Dealing with anger

SuperSadie

This is my first time here. I've spent a lot of time reading some of the questions and answers but haven't found my specific concern.

My father is 90 and has some dementia symptoms (we don't have a diagnosis yet). He and my mom live in their home. My mom does most of the work in the home including cooking, with some outside help. My father seems to be thinking clearly at times but that changes throughout the day. The fact that he seems clear minded some of the time makes it all more difficult to put him in a facility (which I'm pretty sure he will hate). So we are trying to keep him at home as long as we can.

My concern is that my father can get very angry with my mother and become very verbally mean. He never does it while I'm there; not sure if it's because I usually don't stay into the evening or if he waits for me to leave. This puts additional stress on my mom and makes her (and me) worry if he will get worse. I'm worried about my father and also about my mother's mental and physical safety.

From what I've read, it seems like the right thing to do in most situations is to redirect the conversation. But how do you redirect someone who is angry and mean and yelling? Any suggestions on ways to stop this behavior while it's happening. I wouldn't care if he was doing it to me but I worry about what this is doing to my mother. She knows his mind is not working correctly but she doesn't understand. His PCP is trying different medications but nothing has worked yet. (He tested negative for UTI but has very elevated glucose levels that he is being treated for.)

Would appreciate any suggestions and ideas.

H1235

Welcome. Sometimes it’s helpful to figure out what might be upsetting him. People with dementia often have anosognosia. They don’t recognize their symptoms or limitations. Drawing ANY attention to these can cause problems. Lose of independence can be very difficult. Any hint or suggestion that he is not capable or needs help may cause him anxiety. No judgement here at all. It can be tricky to help someone with something they don’t know they don’t know how to do. There are some great videos on YouTube(Teepa Snow and Careblazers are both good). I imagine this is a lot for your mom. You are right to be worried about her. It’s not uncommon for a caregiver to put so much into their loved one they neglect themselves and pass before the person with dementia. Just in case you haven’t looked into it, some facilities can have a waiting list to get in. It might be worth getting him on a list just in case.

SDianeL

I would ask for a referral to a Geriatric Psychiatrist which is the best type of doctor to prescribe medications to calm dementia patients. You are right to be concerned about your Mom.

SuperSadie

https://alzconnected.org/discussion/comment/269336#Comment_269336

Thanks for your comments. I have not figured out what is triggering his anger. I will check out Teepa Snow.I've seen her videos mentioned a few times in this site.

harshedbuzz

@SuperSadie

Your dad needs to be evaluated. There is a possibility that he could have a treatable condition that mimics dementia. In my mom's case, it was an untreated case of Lyme Disease triggering her memory issues.

It sounds like you dad might be exhibiting 2 classic dementia behaviors. The first is sundowning. This is when symptoms and behaviors associated with dementia become more extreme in the evening. Medication can help with this. Dad saw a geriatric psychiatrist who put together a cocktail of lower dose medications to help regulate his agitation while avoiding side effects and sedation. Dialing back the aggression made it possible to address what agitation remained with redirection and validation.

You say you'd prefer to keep dad at home, but the reality is that this kind of behavior can make placement a challenge. Facilities are obligated to create a safe and calm setting for their other residents and staff, so they do sometimes ask residents to leave.

The other phenomenon you may be seeing is showtiming. This is when a PWD is able to get themselves together and present as less impaired than they actually are. This isn't sustainable, so PWD only do this for visits with doctors or family that don't live with them. If you're local and dropping by for an hour or two, you may not be seeing reality. Because I lived a distance from my parents I stayed overnight— I recommend this highly as dad could only maintain showtiming for a relatively short (early on he could maintain the facade the first evening and would be fretful by noon the next day) period of time.

Safety is paramount for both of them. Safety is more important than dad's happiness. You are wise to be concerned. PWD can become violent.

https://medianewssource.com/montgomery-county-man-imprisoned-for-killing-wife-over-cats-vet-bills-denied-lifesaving-medical-treatment-according-to-lawsuit/

The other piece is Plan B. Do you have one? One third of dementia caregivers die before their LO. Do you have a plan to take over should your mom become unable to provide 24/7 care?

HB

SuperSadie

Thanks for your comments. He has had a lot of different tests, including blood tests, and CT Scans. I think he probably is experiencing sundowning a showboating (new term for me). I keep thinking my dad will die first but I should plan for the alternative too.