 | | | Linda Fodrini-Johnson, MA, MFT, CMC, is a Licensed Family Therapist and Certified Care Manager. She has been practicing professional care management since 1984. Linda founded Eldercare Services, a full-service care management and home care company in 1989. Eldercare Services is now a division of Home Care Assistance and continues to provide Bay Area families with care management, advocacy, counseling, support groups and education. | | | | | | "Since my mother has shown signs of dementia, now confirmed as Alzheimer's, she seems to get angry all the time."
"Dad seems to be blaming me for everything that he can't remember and has a tendency to wander off if he is upset."
Family caregiving does not come with a manual; it is often by trial and error that primary caretakers learn what is upsetting the individual with a dementia to cause that person's reaction in an angry or hostel manner. Sometimes, it takes a lot of detective work trying to find the "trigger" to a behavior.
This anger can be expressed by shouting, screaming, pacing, wandering or striking out if someone is trying to restrain them. This type of behavior is difficult to understand and in order to find solutions, it takes some sensitivity and exploration. Understanding more about the individual with the dementia will help family and preserve the dignity of the individual, reducing stress for everyone.
Those with dementia aren't intentionally being difficult. It is more about the process of the illness and how it affects the ability to communicate thoughts and feelings. As dementia progresses, both receptive and expressive language skills decline. So, the result is that they don't understand what you are saying and they don't have the skills to find words for their feelings, which results in frustration and anger toward you.
In a recent support group session I did on Zoom, a couple attended, one with dementia and the other the caregiver. The individual with dementia had been in the health field as a professional. However, she was at least six years into the dementia journey. She heard a name spoken that was the same as a deceased relative (it was only the name of a participant) and she heard participants talk about caring for their mothers as well as spousal members talk about the burdens of caregiving. After the session, the caregiver said that the spouse was grieving the loss of the person's name she heard as if it was her family member all over again. She was also fearful she would lose her spouse, and wanted to go care for her mother who had died many years before.
You can see from this example that "triggers" to behaviors can come from the environment: situations in which they don't understand the conversations that may be outside their own experiences. This reaction should inform the family that they as much as possible will need to protect this person from situations that can cause triggers for her to want to be a helper, and those that cause her to feel sad because she thinks she is a burden.
Some tips to avoid negative/angry outbursts:
1) Environment: Be consistent with a routine. Do activities of daily living the same time every day. If you bring in a new item or person to the routine, expect some type of behavior change and reassure the person with dementia that they are safe. Physical changes like heat or cold can cause negative reactions such as is being hungry, thirsty or needing to use the bathroom and not being able to communicate that to you.
2) Rationalizing: Make your explanations simple. Don't give lots of information that could be hard for the individual to understand. For example, if you are needing to leave for an appointment, say something like, "We need to leave early today because of traffic on the roads." Don't go into detail about why you need to get to an appointment early - make up a simple story that is easy to understand.
3) Refusing: This is more about confusion. So, when asking the person to do something, like eat breakfast, be sure to use a calm voice and not push. Instead of using the word breakfast, use the name of food you are serving, such as, "Your oatmeal is ready." Go away if that doesn't work and come back with a different soft approach.
Mood swings become more prevalent as the disease progresses. Each individual might have different triggers, so avoiding those will help you care for your family member longer and with less stress. Sometimes it can be a mystery for family to see what might be a "trigger." When this is the case I recommend working with a Professional Geriatric Care Manager and/or attending support groups and classes offered in your community or through the local Alzheimer's Association.
We have a team of four highly experienced Care Managers at Home Care Assistance, a monthly Zoom support group, and I offer a variety of classes. On Jan. 8 at 11 a.m., I will be doing a Zoom class specifically on "The Road Map from Diagnosis to Family Care." These support groups and classes are free and educational. Please give our office a call at (925) 937-2018 or email me at LFJohnson@
HomeCareAssistance.com.
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Lamorinda Weekly, Moraga CA