Coping with Anger and Agitation in Alzheimer's

I knew very little about how to calm a person with Alzheimer's who was agitated. I knew Dad was agitated a lot. I assumed it was because he was losing control of his world, and honestly, it was part of his personality in the first place. When Mom would talk about it, she would describe some of those times with Dad. I learned some therapies are common for dealing with anger and agitation. Some of these are useful, some are not allowed, and some are strange. Daily routines help those with Alzheimer's It wasn't until Dad moved to his new memory care home that I realized it was part of the disease as it progressed. After a very short time, Dad calmed down. I attributed this partly to the fact that Dad now had a 'routine' day, routine activities. At home, he had no real routine other than his 3 meals a day, primarily because Mom let Dad lead the day, even beyond his capacity. Animal therapy I recently wrote about a couple of amazing dogs that managed to calm Dad. Now, I swear by animal therapy. I had some pretty amazing memories of Dad's smile when the pups were near him. Familiar voices Many times I saw my Mom use a soft voice and her touch to calm Dad. She would talk quietly in his ear and remind him as he was swearing or being nasty to someone - that wasn't how you treat people. Even when he could no longer speak and the agitation was great, Mom would stroke his head and hair and again talk softly into his ear. I was in awe of how well that always seemed to work. It also speaks to the love Mom had for Dad. Medications to treat anger & agitation My husband told me, in an attempt to prepare me, they would medicate Dad once he got to his memory care home. We had more than one conversation go south because I didn't want to hear that they would 'sedate' him. At least, that was my interpretation. What kind of life would that be if he was constantly sedated? That wasn't how it was. Medication was needed to help Dad cope. It wasn't so staff could lounge around. It wasn't needed because the memory care home was understaffed. It was needed for Dad's health. I could see the difference in him very quickly. As Dad was unable to communicate verbally, he expressed his displeasure by waving his fist at the staff. They had an amazing way of cajoling him out of his displeasure and gained his cooperation. Reflecting back, I fail to understand why Dad wasn't started on some medications for anger and agitation in those years he lived at home that were hell on Mom. Guess I won't ever have an answer to that one. Music therapy Music was definitely a calming influence on my dad. Music was part of my life growing up because it was part of Dad's everyday life. Roger Miller, Johnny Cash, Petula Clark, Dave Clarke Five, and later on, any style of jazz. As Dad declined, the more music he was exposed to, the calmer he was. Music was a big part of life in Dad's new home. Not loud, not demanding attention, just present at certain times, like when the recreational gals came to do group exercises. Aromatherapy Aromatherapy is another therapy that I have read is helpful. Since many environments are now scent-free, I don't think it is widely used. I never saw it being used where Dad lived. It would not only put the residents at risk for scent-related health issues but also the staff. Dolls and stuffed animals There was one therapy I found very disturbing. When I first toured different memory care places for Dad to live, I saw many people with baby dolls or stuffed animals in their laps or on the trays of their wheelchairs. I had a visceral reaction. I was appalled. At first, I thought it was making fun of people and not treating people with dignity. I didn't ask about it right away because I didn't think I could without getting angry. Eventually, I learned it is a form of therapy. As I looked more into it, I found little evidence that it is effective.1 Evidence is one thing, but observation is another. I saw how it worked for some folks at Dad's home. When Dad became a wheelchair user, I put a doll on his tray. It didn't feel right, but I thought, what's the harm in trying? He knocked it on the floor several times. Yup, despite the disease, Dad was still in there — no more dolls. I have learned so much about the strategies available to treat the anger and agitation that comes with Alzheimer's. So many of them worked for my Dad. Maybe some of them will work for your loved one. [forumDriver id=13704] [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site"] Alzheimer's disease damages brain tissues, and so over a period of time the brain slowly changes. In addition to the cognitive symptoms that arise, this can also causes behavioral and personality changes to occur. This can be especially hard to watch in a loved one, but remember that this is a result of the disease and not the person. Sometimes medications, the surrounding environment, or concurrent medical conditions can also cause behavioral symptoms, so be sure to rule out other causes so they can be addressed, if need be. Behavioral symptoms There are a variety of behavioral symptoms that might occur, and not everyone will experience the same symptom or symptoms at the same time or to the same degree. In the early stages of Alzheimer's disease, the person might display some irritability, depression, or anxiety.1 As the disease progresses, behavior and personality changes become more pronounced and can include1,2: Aggression Anxiety and agitation Restlessness and wandering Hallucinations and delusions