Call it a catastrophic reaction, a meltdown, or simply having a fit, when someone with dementia has a tantrum, both the cause and the effect are often very similar to a two-year-old's tantrum.
Ask a two year old to pick up his blocks and without warning you can be in the middle of a full-blown tantrum hurricane. Wow! What happened? Ask someone with Alzheimer's or a similar dementia to change clothes or take a bath, and you can find yourself in the eye of the same storm. Whoops! What happened?
In the case of the two-year old, the tantrum is his way of expressing his frustration about something. He may be hungry, overtired, over stimulated from the day, or simply overwhelmed by the number of toys on the floor. He doesn't have the words or the insight to express his frustration, anger or discomfort, so he howls.
In the case of someone with dementia, the frustrations are similar. Hunger, thirst and simple tiredness may overwhelm someone who can't identify or verbalize the reason for his discomfort. Something as small as a piece of uncomfortable clothing or an itchy mosquito bite may heighten anxiety. A formerly routine task that's suddenly too complicated creates frustration, anger and embarrassment. The early stages of a developing illness are notorious for causing tantrum behavior. Just like a toddler, any one of a thousand possible triggers can cause a dementia victim to have a meltdown.
Managing a two-year-old in the middle of a full-blown tantrum is easier than managing a full-grown 80 year old man who's lost it. And while we can look forward to eventually being able to reason with our toddler, we don't have the same happy prospect to look forward to when we're caring for an elderly person with dementia.
No one should try to kid you that the following suggestions will put a stop to dementia tantrums, just as no one can assure you that your youngster will never have another meltdown. Life isn't that easy for parents of toddlers, and it certainly isn't for dementia caregivers. However, some of the following may prove useful as you move from stage to stage through the maze of dementia care:
Simplify, Simplify, Simplify
Overwhelm seems to spark more dementia tantrums than any other single cause. As mental confusion increases, the ability to cope with too much stimulation and too many choices diminishes. Reducing both the amount of stimulation and the number of choices offered often helps greatly to reduce the sense of overwhelm.
Clear out closets, drawers, and the environment. Put away the knickknacks. Put pictures on the wall instead of on the table, and cut down on the number of pictures. Get all out of season clothing out of the dementia patient's closets and drawers. If choosing what to wear is becoming difficult, remove all but two or three outfits. Do the same with shoes and accessories.
Try breaking your requests and instructions into simple steps. Just as you would never instruct a two-year old to "get dressed," you will have faster and more peaceful progress if you give your elder cues one simple step at a time. If necessary, lay out clothing in the order it needs to be put on (underwear first, then socks, then trousers, then shirt, etc.).
Keep choices to two. "Do you want the red sweater or the green sweater?" works much better than, "Which sweater to you want?" The next time you try this, notice if your elder seems to choose the second item more often. "Last heard, best remembered." This is a handy piece of trivia if you'd like to subtly provide some guidance, or you'd really secretly prefer to make a peanut butter sandwich rather than mess with making a hot meal.
Stick to a Routine
The further into the middle stages of dementia a person moves, the more routine becomes a critical stabilizing factor. As much as possible, try to do the same things at the same time every day. Even if your elder can't articulate the schedule, she will still have something resembling an internal clock that she depends on for "normalcy." If her day has no predictable routine she will be constantly off balance and she'll react accordingly.
Build rest periods into the routine. A brief break in the middle of the morning and after lunch will give everyone, including you, the chance to recoup and re-energize. Put on an old movie, or play some slow and soothing music. If your elder won't rest in his favorite chair, try a simple sorting activity or something else not too mentally or physically taxing.
Take it Slow
People with dementia need more time to process what you're saying and what they should do about it. Give them time to answer or respond, and plan for everything to take twice as long as it "should" (just as with a two-year old). Be ready for two or three slow trips back for the forgotten sweater, the wallet or purse, and the handkerchief before you finally get out the door.
If you need to be somewhere at a particular time and you're starting early, pack a drink and a snack. If you actually manage to get there early because you gave yourself extra time, have a snack in the car as a way of passing the time.
Unless it's life threatening, and if you can figure out what set it off, back off from whatever seems to have prompted the melt-down. Short of wanting to leave the house to "go home," or playing with the power tools, there is little that can't be overlooked or postponed, at least for a little while.
If you can safely leave the room, do so. It will give you both some much-needed space and keep you from being tempted to raise your voice. Tempting as it is to shriek right back, it will only make things worse.
Go to "Time Out"
You already know, "It's not the person, it's the disease." That's all well and good, but it's still your mother/father/spouse calling you names and accusing you of awful things. It's hurtful, and over time it can make you resentful, no matter how much you love the person you're caring for. Even if it's only for an hour, see if you can find someone to give you a break on a regular basis so YOU can have a "time out." It will help. If you can come back just a little refreshed, you'll be better able to manage the next crisis. You know there will be one, and it's not your fault. Just as with the two-year-old, no matter how hard we try, there are some things we simply can't completely control. Dementia tantrums are high on the list.