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Handling Catastrophic Reactions

Have you ever had one of those days?  The alarm clock didn’t go off, so you have to run around like crazy to get ready for work.  The coffee pot isn’t working, the dog won’t stop barking, your son misses the school bus, and you get a run in your panty hose as you hurriedly try to put them on.  Then you discover that your car is almost out of gas, and the traffic seems worse than usual.  Finally, you just want to let out a big scream and run back to bed as fast as you can.

Many persons with dementia experience this sort of thing almost every day.  They have reached the stage in the disease where their brains have difficulty processing more than one thing at the same time, not to mention having to remember all the little steps that go into what should be everyday activities, and they have trouble figuring out how to deal with distractions or even minor obstacles that they encounter along the way.  And  some folks with dementia have difficulty controlling their emotions.  So, it’s no wonder that there are times when the person with dementia quite literally throws up her hands and says, “Enough!”  But then, maybe someone is standing right next to her, saying, “Come now, Mrs. Jones.  You know we do this every morning.  We need to hurry up and get you dressed so we can get to the dining room for breakfast.  I had to change Mr. Lewis’ pants this morning, and that got me behind schedule.”

Now, bear in mind that Mrs. Jones has to remember how to get undressed, including how to unbutton her pajamas, often only a few moments after she has been woken up from a sound sleep.  The aide has hurriedly picked out an outfit she doesn’t like, and even after she puts on her blouse she’s cold.  She feel so very embarrassed about having to undress in front of this strange young woman, and she’s doubly embarrassed that she can’t even get herself dressed without help.  And then this rude young woman talks to her like she’s a child.  Can you blame her for getting upset?

Often, we call these behaviors catastrophic reactions.  They may or may not involve shouting or crying out, and the person who exhibits one may or may not become aggressive or combative.  But she will appear to be stubborn, critical, and over-emotional.  Everyone involved will end up frustrated, and usually exhausted.  To the caregiver, it can seem like the person with dementia is getting carried away by something that seems so trivial, and may just throw up her hands in disgust and leaving the task incomplete.  Or the person may end up receiving medication to calm her down.

The key here is to avoid triggering such a catastrophic reaction in the first place.  Often, this task falls on the caregiver to observe what it is that makes the person upset, and change her own behaviors accordingly.  When the person with dementia reacts in this manner, she is trying to communicate the fact that she is feeling overwhelmed, or that she can’t remember what to do next, or in some way needs to have adjustments made in what is expected of her.  The most important thing to remember is that the person is not doing this because she is stubborn, or bad-tempered, or is demonstrating her dislike for the caregiver.

The specific elements that trigger such a reaction will vary from person to person.  What upsets one person, another person will tolerate with no difficulty at all.  This is where it is important for a caregiver to pay attention to how the loved one reacts in response to different situational variables.  Here are some possibilities:

—  having to think about several things all at once (such as the different steps required to get dressed)

—  trying to do something that the person no longer can do by herself

—  if the caregiver is rushed or distracted

—  being embarrassed or upset because she can’t do something that she has always done without a second thought

—  feeling like she is being hurried, when she moves more slowly now and requires more time to think things through

—  not understanding what she has been asked to do

—  not understanding something that she has seen or heard (for example, that photo on the wall that she perceives as someone looking in the window at her)

—  being tired (Do you do your best when you’re tired?)

—  not feeling well

—  not being able to make herself understood

—  feeling frustrated

—  feeling as if she’s being treated like a child

Some other things that can help avoid such catastrophic reactions include following familiar routines, leaving things in familiar places, and using written instructions if the person can still handle them.  Simplify the task involved as much as possible, and try to reduce the number of things the person has to think about at any one time.  Turn off the television, and put on some soft soothing music.  Wait until everyone else in the house has gotten ready for the day and has left for work/school before trying to get her ready for the day.  Break the task down into discrete steps and gently prompt her along the way; allowing her to do what she can and helping her do the rest.  Tell her that you’re going to unbutton her blouse, for example, before you actually do it, and allow her time to process that.

When speaking to the person, give her time to respond to you.  Depending on how far along the dementia is, it may take her up to 15 seconds to process what you say to her.  15 seconds!  If the person seems more easily upset than usual, check for signs of pain or illness.  Has there been any change in her medications lately?  Even something as seemingly minor as a toothache may be distracting enough to cause problems.

If the person does become upset, remain calm yourself, and try to remove her from the situation in an unhurried manner.  Talk to her softly, and perhaps stroke her arm or sit quietly with her for a few moments until she has time to recover.  Try distracting her by talking about something she enjoys, or directing her attention to the television or singing a favorite song.  Often the mood will disappear as quickly as it arose, and you can continue with what you were doing.  Above all, don’t get upset or become angry yourself.  Don’t try to restrain the person or argue with her.

If catastrophic reactions seem to be occurring frequently, and you’re not sure why, try keeping a log of them.  Record when they occur, what was going on at the time, and what the person did before she became upset and during the crisis.  It may be that you can detect a pattern, and take steps accordingly.  For example, it may turn out that every time you try to get her to take a bath in the morning she becomes upset, but if you do it in the evening she does fine.

Remember to take care of yourself.  Being a full-time caregiver is a stressful job, no matter how much you might love the other person.  Allow yourself to take a break occasionally, and find some more healthy outlet for your negative feelings.  Don’t be afraid to ask for help, and don’t try to do it all yourself.  Talk about your feelings with someone you trust, and don’t feel badly if you occasionally become angry or irritated with your loved one.  And, lastly, if you find you just can’t figure out why your loved one is acting the way she is, by all means consult with her doctor or another professional.

(The above was inspired by information found in “The 36-Hour Day:  A Family Guide to Caring for Persons with Alzheimer’s Disease, Related Dementing Illnesses, and Memory Loss in Later Life,” (3rd ed.) by Nancy L. Mace, M.A., & Peter V. Rabins, M.D., M.P.H.)

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