Sometimes people with Alzheimer’s and other dementias suddenly lash out in anger or break down hysterically. What should you do?

Most of us aren’t that good at dealing with upset emotions and behaviors. And yes, they are upsetting. But I’ve found a few things that can help both you and your loved one. (If you lead a worship service for people with dementia, here’s how to handle this during services.)

“Catastrophic Reaction”

In dementia lingo, an over-the-top reaction is called a catastrophic reaction. It can happen suddenly, but in my opinion the cause is rarely sudden. Most typically it’s a boiling-over caused by a slow burn of fear, frustration, confusion over complicated instructions, tiredness, embarrassment, illness, rushing, or even a series of small things that have built up over the day.

Your immediate reaction may be defensive or angry: “Hey, you can’t grab me like that! Settle down!” Or you might try logic: “You can’t go out because it’s snowing! That’s no reason to yell at me!”

Here’s where it helps to remind yourself that the person has a brain injury. Try these responses:

• Stay completely calm and speak reassuringly. The person is trying to express something; let them know that you’re listening and that you empathize with her feelings. “I understand you’re angry, Nora; it’s really frustrating, isn’t it?”
• Do not raise your voice; do not argue; do not scold.
• Simplify the environment: Move the person to a less-crowded place, or turn off the TV.
• Let the immediate task (such as hair-brushing or buttoning a shirt) wait for several minutes.
• As the person calms down, try a comforting distraction—go with him to get a snack, recall a favorite story, give her a favorite blanket or stuffed animal to hold.
• When giving instructions or a suggestion, give the person a long time to respond. “Hey, how about a glass of orange juice, Ed?” (then wait 15-20 seconds)

If you are there when the reaction triggered, sometimes the only thing you can do is remove yourself as quickly as possible from the situation. In the demented person’s mind, you are part of the problem.

Leave the room and let someone else take over, calmly changing the subject if possible. (If you’re alone with your loved one, go to another room where you can keep track but be out of sight.) Give it five or ten minutes; it’s likely your loved one won’t have any memory of being angry with you.

How to avoid catastrophic reactions

How would you like it if someone threw 20 different instructions or choices at you all at once, or insisted that you do something that makes no sense to you? That’s what it can feel like to a person with a brain disease; they simply can’t process complex information, let alone quickly.

Prevention is the best medicine:

• Approach a person with dementia from the front rather than from behind, so she doesn’t get startled.
• Move slowly and speak slowly; don’t ever appear or sound rushed.
• Smile, speak the person’s and your name (“It’s so good to see you, Mary—I’m Elisa”), and make friendly eye contact.
• Speak respectfully and reassuringly, not condescendingly or argumentatively.
• Don’t expect a person with dementia to perform tasks quickly, and keep tasks simple.
• As much as possible, keep routines and settings consistent.

If you notice a lot of catastrophic reactions, it might help to keep a record of what was happening each time, including time of day; you might notice a pattern that can help you make simple changes (for example, giving pills at lunch instead of at breakfast).

What about during a worship service?

If a person with dementia becomes agitated while you’re leading a worship service, you can try several things:

• Put on some hymn music so others can be singing for as long as needed while you help the agitated person.
• Use soothing language and eye contact to address (and hopefully distract) the person so she can begin to calm down.
• If possible, enlist another caregiver to gently move the person away from the service area, in order to remove excess stimulation. For example, the caregiver can move and then sit with the resident in an empty row at the back of the room, or leave the room entirely.
• If a resident becomes agitated with a fellow resident—for example, if one person gets angry that the person next to him isn’t on the correct page, or if someone grabs another person’s arm and won’t let go—do whatever it takes to reassure and distract both of them until the focus is no longer on the problem. Then, if there is lingering annoyance with either person, immediately help one of them to another seat.
• Don’t rush. It’s not important for you to get through the entire worship service agenda; what matters is helping everyone enjoy a peaceful time together.

Cut yourself some slack

I know it’s hard, but try not to feel guilty if you’ve gotten angry with your loved one or a resident in the past; it’s completely natural, and we’re all learning as we go. Vent your frustrations with someone you trust, and please let me and other readers know if you’ve used other strategies or have questions.

Peace be with you,

Photo credit: Conger Design