Depression and emotional distress Acting out sexually Paranoia Physical or verbal outbursts If caregivers notice any changes in behavior, make sure that the person isn't in pain or having any issues with soiled clothes, hunger, or thirst. If the changes come on suddenly, talk with their doctor about possible medication interactions or physical ailments like infections or illness. Ways to cope It can be hard watching these personality and behavioral changes happen, but there are ways to cope with these changes. Here are some tips1,2: Don't take it personally – it's the disease, not the person Create a calming, familiar, safe environment for the person Use humor whenever possible Don't argue or act confrontationally with the person Reassure the person that they are safe, that they are not alone, and that things are okay Focus on the person's feelings, not the words; they may have trouble expressing what's really going on with them and acting out instead Keep things simple and follow a basic routine to help cut down on everyone's frustration Use distractions like music, dancing, or singing Use gentle touch or massage to calm the person down, if appropriate – although this might not be for everyone; not everyone likes to be touched Make sure the person is comfortable – check on their toileting needs, pain level, hunger, and thirst Make sure the person is not irritated by background noise, such as something on the television Allow plenty of rest between activities – being overtired can lead to behavior changes and frustration Give the person a security object Follow a guided meditation Ask for help when necessary, and if possible, find another caregiver that can help or step in when needed. Many of these symptoms can be frustrating and can even provoke anger for the caregiver. It's important that caregivers take care of themselves, ask for help when needed, and find ways to remain calm. This can include deep breathing, talking to another friend or loved one that knows what caregiving entails and the presenting situation, going for a walk, or finding comfort in meditation or prayer. [forumDriver id=13707] When to call the doctor If the coping strategies for the behavioral symptoms don't work, or if caregivers suspect there may be an underlying medical or physical cause for the symptoms, call the doctor immediately. A thorough examination can help determine whether there are any medical reasons for the changes in behavior or personality, and if a reason is found, it can be treated appropriately and help resolve the symptoms. If the symptoms are new behaviors from Alzheimer's disease or if the symptoms are not able to be managed by non-drug interventions, the doctor may decide to try medication to assist in managing these symptoms. There are risks and benefits to each medication, so it's worth carefully discussing the options if medication is necessary. Assistance for the caregiver too Getting support is important for caregivers as well. If a caregiver is having trouble coping with these behavioral changes, tell the doctor. They may be able to provide caregiver resources like a local support group that can help navigate the challenges these behavioral symptoms come with. Caregiving is hard, but it doesn't have to be an isolated endeavor. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"],As your loved one's Alzheimer's progresses, you may find that certain tasks become more challenging for them to accomplish. Bathing or showering with Alzheimer's is an area where you may come up against resistance, anger, or hostility.1 But there are ways to help you and your loved one accomplish the necessity of bathing and reduce the stress it can create. In fact, the AlzheimersDisease.net Facebook community was very vocal with tips and suggestions from their own personal experiences caring for a loved one with Alzheimer's. Continue reading to discover what worked (and what did not) for them. Why is bathing with Alzheimer's a struggle? Proper cleanliness as an adult is a societal norm and expectation. A resistance to bathing can feel confusing. You may find yourself frustrated and perplexed. There can be a few things that cause your loved one agitation toward the task of bathing:1,2 They might feel embarrassed that they can no longer do this task themselves. They may feel a loss of control or independence at being forced to do something when they are not ready. They may not understand what is happening or what is being asked of them. They might feel cold or frightened at being exposed. All of these emotions can play into a hostile attitude toward getting clean. Multiple community members shared that their loved ones find bathing to be physically painful: "My husband would say 'needles, needles' when I would have him in the shower. I used the handheld sprayer as he wouldn't like water on his head or face. His head was shaved so I would use a wash cloth on his head and face." "Bath/shower time is now a very real struggle for my relative. It's literally a life and death danger from his viewpoint, he's so very scared of it and fights accordingly. Seeing your 'needles needles' comment makes me think the shower is literally painful on his skin. Such a mystery, all of it." Another community member responded with this helpful advice: "Put a sock on the shower, it helps the flow not feel like needles to their skin." Getting to yes The process of bathing a loved one with Alzheimer's can go more smoothly if you can get your loved one to agree to the process willingly rather than by force. Honor