid deposits are present in the brain. This can help doctors make an accurate diagnosis of Alzheimers before prescribing the medication. Once a person is on aducanumab, their doctor or specialist may require routine MRIs to monitor for side effects such as brain swelling or bleeding in the brain.
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Moving To A Care Home
If the persons needs become too great for you to manage at home, you may need to consider other long-term options. If youre becoming exhausted or the person with dementia is becoming harder to care for, a care home might be the best option for you both.
A move to a care home can be a difficult decision, but there are limits to the care you can provide.
If the person you care for is moving into a care home, familiar furniture, belongings or music can help them feel more settled.
Tips For Managing Your Loved Ones Confusion
Simplification is key here, Hashmi says. To help minimize confusion, he suggests several ways to simplify both the home environment and your interactions:
Provide structure.
- Keep familiar objects around to help reorient your loved one.
- Label drawers and cabinets. This is especially helpful if confusion about where to find things is a common trigger.
- Use tools such as alarms, calendars, and to-do lists to help them remember tasks.
Deliberately use simple, short sentences and ask yes/no questions.
- Normalize their experience. Say, Youre confused. Its okay. Well figure it out together.
- Lead with what you think might be happening. For example: It seems like youre looking for something.
- Its often much easier for your loved one to answer yes or no questions, instead of coming up with the words themselves. Are you looking for your keys? Are you looking for your glasses?
Lastly, Hashmi says, it helps if you can learn to accept the confusion. In the moment, he says, whatever your loved one thinks is real is in fact their reality. For example, they might think theyre at work when theyre really at home. If that belief isnt hurting them or anyone else, its OK for you to play along a little bit. Confronting or trying to change the belief often leads to agitation and aggression.
For us as caregivers, we have to be OK with that confusion, Hashmi says.
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Before A Planned Hospital Stay
With Alzheimers disease and related dementias, it is wise to accept that hospitalization is a when and not an if event. Due to the nature of the disease, it is very probable that, at some point, the person you are caring for will be hospitalized. Keep in mind that hospitals are not typically well-designed for patients with dementia. Preparation can make all the difference. Here are some tips.
Being There For A Person With Dementia At The End Of Life
As dementia progresses, caregivers may find it hard to provide emotional or spiritual comfort to a person who has severe memory loss. However, even in advanced stages of dementia, a person may benefit from such connections.
Sensory connections targeting someones senses, including hearing, touch, or sight may also bring comfort. Being touched or massaged can be soothing. Listening to music, white noise, or sounds from nature seem to relax some people and lessen agitation. Just being present can be calming to the person.
Palliative or hospice care teams may be helpful in suggesting ways for people with dementia and their families to connect at the end of life. They also may be able to help identify when someone with dementia is in the last days or weeks of life.
Signs of the final stages of dementia include some of the following:
- Being unable to move around on ones own
- Being unable to speak or make oneself understood
- Eating problems such as difficulty swallowing
Though palliative and hospice care experts have unique experience with what happens at the end of life and may be able to give a sense of timing, its hard to predict exactly how much time a person has left.
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Recognize Triggers For Difficult Behavior And Stay Calm
If the delusions someone with dementia experiences are severe and may put them or you, the caregiver, at possible risk or harm, it is best to speak to a doctor to see if some medication may be needed.6
A person with dementia can be susceptible to depression, anxiety, agitation, hallucinations, aggression, and loss of inhibition.7 While anxiety and depression issues may need to be dealt with the help of a trained mental health professional, the other behavior may have to be managed by you. You can cope with difficult behavior like aggression by:8
- Identifying triggers for the behavior to see if they can be fixed. Pain can often be the cause for the unusual behavior.
- Not taking the behavior personally. It is not directed at you, but just an expression of the emotions or confusion the patient is experiencing. This may be especially hard to do if the dementia has made them suspicious and theyre accusing you of things like theft, infidelity, or inappropriate behavior.
- Avoiding arguments and confrontation.
- Accepting this as a symptom of the illness as you would any other symptom of a disease.