Alzheimer's patients express their anger by yelling, swearing, pushing, shoving, waving their arms, and in some instances, throwing things. These behaviors not only disturb others, they are threatened by them. Caregivers must learn how to manage anger to ensure the safety of all. I learned this when I was my mother's family caregiver.
For nine years, I felt like my mother was dying right before my eyes. The intelligent, sensible, calm parent of my childhood became verbally and physically aggressive. Her conversation was peppered with swear words and I was shocked when she yelled, "Go to hell!" I was astonished when the assisted living staff told me she was involved in a fist fight. I was embarrassed when she stole someone's teddy bear.
Who was this person?
Gradually, I learned to tell the difference between the anger of confusion and the anger of self-defense. According to "Anger Management Therapy for Dementia Patients," an article on the Answers 4 Alzheimer's website, some patients become so angry they stop talking. Others yell and gesture excitedly when they become upset. Anger management therapy, the ability to understand consequences and redirect anger, helps some patients.
But the problem with anger management therapy is that the person has to remember it. My mother could barely remember her name. From the caregiver's perspective, anger management may look like futile effort. Though the therapy may be only partially successful, the article says "any progress is undoubtedly helpful."
Anger may be a sign of sundowning, the late afternoon mood changes, agitation, fear, pacing and rocking that many patients experience. After my mother threatened to run away her doctor transferred her to nursing care. Mom thought I had put her in a mental institution and was furious. When I visited her one afternoon I observed her sundowning behavior. She paced back and forth and looked out the window nervously. Later conversations revealed that she was having hallucinations.
Similar behavior is described in an article, "Sundowners Syndrome," published on the Alzheimer's A Place for Mom website. Caregivers can dispel anger by sticking to a routine, monitoring diet, controlling noise, opening curtains to let light in, and turning on more lights. Redirecting the person (reading to him or her, playing soft music, giving them a glass of juice) may also help.
Exercise also helps to quell anger, according to "Managing Common Symptoms and Problems, an article on the Help Guide website. But it has to be regular and purposeful exercise. My mother did not like the exercise activities, yet she participated in them. One activity involved sitting in a circle and throwing a ball. "Don't they think I can catch a ball?" she asked.
In the later stages of the disease Alzheimer's patients may become belligerent and aggressive. Caregivers have to protect Alzheimer's patients from harming themselves, the article notes. Provoked as you may be (and my mother certainly provoked me), do not answer accusations, confront the person, or discuss angry behavior. "The person with dementia cannot reflect on their unacceptable behavior and cannot learn to control it."
Get some help if the patient is overly aggressive. You may also say, "I have to leave now, but will come back later," and walk away. Caregivers need to remain calm and look for aggression patterns, such as the anger of sundowning. Remember, anger comes comes from the disease and not the person.
Copyright 2010 by Harriet Hodgson
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