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Ask the OT - Why does my mom with dementia get angry?

Posted by on 10/22/2014 to Communication Tips
  • "Mom wants to go make supper for the children... but she is elderly, with no children to care for. She gets upset when I tell her she does not need to cook."
  • "My wife blames me for taking her jewelry and thinks I am selling it off at a pawn shop."
  • "Dad insists he can pay the bills without help and gets mad at me when I take them away. But too many mistakes have been made, and he needs help."
These are all examples of how the person with dementia might become angry. These situations can quickly escalate to the person yelling and becoming agitated - especially when the caregiver argues back. For caregivers, the situation can be odd, frustrating, hurtful, and possibly scary. Why does the person with dementia become angry? And what are caregivers to do?

Explaining Anger in the Person with Dementia

The fact is that the person with dementia is not processing information correctly - this is the disease. The person may miss pieces of information in conversations, miss cues in the environment, forget events, mix up details, be disoriented to the correct time and place, and have a lack of insight - meaning the mistakes are not even recognized by the person. What seems to make perfect, logical sense to you and I, is no longer logical to this person. Why? Because we have all the pieces of accurate information; the person with dementia does not.

Being 'Mean' with Dementia - An Analogy to Help

Perhaps this analogy will help caregivers to understand the reality for the person with dementia. Imagine you are in a foreign country, where you encounter:

-A bus to take you around the city but a bus schedule that uses military time, that you are not familiar with using.

-A restaurant menu with foreign words and prices you are not sure how to convert to know how much money you are actually spending.

-Public bathrooms that you need to pay for to enter, but you are not sure how the process works.

You get the idea....things do not make sense to you, at least initially, in a foreign country because you do not know all the facts, all the words, all the details. But you, with a healthy brain, can over time learn these things and manage well in a foreign country; the person with dementia cannot. In fact, the world around the person with dementia can become even more foreign as time goes on.

Caregivers Helping Ease Anger with Dementia

Arguments and anger come out of the current reality for the person with dementia, which can be as mixed up as being in a foreign country. Helping the person with details and validating the reality the person is experiencing can stop anger before it starts. In the scenarios above, the caregiver could:
  • Recognize that mom is living back in a time when it is her responsibility to get the kids their supper and that she may not rest easy until she is reassured that they have been fed. The caregiver could tell her that the kids are eating at the neighbor's house tonight. Or they cook dinner together and place leftovers in containers for 'when the kids get home from playing'.
  • Keep all important jewelry in a hidden place that can be shown to the wife when she asks (and to avoid her constantly losing the pieces). And if a piece is misplaced and she is upset, he can validate her feelings of fear - "Wow, you must be worried about that missing piece. Let's look together for it."
  • Intercept the bills before dad sees them and pays them at a different time. Or the caregiver and the dad pay the bills together. Alternatively, the dad is given a photocopy of the bill and a checkbook, not actually linked to an an account. Dad can think he is paying bills, while the caregiver does the actual payment of the real bill later, to avoid mistakes.

People with dementia are still living day to day, and should be encouraged and supported to continue doing things. However, their world and reality is not truly accurate and foreign to caregivers. Moments of anger can arise. Caregivers can diffuse - even prevent - anger from the person with dementia by rethinking and adapting to the patient's foreign world, through validating and managing situations. Find more information and practical solutions to behaviors with this wonderful book, A Caregiver's Guide to Dementia: Using Activities and Other Strategies to Prevent, Reduce, and Manage Behavioral Symptoms.

Has this article helped you as a caregiver? Share you experience below.

Monica Heltemes is a practicing occupational therapist with over 15 years experience working with people with dementia and caregivers and is the founder of MindStart. As an occupational therapist, she helps patients and caregivers with tips for their daily routines, safety in the home, communication, adapted techniques and equipment, addressing behaviors, and more. Monica has used her occupational therapy expertise and experience to design products (such as games, puzzles, and books) that meet the unique needs of people with dementia. The items have a specific design so that they are easier to complete but yet remain adult-oriented in appearance and content. See MindStart products.

Information in this article are suggestions and are not a replacement for medical advice or care.

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