their preferences and try to maintain what they have always done. Did your mom use to bathe before bed? If so, do not ask her to bathe in the morning. Keep to the routine she preferred and was most comfortable with. Did your dad always take showers? Do not require him to now take a bath. Use a shower chair and keep the process as familiar as possible. Try your best to make bath time fun and comfortable. Are there certain scented soaps or lotions your loved one likes? Do they like a particular kind of washcloth or sponge? Does certain music help them feel calmer and relaxed? Make these things part of the process so bathing is something they will enjoy rather than resist.1,2 Because bathing can be so draining on both the patient and caregiver, be strategic when you initiate bath time: "He can get overwhelmed, so I try to keep him calm. Don’t do it when they are too tired." The time of day can also make a huge difference, as this community member suggests: "Bathing earlier in the day is better." Offer choices and clear communication Whenever possible, offer your loved one choices so they feel they have control over the process. Some questions and options you can present include:1,2 "Today is bath day! Are you ready to do that now, or would you like to do it at another time?" "Which towels would you like to use, the blue or the white?" "What would you like to wear once we are done?" "Would you like me or [another trusted person] to help you?" Your loved one may prefer someone of the same sex to help bathe them. For example, a father may prefer his son or son-in-law to assist him rather than his daughter.2 Be flexible Then there are days when a shower or bath just will not happen. That is okay. Sometimes, putting showering or bathing off another day is the only option when your loved one gets upset by it. A sponge bath using a wash cloth in between regular baths could be an option. Or, you could wash 1 body part each day of the week to make it less overwhelming.1,2 According to an Alzheimer's caregiver in our community, going with the flow is key: "LO resists showering. It's a struggle. We try and do it once a week, but if it upsets her too much we just put it off for another day. She used to wash up in the sink but has lost the understanding of how... When she is in the shower she always says how good it feels... Every day is the same yet different, so we go with the flow." Talk them through each step before engaging In order to help your loved one feel as comfortable as possible, communicate each step clearly before engaging in the task. Here are some helpful cues you can use:1,2 "It is time for your bath! First, we are going to walk to the bathroom." "Now it is time to take off your clothes and put on your bathrobe. Can I help you unbutton your shirt? Now I am going to take off your socks and shoes." "I am running the water. I think this feels like a good temperature. Do you agree?" Allow them to feel the water and change it to be warmer or cooler, depending on their response. "Now I would like to help you into the tub. I am going to place a towel/washcloth over your lap once you are sitting." "Are you cold? Would you like a towel over your shoulders?" "I am putting soap on the washcloth. I am going to start by washing your back. I am done with your back now. Would you like to wash your arms, or would you like me to do that?" Keep naming the area and asking "me or you?" as you go. "Now it is time to wash your hair. I am going to rub in some shampoo. Could you lean your head back so we can rinse it out?" "All done! Can I help you stand up and get out?" "Can I help dry you off with the blue towel or do you want to start?" "Time to put on your bathrobe and go back to the bedroom to put on your clothes." "Great job! You look so nice and fresh!" Keep your loved one safe Safety when bathing someone with Alzheimer's is very important, especially to avoid a fall or accident. Never leave your loved one alone in the bath. Here are some things that may help keep your loved one safe and ease the process for you both:1,2 Install bars and grips to help them get in and out of the tub. Invest in a shower chair. Have rubber grips on the bottom of the shower or tub to prevent slipping. Use a handheld shower attachment to ease the process of washing and rinsing. This community member has learned that a warm towel goes a long way: "We have a built-in shower seat that I cover with a warm towel. Even in the summer, I have the bathroom hot, because she is cold." Another community member invested in a shower "hoodie:" "A hair shower hoodie works well with her long hair when washed. It's a wrap to use after washing the hair. Keeps it from dripping all over them." Other personal hygiene tips for someone with Alzheimer's Help maintain normalcy by encouraging and helping your loved one to do things that were always important to them. If your mother always wore makeup, help her apply some or encourage her to put it on. If your dad was always clean-shaven, invest in an electric razor and help or encourage him to shave.1,3 Dressing can be challenging for your loved one as well. After having them choose what they want to wear, lay out clothes in the order they should be put on to help minimize confusion.1,3 Your loved one may need help remembering how to brush their teeth. Show them how, explaining step by step what to do. Brush your own teeth at the same time so they can watch. If a manual toothbrush is hard for them to use, consider investing in an electric toothbrush. Encourage them to do as