Managing Angry Behaviour Understanding Dementia Why does it happen? People with dementia find it hard to talk about or control their emotions. So the easiest way for them to respond to something they do not like is to be angry or agitated. The anger is usually triggered by something that upsets them or makes them feel uncomfortable. Every person with dementia is unique so it is important to take time to understand your loved one and work out what triggers their angry behaviour. That way you can take steps to reduce angry outbursts. What causes it? There are three general areas that trigger angry behaviour in people with dementia: • Physical well-being. • Emotional well-being. • Their environment.
“When I was growing up, my mum was always firm but kind. Over the past two years, dementia has turned her into an angry old woman. She always loses her temper over small things and makes mean comments. I keep reminding my family and myself that it’s the dementia talking not her. Deep inside she is still my mum - the woman I’ve known and loved for 50 years.”
Physical causes • Being tired or a change in sleep patterns. • Pain or discomfort such as a soiled diaper. • Side-effects of medicine. • Seeing things that are not there (hallucinations or delusions). • Loss of emotional control caused by the brain disease. Emotional causes • Feeling lost or insecure. • Sensing their caregiver’s stress, frustration or impatience. • Being scolded. • Changes to their normal routine. • Feeling a loss of control. Their environment • Busy, noisy or crowded places that cause too much stimulation. • Being tied down to stop them from hitting or wandering (physical restraints). • Being around people or places they do not know. • Hearing sounds they are not used to.
Caregiver tip “I keep a daily diary and note down everything that happens. That makes it easier to see differences in my mother’s routine and identify what causes her angry behaviour. Doing this, I’ve realised she gets angry when people she doesn’t know visit the house. So now we plan ahead, for example, my sister will take her out for a walk and for lunch while I’m getting the air-con serviced. My mother enjoys her morning out, I can get some jobs done in the home and the technicians can do their work in peace without being scolded.”
What can I do to prevent it? Set up a daily routine • Try scheduling meals, baths and daily walks. Regular exercise helps reduce stress. • Allow enough time for them to accept changes to the routine if rescheduling is necessary. • Put up a large clock and calendar to help them get used to time. Speak clearly & simply • Speak slowly and clearly using short sentences. • Give them enough time to follow your directions and to answer questions. • Do not ask questions that will test their memory. • Try not to reason with them as this can cause more frustration. • Do not scold them. • Walk up to them slowly from the front so they can see you coming. This will prevent surprises that can be upsetting.
Create a calm & safe environment • Reduce clutter, people and noise in their surroundings. • Protect them from hurting themselves by removing knives and other sharp objects. Keep them comfortable • Take them to the toilet regularly or check their diapers every hour if worn • Check if they are in pain and give pain relief medicine if needed. • Try to work out what triggers your loved one’s anger and take steps to prevent it.
What can I do when they are angry? • Speak to them in a calm, gentle voice. • Try using gentle physical touch such as holding their hands or hugging them. • Try distracting them with their favourite food or activities. • Say ‘I am here for you’ or ‘I understand’, even if you do not know why they are angry. If you feel that you are in danger: • Stand out of their reach and where they cannot see you. • Leave the scene if necessary to prevent yourself from being injured. • Call for help.
Yishun Health is a network of medical institutions and health facilities of the National Healthcare Group. Admiralty Medical Centre • (65) 6807 8000 • www.admiraltymedicalcentre.com.sg Khoo Teck Puat Hospital • (65) 6555 8000 • www.ktph.com.sg Yishun Community Hospital • (65) 6807 8800 • www.yishuncommunityhospital.com.sg The information is correct at the time of printing and subject to revision without further notice.
GRM.IE.07.0517