Dealing with occasional outbursts of agitation and aggression is part of dealing with an Alzheimer’s patient. Sometimes your loved one’s attention can simply by redirected, but more serious and chronic outbursts may require medication, but in either case, having some idea of the cause of the outburst may give some direction to the caregiver and also help reduce the possibility of future outbursts. In her article titled “5 Causes of Alzheimer’s Outbursts,” Marlo Sollitto lists 5 possible causes of these outbursts.
I was fortunate that Mom and Dad were pretty laid back and non-aggressive, but they had their moments. In reading through Sollitto’s list, I was reminded of incidents related to all five causes.
Cognitive Impairment. A patient may lash out in frustration when expectations exceed their abilities. Mom and Dad watched TV a lot, but dealing with the remote controls was a source of frustration to Dad. His TV had two remote controls – one to turn on the set and another to change channels. I taped notes to each one with instructions, but I heard often heard the sound of static coming from their side of the house and knew that Dad had once again lost the wrestling match with technology. I’d find him helplessly punching buttons, and I’d ask him what he was trying to do, intending to find whatever program he was looking for.
“Just forget it. Just turn it off,” he’d say, staring at the floor and looking disgusted.
Granted, it wasn’t much of an outburst, but I hated seeing him so frustrated. What I finally realized was that the remote controls were beyond his declining abilities to understand, with or without my post-it notes. I changed the routine a bit, turning on the TV and tuning it to their favorite shows and then putting the remotes on top of the TV instead of on the coffee table in front of Dad. Without having to deal with those incomprehensible buttons, he was much happier.
Psychological Disorders. Sometimes outbursts stem from a neuro-chemical imbalance that can be treated with medication. Early in her disease, an auto-dial fax machine got Mom’s phone number, and several times a day, her phone rang. When she answered it and heard the electronic sounds of one machine trying to communicate, she was convinced there was a diabolic stalker on the phone whose sole aim in life was to torment her. At best she got angry, and at worst she melted down into a hysterical fit of fear and crying. No amount of reassurance or explanation helped, but her doctor prescribed an anti-anxiety medication. Along with the caller ID Dad installed so she could screen unknown callers, her peace of mind was restored.
Physical Problems. I don’t remember an incident in which physical problems caused outbursts, but there was a time when Mom woke up in a totally confused state and was unable to walk without help. After consulting with her PCP, I took her to the ER, and she was diagnosed with an extreme UTI and dehydration. Antibiotics and fluids quickly brought her back to normal, or at least back to her normal. When you see any kind of unusual condition, whether it’s outbursts or other strange behavior, consider the possibility of a physical problem.
Environment. Mom and Dad were always cold, even in the dog days of summer. We had many conversations about why the thermostat didn’t need to be set at 85 when it was 90 outside. Mom was often the instigator of the assaults on the HVAC, but Dad was the one who carried out her wishes – and he didn’t like being questioned about what he was doing. I finally solved the problem by closing the vents in their side of the house when the air conditioning was on and providing Snuggies and space heaters year round.
Approach. Nobody likes to be told what to do, and Dad especially didn’t like to be told what to do by his daughter. I had several approaches that worked better than a frontal assault. Gentle suggestion and joining in his humor worked pretty well.
“Dad, it’s bath day. I’m going to help Mom, and then it will be your turn.”
“I don’t need a bath,” he’d say with a grin. “I don’t stink.”
I’d roll my eyes and laugh. “Are you sure about that?”
Incentives also worked.
“Dad, we’re going out to dinner tonight. You’ll want to shower and put on clean clothes before we go.”
I know I had it easier than a lot of caregivers. Mom and Dad weren’t prone to outbursts and with the exception of when I took Dad’s car keys away from him, they were never aggressive. If your patient is more volatile, try to discern the causes, and don’t hesitate to enlist the help of doctors and other professionals. Above all, remember that no matter how much you love your patient, caring does not mean accepting abuse.
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