much as they can for themselves.1,4 [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site"] The conversation goes about the same way every time. We are sitting in front of a panel of doctors at a university research lab. They have just done hours of testing and are now telling my mother she has early signs of dementia. They tell her she should probably stop driving. Or we are at her primary care office and they ask her if she has any problems living alone. Or we're in front of her neurologist and she can't recall the words he told her to remember five minutes ago. "I'm fine," my mom insists, over and over. "I don't feel there's anything different about me." My mom doesn't think she has dementia. She seems offended that anyone would even suggest she has memory problems. I was confused by her behavior and assumed Mom was in denial. After all, this was earth-shattering news that challenged a way of life she had happily lived for over 70 years. Her ability to live independently was being questioned. It makes sense that she would push back. Not always denial After that initial diagnosis of mild cognitive impairment, I threw myself into research about the disease and came across a possibility for my mom's confusion. Scientists call it anosognosia, from the Greek words meaning "to not know a disease." I practiced saying this word that now defined part of my mom's disease: "uh-no-sog-NOH-zee-uh." According to an article from the National Center for Biotechnology Information, anosognosia is a "condition in which the patient is unaware of their neurological deficit or psychiatric condition."1 The authors clarify that "anosognosia differs from denial, a psychological defense mechanism that involves avoiding or rejecting information that provokes stress or pain. With denial, the patient may acknowledge a deficit but minimize its consequences and avoid treatments geared to remedy the deficits."1 On the other hand, people who suffer from anosognosia are genuinely not aware of their deficits. Problems for caregivers This lack of awareness is very common with dementia. Researchers found that 60 percent of patients with mild cognitive impairment and 81 percent of patients with Alzheimer's dementia appear to have some form of anosognosia.1 It is a perplexing issue for caregivers. Especially in the early stages, their loved one with dementia can put on a good show and not let on at all that they might be having issues. They might make excuses for symptoms or refuse treatment. It might delay a diagnosis and possibly put them or others in danger. It can also deceive well-intentioned physicians and other care providers who trust that their patient is telling them the truth, when in fact they might be unintentionally concealing important information about increasing challenges or dangerous living conditions. Managing anosognosia as a caregiver It helped me to understand that my mom really did not believe she had any problems. Understanding more about anosognosia shaped the way I provided care to my mom. One place to start: don't keep reminding your loved one that they have dementia. You can address symptoms and provide structure and safety, but it is unhelpful and frustrating for everyone if you keep trying to convince them. Provide structure It takes some leg work to provide Mom structure but it helps balance the anosognosia and Alzheimer's. Because she doesn't believe she has any issues, when she stumbles finding a word or can't remember where she is going, she gets upset and agitated. She and I rely heavily on predictable schedules, visible calendars, and setting reminders on her phone. Patience and compassion from caregivers are key. Take a break if it becomes too much for you. Instead of "quizzing" or "testing" her, I try to help while still respecting her independence. She is not a child and there is no harm in giving hints or the actual answers. I prompt her with names multiple times before someone comes over. In a conversation, I fill in the word she's looking for right away so she doesn't have to feel frustrated. Anosognosia and Alzheimer's: planning ahead Anosognosia requires planning ahead to accommodate for the shortcomings. Mom needs someone to attend all appointments with her because she can't fill out the health history forms anymore or she forgets what was talked about by the doctor. She needs her travel plans checked because sometimes she forgets to plan for part of the trip. Sometimes I notify people ahead of time by email or phone call that she has memory problems so they are not confused or hurt by the dementia behaviors. Involve your loved one One of the most important ways I try to honor my mom is by including her in everyday decisions. For example, she loves gardening. Because she doesn't drive anymore, it would be easier for me to buy all the supplies on my way past Home Depot. Sometimes I have to do this for convenience's sake. But ideally, I get to take her to pick out the plants herself. She gets to think through which plants will fit where, color coordinating, and height requirements, but most importantly, she gets to feel like she still owns her own life. Focusing on what mom can still do Anosognosia, compounded with Alzheimer's, causes confusion and irritation when patients are reminded of all the things they cannot do anymore. I try to focus on what Mom can still do and what she loves and help her with the rest. Join AlzheimersDisease.net [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site"]

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