Our lives while growing up in the little blue clapboard house in a suburb outside of Houston were like most. We had the usual squabbles between siblings, resulting in one or the other of us in time out at the kitchen table under the watchful eye of our mother. She was a fair, but firm disciplinarian, and after much soul searching at that table watching Mom prepare a hearty lunch for my sister and me, I usually saw the errors in my ways and reconciled with Louisa – only to repeat the competition between us the next day when my sister was likely to wind up at that same table while the kitchen timer ticked off the minutes of her sentence.
Mom and Dad’s disciplinary plan generally consisted of one of several tactics designed to help us grow into responsible and loving young women.
Time out followed by a discussion was the most common punishment when we were in our pre-adolescent years, but when we were toddlers and in early elementary school, Mom was the queen of redirecting our attention on to something other than what had misled us in the first place. How well I recall her saying, “Okay, okay, look at this,” while handing me a new toy or book with which to occupy myself. High school brought on a new set of rules with grounding being the prevailing consequences for any misdeeds. However, by that time, Louisa and I had pretty much accepted the rules of the house as our own, and groundings were rare.
I wonder if many decades later Mom remembered those years as Louisa and I sought ways to cope with her own unruly behaviors as an Alzheimer’s individual. None of the usual tactics for dealing with violent behavior were appropriate for the once-loving person we had known as our mother, with the exception of redirection. When she would explode with frustration and utter all kinds of oaths and expletives over the non-responsiveness of the television remote, we could generally distract her long enough to draw attention to a plant that needed watering; and after the plant was sufficiently drenched, she had completely forgotten about the television.
By the time Mom reached later stages of the disease she was growling at the home healthcare aides and spitting and scratching them at the slightest provocation. Dressing and bathing seemed to be the trigger points - but then, so did the ringing of the doorbell, putting a pat of butter on her toast, or going to the beauty shop for a weekly hair washing. Louisa and I were heartbroken to hear these reports from the aides, for this was not the mother we had known. We had nothing to offer the aides in the way of advice or tips for handling violent behavior in Alzheimer’s patients.
It is difficult for me to even pen the words “violent behaviors,” much less know how to cope with them. While I just wanted to hug Mom when she was in the throws of one of these violent episodes in the hopes of loving them out of her like some exorcism, I knew that it would do little to ameliorate her mood. I did not have the knowledge or caregiving skills to care for someone who had become violent. My heart wept for her.
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It is estimated that hostility is common in 5% to 10% of the many millions of Americans who suffer from Alzheimer’s. Cursing, hitting, punching, grabbing, scratching, kicking, pushing, throwing things, screaming and making strange noises are among the actions described by family caregivers. Unfortunately, many find themselves in danger from the violent manifestations of their loved one, sometimes leading to a difficult decision to either move their parent into a home or to seek medical intervention.
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“A Bandaid for the Caregiver” is dedicated to all those families who journey with memory loss in their lives and the sharing of hope and joy and new possibilities. In each difficult moment there lies an opportunity for love.
Journey with courage,
Elaine
Nominated for a 2013 Pulitzer Prize, "Conversations with Nora: a Family’s Journey with Alzheimer’s"
follows the journey of two sisters, Allison and Louisa, as they each struggle to understand the grip of Alzheimer's on their family. The novel, inspired by a true story, takes the reader from the sisters' first realization that something is wrong with Mother; through her agonizing denial and efforts to thwart the daughters' attempts to care for her; and then plunges the reader along with the entire family into the dark and confusing maze of dementia. The path to finding a place where Mother will be secure and can feel at home is filled with many obstacles, not the least of which are her own fight for independence and a medical system that seems unwilling to help them. Told through the conversations between the eldest daughter Allison and her friend Nora, the healing power of love and caring takes on a fresh meaning. Nora's supportive, patient, and nonjudgmental presence provides a safe place for Allison to move through a raw and painful reality toward healing.
Available in Paperback and Kindle
“Tomorrow is always fresh, with no mistakes in it.” Lucy Maud Montgomery (1880 – 1968)
With every sunrise we are given a fresh start. We can learn from the trials of yesterday, rejoice in recalling happy moments, and dive into the new day armed with renewed spirits and refreshed bodies.
“The steadfast love of the Lord never ceases; his mercies never come to an end; they are new every morning…” Lamentations 3:22
About Alzheimer's...
