When Someone with Dementia Gets Mean
People with dementia are still people, prone to getting cranky, upset, scared, and the whole rest of the big bag of emotions we all draw from. But the difference is that they are losing the ability to put their feelings into words, and how they express those feelings aren't always so obvious. And maybe they are losing their filter so they are more likely to say inappropriate or hurtful things. Their reasoning ability might be failing them, so irrational accusations might not seem irrational to them at all. Taking another person's perspective doesn't go so well for them anymore, so they just say what they are thinking. All of this can make mean statements and behavior more likely, no matter what they were like before dementia struck.
It can be a shock if a formerly sweet family member is now spewing nastiness, cussing up a storm, calling you names, accusing everyone of everything. So telling yourself "It's not her, it's the disease" is a mantra that perhaps provides a quick fix.
But if your loved one was already a bit of a crotchety jerk before dementia, you might already be primed to react to new levels as it escalates, and you find yourself locked in fights over and over again.
When you're making sacrifices, exhausted, busting your butt, doing everything you can out of love, it can be devastating to have mean words hurled at you. Shoot, even if your life is easy breezy, it stinks to have someone you love say something horrible to you.
So how can you keep your cool and handle the situation appropriately, even if you're dying inside or all you want is to lash back?
9 Techniques for Coping with Mean Behaviors in Dementia
1) Understand why it happens. Many times, something in their environment is triggering mean comments or unjustified accusations. This can be their response to feeling scared, anxious, uncertain, confused, helpless, frustrated, hurt - physically or emotionally, or uncomfortable.
2) Don't take it personally. This is easier said than done, but an important step. As their brain deteriorates, they will lose all kinds of mental skills we take for granted. Unless you know this is how they've always been, then you can assume they're not doing these things intentionally, that it really is the disease talking.
3) Calm the situation. Turn the volume on the situation way down by first turning down the volume of your own voice. If the room is noisy, do what you can to quiet it or move with your loved one to a quiet space. Remove distractions, ask others to step away. They will often mirror your tone and demeanor, so give them calm to model. Use short, simple sentences, and a calm soothing voice. Do *not* argue. Don't. Do NOT. No arguing. Okay? It will go nowhere productive. Guaranteed.
If you are having trouble calming yourself down, step away, take deep breaths, count to 10, check Facebook, watch a puppy video, whatever it takes to get your heart rate under control. Repeat a mantra like "It's not her, it's the Alzheimer's" to remind yourself of who your fight is really with.
You can try introducing a calming activity, soothing music, or distracting them away from the previous conversation or activity.
4) Look for clues. As best as you can, focus on comfort and reassurance while you try to figure out what might have them all riled up. Is there something going on they might be worried about? Could they be overstimulated? Is this a new and unfamiliar situation, or could anything be causing confusion? Are they in any pain? Is anything in the environment overwhelming them, are they struggling to handle what's going on around them? Are they frustrated and not able to put their feelings into words?
Put yourself in their shoes and as best as you can try to imagine how you would feel. Is there anything you should be tuning in to from their experience that they can't say for themselves? Look for the feelings behind their words and actions.
Here are some more common triggers for big reactions in people with dementia:
Needing to think about several things at once (for example, all the tasks involved in taking a bath)
Trying to do something that they can no longer handle
Being cared for by someone who is rushed or upset
Not wanting to appear inadequate
Not understanding what they were asked to do
Not understanding what they saw or heard
Being hungry (the hanger is real!)
Not feeling well
Not being able to make themselves understood
Being treated like a child
5) Look for patterns. If you're noticing a lot of this kind of behavior, consider taking notes and keeping track of what happens when, the time, the place, the situation, and see if you can identify patterns. If you find a pattern, see if there are any ways you can prevent the outburst from happening.
If they always seem to say mean things when you are trying to get into the car, what can you do to make that an easier experience for both of you, or at the very least how can you prepare yourself for the onslaught when it's time to get in the car? If they're getting upset an hour before dinner every day, could they use a snack?
6) Is it a UTI? Bizarrely, a urinary tract infection has all kinds of effects on an older person's mental state. If you notice a sudden, dramatic change in their behavior, where they are more agitated, acting out, or less responsive, have them checked ASAP.
7) Give them a change of scenery. Check out what programs your local senior center or adult day care centers might have. Keeping them active and stimulated with activities geared for their abilities can reduce stress, which in turn reduces agitation and inappropriate behaviors.
And they might just need a break from you too. Being a grownup needing care is not something most of us would be too excited about, and we might tend to act out on those providing that care.
8) Get a break. If you're frazzled, your fuse will be shorter, and all these handy tips will be buried under your own mountain of frustration and annoyance. Ask friends and family to give you a break - make specific requests, and see if there is any way to have breaks be a regularly scheduled thing. Look into respite care programs, adult day care centers, and in-home caregivers as an alternative.
9) Take care of you. Your loved one will only do as well as you are doing. You can't pour from an empty cup. If your reserves are depleted, there will be nothing to draw from when the nastiness comes knocking. You are worth taking care of, so find ways to inject self-care into your days, whether it's as simple as staying in the bathroom a minute or two longer for some intentional deep breathing or another puppy video. Look for ways to add something for yourself to every day, even if you have to start very small.
Having someone you love question your love for them or call you a horrible name will never be an easy or nice experience, but hopefully with some of these strategies, you can cut down the damage, both to yourself and them.
Taking care of someone with dementia is one of the hardest things you will ever do. If you have read this far, this tells me you are trying your very best to figure this difficult thing out and have someone in your life that you love very much. I wish you the very best in your journey and would be honored to help you in any way that I can. Please don't hesitate to get in touch.