When Dementia Patients “Misbehave”

Every caregiver who helps a patient with dementia dreads the episodes of unexpected defiance and anger. One day it may be while getting dressed or another day during a pleasant outing at the park. The caregiver, trying to smooth things over, becomes the target of the patient’s hostility. You feel discouraged and frustrated.

What can you do when your loved one, or the patient, behaves inappropriately, whether at home or in public? Here are two bits of advice from professionals:

• At home, take a deep breath and leave the room for a minute. Don’t try to convince the patient to do something she is resisting. Says Lynette Whiteman, Executive Director of Caregiver Volunteers of New Jersey, “Locking horns is a no-win.” She should know, because her 89 year-old mother refuses to take showers. “I tried to separate the fact that if my mother was fully cognizant…she would be mortified.”

• Remember that the patient isn’t deliberately being cruel. Dr. Gauri Khatkhate, a geriatric psychiatrist at Loyola University School of Medicine, explains “They may lack a good way of expressing physical or emotional discomfort. They lash out in anger—shouting insults, cursing, or physical aggression. Those are not genuine thoughts or feelings; they are the symptoms of a devastating condition.”

As the caregiver, how you react to outbursts can impact the situation, too.

• Besides stepping away, try to distract the patient. Try turning on the television or radio, or offering another activity. Don’t try to explain, argue, or rationalize.

• If in public, quietly explain to others that your loved one has dementia. Not everyone knows that it affects behavior, emotions, and understanding of what’s going on.

• Don’t feel guilty if you’re embarrassed. Remain calm and do your best to soothe and comfort the patient. Try to lead him to a different spot as a diversion.

• If the outbursts are regular, look for possible reasons. Could it be fatigue? Hunger? The time of day? A change in routine or medication?
• Ask your support group for advice. Others who face the same challenges offer ideas, as well as understanding. If you don’t have a support group, whether “real” or online, find one today.

• Get away. Even for a few minutes, do something you enjoy to help restore your own mood. Take a walk, knit, cook, visit Facebook.

Besides the advice above, take time to learn as much as you can about dementia and Alzheimer’s disease. Study the stages and symptoms, so you can be prepared. When you understand that the patient is frightened and confused, you can see why once-routine tasks may now seem strange.

Watching anyone with dementia struggle with behavior and emotions is difficult. Learning to step back, disengage, and take care of yourself will give you the space and time to recharge and get a better perspective.