Adult children of an Alzheimer’s individual often want to take the blame for the violent outbursts of a parent under their care. Dad may lock them out of the house or threaten to run them over with the car.
Alzheimer’s disease specialists stress that it is not your fault if Dad suddenly slaps your face because the green beans are not hot enough. Children may take it personally, but his lashing out is not a result of anything they may have done or not done.
A University of Kansas study showed that the strongest trigger point is Dad’s inability to recognize something or someone. Forgetting what is inside something or what the object is to be used for understandably creates a sense of frustration and insecurity in Dad. Not able to fully communicate his feelings, the frustration finds an aggressive or violent outlet. Caregivers can expect an increase in agitation and combativeness.
These behaviors could also be a result of physical discomfort, such as a headache, constipation, or nausea from medications. Watch for the outward signs of rubbing his head, holding his belly, groaning or gagging. Interestingly, antipsychotic medications to control aggressive behaviors may have similar side effects. The use of antipsychotics is highly controversial and should be carefully discussed with Dad’s doctor.
(Read more in the article “Alzheimer’s Aggression” at www.aplaceformom.com/senior-care-resources/articles/alzheimers-agression.)
Caregiver Tips...
The first step in dealing with hostile behavior is to determine from where it originates. Is there something in Mom’s past career as a math teacher that causes her to throw a tantrum in the grocery store because she cannot determine which canned good is the better value? Does turning on the microwave for a specified number of minutes cause her to throw the frozen dinner across the room? Discovering the catalyst for outbreaks can give you valuable clues in how to offer help when most needed to keep Mom happy and on even keel.
The time-proven technique of redirecting Mom is an easy way to squelch an angry episode before it moves into a physically hurtful situation, either to Mom or to you. Acknowledge that you know it is difficult to get the plates down from the cupboard and invite her to get out the silverware instead. Praise her for her efforts to match socks and suggest that she fold the towels rather than to continue searching for that illusive brown sock.
Interjecting humor into a situation can diffuse frustrating moments. “Mom, this is a new fashion statement to wear your bra over your blouse! You are going to be famous.” A laugh between you can go a long way towards helping her accept a mistake gracefully and she may then be more likely to let you help her redress without a struggle.
Sometimes the situation has already escalated beyond redirection, humor, or acknowledgement. It may be necessary for you to back down and let the anger play out. Make sure that Mom is safe and cannot harm herself while keeping a watchful eye over her protest.
The task of taking a bath is just not that important in the grand scheme of things, so avoid negotiations and reasoning over the smaller issues of life. Apologize, even when it is not your fault. Using this strategy buys time and good will. Exemplify calmness, and by your modeling of a peaceful attitude, Mom might return to a good mood.
Move out of her way to protect yourself, and call for assistance if the situation moves beyond what is safe for either one of you. Do not hesitate to call 911 for those times when Mom may be violently breaking things, brandishing a weapon, or threatening to do serious bodily harm.
Staying Upbeat...
Your Mom needs continual reassurances that she is loved and safe. Use gentle tones and soft touches to convey these feelings. Meeting her blank gaze with a smile and twinkle in your eye will brighten her day. Compassion, patience and loving kindness will be returned to you in small ways.
Surround her with pleasant faces and happy conversations while validating her feelings of sadness, frustration or loneliness. Whenever possible, ignore Mom’s negative behaviors and respond enthusiastically to the tiny moments of a task well done.
The good news is that most aggressive behavior eventually calms down as Mom progresses further along in the disease process. Although, the angry and violent stage may last for a few years, the time will come when she returns to the kinder demeanor she once had.
Treat Yourself...
Arthur Christopher Benson, an English poet and author, once penned an intriguing thought, “Very often a change of self is needed more than a change of scene.” For those of us with Caregiver’s Guilt, this is an important part of staying sane – we must treat ourselves to a different perspective when we begin thinking that Mom or Dad’s outbursts are our fault and that we are helpless to counteract them.
As vital as taking time away from caregiving is the idea that our parent’s reaction to our caring is not something he or she can control. Lift yourself up above the negativity and embrace the fact that you are a wonderful nurturer and source of comfort to your parent. Treat yourself to a positive attitude about your skills and talents, and above all, realize that your love reaches farther than the hand that may be raised against you.
Gentle Reminder: Alzheimer’s brings out the worst in a loved one and the best in a caregiver.
In the News...
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