Have you noticed that as your loved one has aged, you’re seeing things in them you’ve never seen before? Memory loss? Difficulty managing emotions? Do they make decisions that compromise the safety of themselves or others? Do these troubling behaviors sometimes have a clear trigger and at other times no discernible reason?
Difficult aging behavior can take a huge emotional and physical toll on the family member who is providing care. Learning to navigate these changes is critical to developing caregiving endurance.
Let’s walk through a few common scenarios that frequently pop up for family caregivers. It’s important to keep in mind the symptoms will vary from one person to the next, and for any given individual, what works one day may not work the next. So keep these tools in your back pocket.
Frustration After Forgetting
Beginning early in the onset of dementia, a person may become angry or frustrated when they forget something. They may realize this on their own or when it’s brought to their attention. The key is to try to take the focus off these moments of confusion.
In most cases, not correcting your loved one is vital to avoiding frustration. Some people living with dementia experience anosognosia (pronounced ANN-uh-sog-KNOW-zha). This means that they have limited or no insight into their deficits. A person living with dementia may acknowledge their disability on some level but perhaps not the full extent of it.
When their forgetfulness is brought to their attention, they may become defensive, angry or even frightened. Taking the emphasis off their forgetfulness minimizes the chance of a negative reaction.
Coping with a Diminished Filter
As your loved one ages, especially if they have a cognitive impairment, they may experience a loss of filter. They may make strange comments or use inappropriate language, even out in public. They may be unaware of the impropriety or rudeness of their actions, but this can still lead to an uncomfortable or embarrassing situation.
Some caregivers find it helpful to bring along a small card noting that their loved one has an impairment. This subtly alerts others to the situation and, hopefully, promotes patience in the other party. Try gently correcting—not shaming—your afflicted family member, then redirecting their attention to a new activity or topic of conversation.
Resistance to Activities of Daily Living: Bathing, Eating & Medications
As needs change, your loved one may need assistance with personal care. This is an area that can often cause stress, which may result in anger or agitation. The family member may refuse your assistance because they may not see their need for help, or they could be seeking control. Consider how you can present the task without bringing attention to their challenges.
At shower time, you might say that you bought a new product and you’d love for them to try it. When you place a meal in front of them, say you made a big dish and have leftovers.
In the same way, preparing your loved one’s medications is a convenience for you—you were in the kitchen, so you got them ready. If your loved one is apprehensive about the pills themselves (perhaps even suspicious), try to connect them with something positive, such as staying healthy to see the grandkids.
Statements like these provide a cue without being accusatory. They maintain your loved one’s dignity and feelings of independence by drawing attention away from their need for your help.
When it comes to personal hygiene, hands-on help may be scary for some people. Try to make the experience more pleasant. Think about temperature, smells, music. Anything that can make the surroundings more pleasant can make a difficult situation more comfortable or familiar. This can create a dementia friendly environment.
Instructions to your loved one are best kept short and sweet. Anger and agitation that arise during personal care are typically a way of communicating their needs. Being mindful of what they’re trying to express can guide you to the most appropriate response.
Adjusting to Residential Care
Struggles can also arise with change, such as the transition to a senior living residence. Your loved one may not remember where they are or why they are there.
In this situation, your goal should be to validate their concerns while also giving a simple explanation. Try framing it as a temporary situation, or agreeing with them and telling them you’ll work on bringing them home soon. This idea, known as a “therapeutic fiblet,” is used frequently in caring for people with memory issues.
It may feel counterintuitive not to tell the complete truth, but you’re meeting your loved one in their reality. Trying to argue and rationalize will likely cause frustration for both parties. Even if you persuade them they may subsequently forget, and then you’ll have to relive this difficult conversation.
It’s important to keep in mind that you’re not trying to get your loved one to permanently remember something. You’re simply offering comfort and reassurance in the moment.
Preventing Triggers
The family member in your care may exhibit outbursts even without any triggers. When they experience anger, agitation and other challenging symptoms, keep track of them in a journal. Journaling their symptoms can help identify any consistent triggers.
Write down what happened leading up to the outburst and record what strategy was successful in de-escalating the symptoms. While the strategies to deal with the situation can help your senior get through a difficult moment, avoiding the trigger in the first place can keep the situation from developing or escalating.
However, avoidance may not always be possible, so keep this formula in mind: validate their feelings; provide a simple (even temporary) solution; and redirect to a more pleasant activity.
“Don’t Take It Personally” (Easier Said Than Done)
Aging can cause personality changes or behaviors that can be upsetting and emotional to deal with as the caregiver. It’s not easy to provide such a high level of care for someone who may not notice or appreciate the care, or who may be resentful and angry.
At times, it may be necessary to walk away after doing a quick assessment of your loved one’s safety. Whether it’s to recharge emotionally, or for your safety, having a separate space to walk into is important. If you're providing care and meeting resistance, it’s okay to consider whether that particular task really needs to be accomplished at that particular moment. Reapproaching at a later time may be advisable.
It’s not uncommon that your loved one may at times respond better to someone other than you. Are there friends, family members or professional care providers to whom your loved one may be more receptive? Is there someone who can physically step in with a different approach or provide a distraction over the phone?
The most challenging behaviors are often directed at the primary caregiver simply because you’re the one who has the most trusting relationship with the aging family member.
It’s important to keep in mind that your loved one doesn’t have control over their symptoms, and what they say in a painful moment is not personal, nor is it a reflection on the care you provide.
It’s still valid for you to feel upset. Allow yourself to feel the emotions caused by their behavior. Journal them as you would journal your loved one’s symptoms and triggers. Connect with someone you trust to help you deal with these moments.
Most importantly, have patience with yourself. If you respond in the wrong way, chances are you will remember that longer than your loved one will. Giving them some space will help them reset, and you should take that as an opportunity to reset yourself.
Difficult aging behaviors aren’t easy to navigate. They can take a lasting toll on the caregiver and the whole family, and positive moments can be hard to find.
But take every opportunity to remind yourself of all the things you loved—and still love—about this person you’re caring for. Those thoughts can help carry you through the most challenging times.