It’s no easy task to care for an individual suffering from Alzheimer’s or dementia. Still, difficulty can quickly escalate when that person starts using hurtful words to interact with you. It’s human nature to take rude or mean words personally and feel that the individual is consciously attacking you verbally; however, in the case of those living with a form of brain change.
By understanding what’s going on in the person’s brain, you’ll gain a much greater tolerance and learn how to respond to his or her behavior rather than react. It all comes down to realizing that the brain is undergoing significant changes as it declines due to disease. In particular, dementia affects the parts of the brain that produce language, enable you to express yourself, interpret threat perception, and control your impulses. Any of these issues would cause personal interaction to be challenging, but combining all four can create a perfect storm.
As dementia progresses, the ability to produce language decreases. Interestingly, while lifelong vocabulary may begin to be lost, the brain often retains forbidden words (such as profanity, vulgarity, racial slurs, or insults). Imagine, for instance, a person suffering from dementia getting angry or distressed because you misplaced their glasses. She/he may no longer be able to communicate a complex sentence such as, “I wish you didn’t move my glasses because now I can’t find them.” Instead, what might come out is a derogatory term or insult simply because that is the only language available at the time.
Additionally, as the parts of the brain responsible for threat perception are heightened and the ability to control impulses to say and do things at the moment is compromised, the stage is set for any surprises. Even the individual may be caught off guard by what s/he says. Everybody has experienced situations where we have said something we immediately regretted, usually caused by feeling stressed or threatened. When dementia is added to the mix, it’s very understandable why unexpected things come out of peoples’ mouths.
Once it’s more obvious why hurtful words are being used, it becomes easier (though still not easy!) to cope. The first step is to set expectations for yourself. If you care for someone with dementia, it’s almost inevitable that s/he will say something that offends or hurts you at some point. Accepting your natural reactions of feeling hurt, shocked, angry, or resentful is okay. After all, you’ve been doing a lot to support this individual and they didn’t deserve to be treated that way. Also, you may have never heard profanity come out of this person’s mouth before, and suddenly it’s being directed at you! These are all human reactions and are acceptable to feel initially.
The key becomes learning how to respond with wisdom and maturity rather than react in the heat of the moment. Take some deep breaths, and remind yourself that the person with dementia most likely can’t help it. Realizing that shouting back at the person or returning unkind words will not help the situation and will worsen things. Point out the emotion you sense in the individual, such as, “I understand that you’re unhappy and that what I did to try to help didn’t work.”
Start doing detective work to determine the person’s unmet need that is causing him or her to react. Find out if s/he is in pain or experiencing other physical discomfort, such as needing to use the bathroom or being overtired, hungry, thirsty, hot, or cold. The need may also be emotional, such as feeling lonely, sad, angry, scared, or unimportant. By focusing on what you can do to provide support rather than focusing on the hurtful words themselves, you’ll be developing an essential skill of being an effective caregiver.
Most importantly, take care to preserve your relationship with the person for whom you’re caring. Don’t allow unkind words or interactions to sever the bond. By understanding the reasons behind the behavior, you can hopefully get beyond the initial hurt and move forward. If you need to, you can share the experience with someone else or discuss it in a caregiver support group (such as https://www.facebook.com/groups/103001490399094) to get perspective and process your emotions. And remember – if you happen to react inappropriately, don’t beat yourself up. Just learn from the experience and practice greater awareness the next time it happens.