Understanding the Behavioral Outbursts of Seniors with Dementia

Agitation, aggression, and unpredictable behavior caused by cognitive issues can make being a family caregiver to a senior loved one challenging and, at times, upsetting. Understanding the root cause of behavioral outbursts, knowing how to avoid them, and how to deal with them will help you cope and be better able to care for your elderly mom or dad.

When seniors, such as a parent, start to display difficult behavior because of the effects of Alzheimer’s and other cognitive diseases, it can be extremely distressing to watch. In fact, the Alzheimer’s Organization states that changes in a senior’s behavior can be the most challenging and distressing effect of the disease.

Illnesses such as dementia, including Alzheimer's Disease, can change the personality of a loved one dramatically. While depression and anxiety are common symptoms of early-stage dementia, according to the National Center for Biotechnology Information’s (NCBI) Library of Medicine, physical and emotional outbursts, verbal abuse, and physical aggression are very common among people with later-stage dementia.

These types of behaviors are known as responsive behaviors, meaning the senior is lashing out in response to a trigger or reacting to something happening to or around them. Essentially, it is a means of communication; much like an upset baby will scream to get his or her parent's attention, a senior can sometimes lash out to let you know something is troubling them.

The senior might not even be aware of their own behavior or recognize it as a reaction to a trigger, but by getting to the bottom of the causes of emotional outbursts, you can help them with their dementia care and help yourself, too.

Common Triggers of Problem Behavior in Seniors

Broadly speaking, there are three main triggers for behavioral outbursts:

• Physical – Your mom or dad is cold, tired, hungry, or uncomfortable. They may be experiencing pain or having difficulty seeing or hearing, causing frustration. Another physical trigger could be a new medication in your loved one's routine, which is causing aggressive behavior.
• Social - A senior might be frightened or intimidated by unfamiliar surroundings or by being in a crowded space. Changes in routine can be distressing for dementia sufferers, so it would be worth noting if their outbursts happen at times of disruption to their normal day. Sometimes a person may remind a senior of somebody they knew long ago, or they might be distressed if they don't recognize a family member.
• Psychological - The mental health issues associated with old age and dementia can lead to outbursts. These could include paranoia, fear and anxiety, depression, increasing difficulty in processing information, and memory loss.

Frustration in Seniors

Elderly people with dementia or Alzheimer’s will often lose the ability to express themselves long before they stop understanding their surroundings, as Aging Services outlines. That means that when they are uncomfortable, afraid, or in pain and are unable to express it, they may act out of frustration.

Avoiding Outbursts by Elderly Loved Ones

It won't be possible to eliminate every situation that could trigger outbursts, but if you become familiar with the stress points for your loved one, there are actions you will be able to take to keep them from feeling threatened or uncomfortable in the future.

• If social stimulus and crowds are overwhelming, be open with friends and family about visits, explain the situation to other family members, and restrict the number of people, or length of time, of any one visit.
• Try to stick to familiar surroundings and routines; many seniors find great comfort in a daily routine.
• Don't be tempted to rush your loved one or be dismissive or condescending in your approach to them. Even if they are non-communicative most of the time, they will quickly pick up on negative moods and could respond badly to them.
• Aim to communicate effectively. Talk through plans, so Mom or Dad knows what's happening. Use visual cues, such as picking up a coat when it's time to go out, or involve them in setting the table before a meal in order to prepare them for the next activity of the day. Predictable actions create a secure environment.
• If you notice a change in behavior soon after your mom or dad begins a new course of medication, talk with their doctor to address it as soon as possible.

Dealing With Emotional Outbursts and Behavioral Problems

Don't panic when confronted with an outburst, either at home or in public. Instead, try these techniques to diffuse the situation.

• Validate your loved one by listening to what they are trying to say. If they are asking for someone who has passed or wants to “go home” despite being at home already, don't try to ground them in reality.  Instead, talk about their present “reality” (these are sometimes referred to as “fiblets”) to appease them until the episode passes.
• Respond to their emotions. A Harvard Medical School article emphasizes the importance of understanding the emotions of dementia sufferers and helping them express these emotions. If it's clear to you that your loved one is in pain or is afraid, name the feeling for them and let them know that you have understood.
• Stay calm, and speak at a low level, using a reassuring voice. Keep eye contact, and try not to show alarm or anxiety (even if that’s what you’re feeling).
• Following the outburst, continue to reassure your mom or dad, and then move on as quickly as you can by distracting them with an alternative activity or subject of conversation.
• Reach out to your doctor, family, or friends to discuss what you have been through. It's important to remember that you are not alone and to share your feelings with those close to you, as elder care for someone prone to outbursts can be emotionally draining for you, too.

Respite Care is Essential for Family Caregivers Caring for a Loved One With Behavioral Problems

If you are caring for an elderly person who has frequent outbursts or has challenging behaviors due to their illness, it's vital that you arrange to take an occasional break so that you can look after your own mental health and avoid compassion fatigue. Try to find a short space of time each day or week and a longer stretch of time every few weeks or months.

It is often a good idea to consider receiving respite care from a Home Care provider. As well as offering a tailored Alzheimer’s and Dementia Program for your loved one, a reputable Home Care company can give you the time away from the caregiver role that you need.

Another benefit of a Home Care Aide is that they can provide compassionate in-home care for your mom or dad at home, so your loved one can keep to their usual routine when you can’t be there.

At Ezra Home Care, our caregivers are compassionate, professional, and experienced in a number of age-related illnesses. To find out how we can provide the assistance you and your loved one need, please call one of our experienced and compassionate staff.