How do I diffuse Mom's anger when I explain things to her?

A fellow caregiver asked...

My 87 year-old step-mom has advanced dementia stage Alzheimer's. She gets angry if you try to explain something to her. Should I never attempt to explain some things? How can I diffuse the situation, before she blows up? Presently, I am her only caregiver.

Expert Answer

Jytte Lokvig, PhD, coaches families and professional caregivers and designs life-enrichment programs and activities for patients with Alzheimer's disease and related dementia. Her workshops and seminars help caregivers and families create a healthy environment based on dignity and humor. She is the author of Alzheimer's A to Z: A Quick-Reference Guide.

The good news for you is that it's not at all difficult to diffuse and distract a person in the advanced stages of Alzheimer's. Try asking your step-mom for help - or for her opinion, or give her something to hold for you. By reversing your roles in that moment, you have instantly changed her focus by making her feel useful. To your specific question, you're correct that it's best to simply stop the explanations that upset her.

The adults in our lives pounded into our young heads always to tell the truth "“ and the whole truth. It's difficult for us to unlearn this, but that's a necessary element in caring for a demented person. There comes a time when we need to be selective in what we tell a person with Alzheimer's. Some explanations can be outright cruel. When a person has no short-term memory, every time you repeat something, she's hearing it for the very first time. Some truths are very painful to hear and if a person is powerless to change anything, why sharing in the first place?

Here are a couple of the most common issues that arise for a demented person: going home and asking for mother.

Where am I? Why am I here? When do I go home? (She's likely feeling lonely and unstable.) You may have been trying to tell her the truth: that she's living with you and not going home again because she has Alzheimer's. You don't have to ignore her question, instead tell her that she's "staying with you for a while." The difference sounds insignificant, but to a distraught person, there's a big distinction between the permanence of "living" there and the temporary "staying for a while." Her question is prompted by a sense of insecurity, so you may want to add that you really enjoy her company.

The other common topic: "mother." When is my mother picking me up? Where is my mother? Why doesn't my mother come to see me? At that moment her mind has taken her into an altered reality. She's reliving being a child. The worst you can do is to "remind" her that her mother died ages ago. Instead, you can tell her that her mom isn't there right now. If that's not enough to soothe her anxiety, you can add that her mom called to say she's running a little late but will be there as soon as she can. A colleague of mine reminds us that this kind of "loving lie" to a demented person is based in her reality at the moment and thus becomes her truth.

It's futile to explain to her something that may upset her. She either won't believe you or you'll touch a raw nerve. Either way, she's feeling bad, which will be reflected in her attitude and behavior. Studies have shown that people with serious memory problems experience bad feelings much longer and in fuller intensity than the rest of us, so as caregivers we want to maintain as positive a mind-set as best we can.

Being a caregiver of a person in the advanced stage of Alzheimer's can be a roller coaster. The positive side to a person having reached the advanced stage of the disease is that she will respond to your diversions and distractions with no hesitation.

When you learn to go with her flow, you'll find that everything is much smoother. Her realities are not only different from yours but they may fluctuate from one day to the next. All that matters is that you both have a good day, one day at a time.