Does aggressive behavior help release the tension of a dementia patient?
I have been assisting my husband and father-in-law to take care of my mother in law who suffers from dementia for several years, but appears to get worsened during the past 2-3 months. It appears that we got to a full cycle on the various nuances of her personality: 1) Forgetfulness; 2) Wanderer; 3) Suspiciousness (this was one of the hardest of all and forced me to stay away for a while, since on her hallucinations and paranoia, her husband and I were the worse persons in the world. This phase took a while to get stabilized (hospital visits and antipsychotic drugs), and led to the next phase; 4) aggressive behavior (that continued upon her return home). She speaks to invisible people. Occasionally they begin to "tell her" that her husband is a killer and I am a terrible person and must be killed. Sometimes she accuses me of stealing something, or having affairs with her husband! "Someone poisoned her food!" "Someone stole her money". Every single day"¦ When she starts these stories I know who is going to end up in the "dog house": me. She asks me to leave, since I am an "intruder". I have tried various approaches when I predict this is coming: Either I ignore, or I defend myself (that never works), or I make jokes (she gets furious if I do that). Since I know full well that is the disease speaking and not her, my question is: Should I let her vent and shout at me, bit me, etc.. Would that help her out? Would that release her from her internal "devils" (as she refers to me and sometimes her husband). I really don"˜t mind receiving the impact of her anger should that improve her condition. I am afraid that by not being around so much, she is developing signs of social withdraw and depression. What can I do to help?? I would do anything! Thank you.
Expert Answer
Dear Blueberry:
I'm very sorry you're having to go through all these challenges with your mother-in-law.
You certainly seem to have an excellent understanding of the disease, and the fact that you state you don't take her comments personally and can handle what she does to you, is a testament to your strength, dedication and love.
As you noted, your mother-in-law has gone through a number of phases, and this is yet another phase. You're already doing many of the right things to personally reduce her level of aggression toward you, but as far as her "internal devils," I'm afraid that's beyond your reach.
What I do suggest is that you fully document her various behaviors, note her withdrawal and depression and what might trigger it, and make an appointment to have her fully evaluated by a geriatric neurologist and possibly a geriatric psychiatrist as well. It's important you do this quickly because her behavior has reached a level which could cause harm to her or others.
There are definitely medicines available that can be used to alter her moods and behavior, but there are also side-effects that you must be aware of. Not all the drugs work or work the same way on all patients. If she is physically combative with you and or others, there is the risk of injury to both parties.
Your receiving her anger will do nothing to improve her mood because her problem isn't anger per se. That's an outward manifestation of her illness, and one or both of the medical specialists I suggested are very familiar with this type of behavior as part of the path of some dementia patients.
One last comment relative to your being the caregiver and support to your husband, his father and your mother-in-law. Based on the level of stress that you described, don't deny yourself time off and the opportunities to decompress and get away from the daily grind of "being there" for extended periods of time. Your health and well-being are also under pressure and your first responsibility is to take good care of yourself, you husband, and then the rest of the family.
A suggestion for you, your husband and father-in-law is to call the Alzheimer's Association and ask about local support groups. By attending these group meetings, you may find that you're not alone in this type of situation, and the other group members may be able to give you ideas and suggestions for dealing with similar situations that they have faced.
The sooner you have your mother-in-law assessed and evaluated, the sooner you'll be on a road to providing some of the solutions to this very complex and stressful situation under which every member of your family is living.
Good luck.