Dementia: Difficult situations

Emotional outbursts and irrational behaviors are cited as some of the most stressful aspects of caring for a loved one with dementia. In this handout we outline proven strategies for reducing and managing these situations, including distraction techniques and even “therapeutic fibbing.”

Embarrassing behaviors

What do you do when sweet Mom starts cursing angrily? When straitlaced Dad makes off-color remarks?

In persons with dementia, these behaviors are not on purpose. They are caused by the brain changes of the disease.

If you can’t find humor in the situation, draw on your patience. Believe it or not, your relative is doing his or her best.

Consider these strategies to reduce or discourage outbursts:

  • Stay calm. Your relative is likely frightened or uncomfortable. Try to respond with curiosity. See if you can figure out why they are behaving as they are.
  • Redirect attention. When embarrassing behaviors occur, try focusing your relative’s attention on something else: “Dad, look! They’ve got chocolate cream pie today.” Or, “Mom, I almost forgot to tell you….”
  • Simplify the situation. If Mom is acting out, perhaps it’s the environment. Lots of people? Too much noise or stimulation? Do what you can to go to a place that is quiet, calm, and uncluttered.
  • Identify (and avoid) common triggers. Angry lashing out is often a sign of too much to handle. Look for patterns. Do they occur when you are in a rush? When there is a lot to do? Try slowing down. And keep instructions simple, one step at a time.
  • Go along when you can. If Mom thinks her babies need her at home, or if Dad wants to go to work, it’s harmless. No need to argue. Trying to persuade your loved one that he or she is wrong will only result in anger and mistrust of you.

Check with the doctor
There may be a problem with hearing or vision. Unexpected outbursts in people known to have dementia can also be caused by pain. An undiagnosed bladder infection is a common culprit.

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Distraction techniques

If the person you care for has a problem with memory loss (dementia), you may find that he or she gets agitated about things that don’t make sense. Your long-retired dad may wake up in the mornings and insist, “I have to go to work!” It can be confusing for you. And annoying!

Disregarding these comments will only make your relative more determined. And it’s pointless to try to reason. The disease has robbed them of that ability. Instead, spend some time connecting in “their reality,” and then use distraction techniques.

Compose yourself. Your body language, face, and tone of voice speak volumes. People with dementia still perceive respect versus dismissal. If you need time to calm yourself, make an excuse to get something from the car or to go to the bathroom, so you can return refreshed.

Validate their concern. “Gosh, Dad, I see you are ready to go. I wish I had your enthusiasm about work! Is there something special at work today?” By joining in their emotional reality, you are not telling them they are wrong. They feel reassured you understand.

Distract. Engage them in a fond memory of something related. “Remember your first client back when the business was new? What was it they had you do?” As you reminisce, consider walking together into another room to shift their attention. Once in the other room, draw on their forgetfulness and eventually offer an alternative activity: “I’m hungry. Let’s have breakfast” or “Oh, look at that messy walkway! Would you sweep it? That would really help.”

Reflect. If your relative obsesses on things that don’t make sense, look for triggers or the underlying meaning. If Dad associates morning with time to go to work, have a task for him to do that addresses that need—in this case, to feel productive.

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"Lie to my mom?"

Mom taught you to always tell the truth.

But in the context of caring for someone with dementia, honesty may not always be the best policy.

There may be times when the kindest strategy—the one that reduces your loved one’s anxiety or fear—is to omit the truth or bend it a little.

This is called “therapeutic fibbing.”

Try distraction first. Put your relative’s forgetfulness to work for you by focusing his or her attention on something else. For instance, if your dad is persistently asking to see his mother, don’t bother explaining that she died decades ago. Instead, validate his emotions and meet him in his memories. “You want to see your mother. Tell me about your mother.” Shortly, change the subject, even move to a different room. Then lead his attention to a favorite activity.

Bend the truth. If distraction doesn’t engage his attention, you might say, “Your mother is visiting her sister and will come see you tomorrow.” Or, if he wants to drive to the store, rather than reminding him that he can’t drive and the car was sold, say, “The car is in the shop, Dad. It should be back tomorrow.”

Omit the truth. If Mom gets fretful about going to the doctor, consider: Does she need to know that that’s where she’s going? Perhaps instead, go to lunch and then “happen” to stop by the doctor’s on the way back. Was anything—other than her anxiety—lost in her not knowing ahead of time?

Therapeutic fibbing may not immediately appeal to you. Simply know it is a proven technique for relieving distress and bringing a confused loved one back to a state of tranquility. Your relative benefits more from feeling safe and calm than from knowing “the truth.”

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