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Verbal Abuse from Elderly Parents is Really Responsive Behavior

By Kimberly FowlerNovember 12, 2015
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Perhaps nothing is as stressful or upsetting than caring for a senior who has verbal or physical outbursts on a regular basis. Such outbursts are referred to as responsive behaviour, indicating that there is a reason behind the behaviour — it is the person with dementia’s way of communicating. If you’re caring for a senior who has verbal or physical outbursts know you are not alone.

More than one-third of people with dementia have exhibited aggressive behavior, especially those whose condition is in the moderate to severe stages. Knowing the cause of the behaviour, how to react in the moment and ways to reduce incidents of physical or verbal outbursts can help you cope.

What Causes these Outbursts? Common Triggers of Responsive Behaviour

Responsive behaviours in seniors with dementia are common and finding the trigger is not always easy. Keep in mind that someone with moderate to severe stages of dementia may be unable to recognize, meet or communicate their needs to their caregivers. Also, someone with dementia may have difficulty understanding what behaviour is socially acceptable.

These are some issues which can lead to such physical or verbal incidents. Often the trigger of the responsive behaviour falls into one of three categories:

Biological Triggers

  • Pain or Illness: The senior may be in pain or unwell
  • Difficulty Hearing or Seeing: Can cause the senior to feel frustrated or misunderstood
  • Hallucinations or Delusions: Can cause seniors to act out because they are confused or feel scared
  • Physical Discomfort: Feeling hungry, thirsty, cold or hot can also lead to outbursts
  • Medication: Inappropriate behaviour like aggression could be a side effect of medication

Talk to your senior’s physician about the responsive behaviour. Your doctor will help rule out some of these biological triggers. If the senior is on medication perhaps it needs to be adjusted or changed. Or maybe a new medication can help. Talk to your doctor about a treatment and care plan for your loved one. Remember to act as their care advocate – ensure that any medication they are on is safe, is not over prescribed and is effective.

Social Triggers

  • Confusing or unfamiliar settings
  • People who remind the senior of someone from their past
  • Someone or something that causes fear
  • Large, unfamiliar crowds
  • Boredom
  • Feelings of loneliness, mistrust, anxiety and paranoia

A number of social triggers can confuse, upset or cause fear for a senior who may react inappropriately. Although not all of these scenarios can be controlled or reduced, when you understand the trigger you can address the responsive behaviour in a more understanding and knowledgeable way. Knowing the trigger may help you to avoid or at least diffuse the situation more effectively.

Psychological Triggers

  • Memory loss
  • Difficulty processing information
  • Loss of touch with reality
  • Paranoia
  • Fear
  • Anxiety

Psychological problems resulting from dementia can lead to misunderstandings, misperceptions and difficulty communicating. These psychological symptoms often cause frustration and physical or emotional outbursts. Again, you may not be able to avoid or reduce these triggers but knowing the cause may help you take command of the situation before it escalates into a serious outburst.

How to Handle a Senior Acting Out?

In the moment, you should:

  1. Take a deep breath and try to remember that this is not abuse or aggression toward you (yes, this is hard but don’t give up).
  2. Adapt to the perspective and needs of your senior.
  3. Remain calm, even if it means stepping out of the room.
  4. Don’t show anger, fear, alarm or anxiety, even if you feel it. Showing these emotions could increase the senior’s agitation and escalate the situation.
  5. Speak using a calm, reassuring voice.
  6. Acknowledge the senior’s feelings and listen to what they are saying. This will help you try to understand and determine the trigger while also showing that you want to help.
  7. Maintain eye contact while you communicate.
  8. Try to understand what is causing the behaviour.
  9. If you can’t resolve or eliminate the trigger, try to distract the senior from the problem.
  10. Give them the space they need in the moment.

Afterwards, you should:

  • Focus on the person, not the behaviour
  • Don’t punish the senior for their behaviour or try to revisit the incident with them (they may not remember it and revisiting it could upset them again)
  • Remember that the senior may still feel upset, so try to be reassuring while carrying on as normal
  • Make sure you have someone you can talk to about the incident
  • Take care of your own emotional needs and seek the help of your doctor, family members, community support groups, counsellor or dementia support worker

How to Reduce the Instances of Responsive Behaviour?

Try one or more of these therapeutic approaches, especially if you and your doctor have ruled out biological causes of the behaviour and you have been unable to identify or resolve the trigger:

  • Regular physical activities: Exercise is a great option for you and your senior because it can help you both relieve stress, combat boredom and encourage good health. Even a short, daily walk can make a huge difference to the emotional state of someone with dementia. Make sure you get your doctor’s approval before implementing a new exercise regime.
  • Social interaction: Spending time one-on-one with individuals can help combat loneliness. If you don’t have family or friends to help there are many local programs through which you can connect with volunteers who can give you a break while spending quality time with your senior.
  • Stay busy: Watering plants, folding laundry or even just reorganizing an area of the home are good ways to keep your senior occupied, feeling useful and may help improve their overall mood.
  • Music therapy: Calming music is a great way to get someone to relax and many music therapy programs have proved to help combat the effects of dementia. Try adding music to your daily routine, especially at times where you are faced with unavoidable triggers (like bath time).
  • Art therapy:Art therapy is calming and may help your senior find new ways to communicate or express their emotions, thoughts and feelings.
  • Pet therapy: Many cats and dogs are trained to be companions to seniors with dementia. Studies show that the simple touch and love of these animals can help decrease responsive behaviour in seniors with dementia.
  • Doll therapy: Doll therapy is a new form of therapy in which a patient with dementia cares for a doll as if it were their child. A study found that doll therapy is an effective approach when trying to increase positive behaviours and decrease negative behaviours in Alzheimer’s patients.

If you are caring for a senior with dementia who has negative outbursts the most important thing is to remember to seek help.

You don’t have to (nor should you) deal with this extremely stressful and distressing situation on your own..

Don’t be afraid to share what you’re going through with your doctor, friends and family and ask for their help. Your local Alzheimer’s Society can also offer support, help and advice. Finally, your provincial government may provide caregiver respite to offer you a break from the stress of caring for your loved one.

Remember, that this is not abuse or aggression, but rather a behaviour stemming from a condition that creates tremendous frustration and emotional turmoil in our loved one. Be sure to take care of yourself so that you can better care for your senior.

Are you caring for a senior parent with emotional outbursts?  How do you handle their behaviour? Share your suggestions with us in the comments below.

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Kimberly Fowler