How do I deal with Mom's angry outbursts?

Mudgie asked...

I am new to this site and I need information from those who actually have been through what I am doing now. My mother has had some cognitive decline over the last few years, but has not been diagnosed with dementia related problems. She has memory loss, but the anxiety and the hallucinations she is now experiencing do not seem to fit the characteristics of some with dementia. During her "hallucinations" and her angry outbursts like "temper tandrums" she is extremely articulate. These episodes are like someone has hit a switch and she changes from a very pleasant woman to a raving witch within seconds for apparently no reason. She has no sign of TIAs, but her change of mood is dramatic. She actually will remember that she gave me a "hard time" and she apologizes for it. She knows everyone around her by name and she knows relationships (who belongs to whom, etc.) She will ask reasonable and appropriate questions, but she has these anxiety attacks suddenly and she acts like a small child not getting her way. No tears, just hyperventilating. Reasoning does not work. Medications don't work. How can I handle these outbursts? She wants me to take her "home" all the time and when I cannot do that because she is in fact at HOME, she becomes combative with me. HELP!!! I'm at my wit's end. She will stay at home. No nursing home for her. That's a decision already made, so I need help to keep her home and content as long as she lives. Thanks everyone for listening and helping me in some way.

Expert Answer

Joanne Koenig Coste is a nationally recognized expert on Alzheimer's care and an outspoken advocate for patient and family care. She is the author of Learning to Speak Alzheimer's. Also, she currently is in private practice as an Alzheimer's family therapist. Ms. Koenig Coste also serves as President of Alzheimer Consulting Associates, implementing state-of-the-art Alzheimer care throughout the United States.

Handling angry outbursts in the elderly is a complex situation. The fact that the angry person is your parent certainly complicates the caregiving scenario. I'm sure many suggestions have already seemed counter-intuitive simply because you are the child of the affected person. Most likely, you feel the need to continue recognizing this role while the viable treatment may involve times when role-reversal is necessary. My husband, who had an early onset mixed dementia also showed signs of different disease entities. Angry outbursts that seemed related to a frontal-lobe dementia, great mood & functional changes that sometimes only lasted a few short minutes and were related to vascular disease, and cognitive decline in concert with Alzheimer's. I needed to try many various reactions to the anger and different treatments for the other symptoms. Reasoning never worked -he had lost the ability to respond to it and trying to offer logical explanations complicated his behavior. In the decades since, as a professional working exclusively with this population, I have seen hundreds of people with progressive organic brain disease such as your mom appears to have. I would revisit the medication regime. Perhaps try entering into a dialog with your pharmacist who may be the best professional to know which medications may work best for each of the symptoms. This may take time and is generally a trial and error program. What works for one patient may not work for another, but when you find the right one it will be well worth the wait!
Meanwhile, you may want to address the 'hallucinations' by examining the environment. Check to be sure she isn't interpreting something (shadows, noises, TV etc) as a perceived threat. If she is on any medications ask your pharmacist if one of these may be contributing to her various behaviors - particularly the hallucinations. Again reasoning usually does not work since these things she is reacting to are very real to her. Trying to explain the reality of the situation will most likely exacerbate her distress and escalate the resulting anger. If you do not already belong to a support group, I encourage you to find meetings that will help you adjust to this very difficult and demanding situation. Not only will this be emotional assistance but you may also learn helpful techniques for dealing with each of her behavior issues. Remember that to be the best caregiver possible, you MUST take care of yourself.