FlowersChallenging Behaviors for the Caregiver

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If you are caring for someone with dementia, you may find that they sometimes over-react to a trivial setback or a minor criticism. They might scream, shout, make unreasonable accusations, become very agitated or stubborn, or cry or laugh uncontrollably and inappropriately. This tendency to over-react is part of the disease and is called a "catastrophic reaction". Sometimes a catastrophic reaction is the first indication to make relatives aware of the dementia. It may be a passing phase, disappearing as the disease progresses, or it may go on for some time.

Coping with such behaviour can be very difficult and is often a matter of trial and error. Remember that the behaviour is not deliberate: it is out of the person's control and they are probably quite frightened by it. They need your reassurance, even though it may often not appear that way. Trying to make sense of the environment becomes a difficult task confronting the person with dementia. Simple tasks such as bathing, dressing and eating are all major hurdles to overcome. People with dementia are frequently confronted by failure, so maintaining their dignity is most important.

Three common worries:
Is the person for whom I am caring brooding about past tensions and misunderstandings which have occurred between us?

  • Does he hate me now?
  • Have I done something unintentionally to upset him?
  • These are all normal reactions - it is important to realise that most of the anger and aggression is directed against the carer because you are the closest person, however, it is not a calculated personal attack.

    Causes of Catastrophic Behaviors

    Aggressive behaviour may come on without warning and make you feel very apprehensive. However, if you can figure out what situations trigger catastrophic behaviour (perhaps by keeping a diary), you may be able to work out ways of avoiding them. If not, you may still be able to find methods of dealing with the behaviour quickly and effectively when it occurs. Remember, each person with dementia is an individual and will react to circumstances in their own particular manner.

    Try to Minimise Stress

    A calm, unstressed environment in which the person with dementia follows a familiar routine can help to avoid such reactions.

    Modifying The Environment

    People with dementia often become extremely upset if they find themselves in a strange situation or among a group of unfamiliar people where they feel confused and unable to cope. The situation may seem to be very simple, but the frustration caused by being unable to meet other people's expectations may be enough to trigger an outburst.


    Things To Avoid

    Violence And Aggression

    Sometimes the person with dementia may become very violent for a short time. They may become verbally abusive, cause damage to property or become physically violent. (Physical violence almost always occurs when someone else initiates physical contact.) Try to stay calm and not show fear or alarm. Try to understand that even if the aggression is directed at you, it is not a personal attack.

    Violence could be caused by:

    Coping With Aggressive Behaviors

    Preventive measures

    Coping Strategies

    Looking After Yourself

    Sudden over-reactions may leave you upset and a little shaky. It is essential that you seek support for yourself from a supportive family member, a friend, an understanding professional or a support group, and that you get a break from the constancy of the task. Identify the areas of support that you need and learn about the services in your area ( respite care, in-home care, day care etc.) which are available to help you.

    Allow yourself to get help with other tasks such as cleaning so that you can conserve your energy.

    Remember that your own feeling of distress, frustration, guilt, exhaustion and exasperation are quire normal: However, sometimes situations are beyond your control, so seek help.


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