Alzheimer’s and Dementia: The “Tantrum” Problem

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When a person with Alzheimer’s or dementia has a meltdown, it’s often referred to as a tantrum because they seem to be exhibiting the stubbornness and emotions of child. However, they are the result of being unable to process new information. This is why the authors of The 36-Hour Day call these meltdowns “catastrophic reactions,” akin to what normal people would experience if they were presented with way too many demands at once. While not the fault of the person, but rather the disease, catastrophic reactions can still be difficult for caregivers to experience.

What is a catastrophic reaction and how can caregivers prevent them?

A catastrophic reaction can be caused by one or more of the following problems, according to the Alzheimer’s Association and AgingCare:

  • Physical problems and discomfort. Outbursts can be a result of hidden physical pains in your loved one. For instance, he or she might have a headache, a urinary tract infection, a rash, constipation, fatigue, temperature, dehydration, and more. Because people with Alzheimer’s or dementia have a decline in cognitive function, they might not be able to verbally tell you that they are in discomfort, and instead express it in an emotional outburst. Try your best to make sure your loved one is able to let you know if he or she is experiencing physical pain, and discuss possible medical issues with your loved one’s primary care doctor or neurologist.
  • Environment. Your loved one might feel overwhelmed or overstimulated if he or she is surrounded by a loud, busy environment, prompting them to lash out. If they are in a new place, or one that is physically uncomfortable (such as a room being too cold), they might feel too overwhelmed or unable to clearly communicate discomfort, anxiety, or confusion.
  • Communication and cognitive impairment. It’s easy for your loved one to overreact if your instructions or dialogue overwhelm their abilities to process information. Avoid asking complicated questions or making extensive statements all at once. Remember that your loved one is impacted by a degenerative disease, so you must adjust your expectations and communication methods as their cognitive functions decline.
  • Other psychological disorders. According to Cindy Steele, an RN and Nurse Scholar for Copper Ridge (a residential care community located in Utah), 40 percent of people with Alzheimer’s also develop depression due to a neurochemical imbalance in the brain. Disorders such as depression can cause tantrums.
  • Caregiver approach. How you speak to your loved one is key. Always use calm tones, and avoid rushing them or speaking with a harsh voice to prevent aggressive or stressful moods.

How can caregivers stop a meltdown once it’s begun?

The Alzheimer’s Association suggests the following strategies to stop a loved one’s meltdown once it’s begun:

  • Determine the trigger. Try to think about what might have caused it in order to get to the root of the problem.
  • Focus on the person’s emotions, rather than specific word cues. Look for their feelings behind their dialogue and action, rather than analyzing their verbal or physical statements.
  • Keep yourself calm. While it can be tempting to defend yourself or silence the situation with a matching aggression, be positive and reassuring to your loved one. Speak slowly and softly to calm them.
  • Limit distractions for the future. Scope the surroundings of your loved one during an outburst, and adapt them to avoid possible triggers they might provide.
  • Take a moment for yourself to calm down if the person is in a safe environment.
  • Always ensure safety for yourself and your loved one. If he or she is unable to calm down, get help from others.
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