Most caregivers discover that’s just how quickly moods can change. In the proverbial blink of an eye, those with Alzheimer’s or other forms of dementia can go from sullen and uncooperative to relaxed and quiet. Just as quickly, conversation and smiles may become shouting and restlessness. Obviously, it’s not too challenging for caregivers to keep up with positive change. But how do we shift gears when a positive mood suddenly becomes negative?
After a morning of easy talk, easy smiles, easy cooperation, Mom scowls, first at me, then at the plate I’ve just set before her. I study the plate but find nothing that might have upset her.
“It’s just lunch, Mom,” I tell her.
No doubt she can’t hear my upbeat, positive voice over her own shouting. “What is that? I don’t want it. I don’t eat here.”
I’ve learned to pay close attention to what Mom says when she’s angry. The angrier she is, the harder I listen. Sometimes her words tell me nothing; often her shouting contains no words. But this time she’s hinted at three possible causes for her anger. I address them one by one.
“This is your lunch, Mom. It’s pimento cheese, one of your fav—“
“No! No, no, no!”
“OK. If you don’t want it right now, I’ll wrap it up and put it away for later.”
No shouting this time. She lifts one bare foot and kicks my shin.
I back away. “If you don’t eat here, where would you like to eat?”
“At home. With Mama. Take me home!”
An impossible request. Now what?
- Stay calm. And try to take your feelings out of the situation.
I take the plate away, sit with her at the table, and do my best to wipe my face clean of emotion. If I’m sympathetic, she often gets the wrong message. In this case, she might read my attempt to comfort her as “OK, I’ll take you home now.” But if I look stern or tell her what to do, her anger escalates. So I try to erase all emotion from my voice, too. “I know you want to go home, Mom, and we will. Soon. But right now we have work to do here.”
More shouting. “No, no, no, no!”
- Try distraction.
I point out the window. “Look Mom! It’s that squirrel you saw yesterday! I hope he doesn’t go to the garden and eat another tomato off the vine.”
Without even turning her head, she says, “Take me home now.”
I try other distractions: folding pillowcases, taking a walk, a cup of tea. Each activity is met with a loud “No!”
- If the situation allows it, wait until the storm passes.
So we sit. Or sometimes we walk; if Mom gets out of her chair, I follow her. This always makes her even more furious, but safety requires it. Eventually the shouting appears to be too much of an effort for her. She sits without a word. Is she ok now? Sometimes, but usually she’s still angry, glaring at me. Trying to keep my face neutral, I watch her and say nothing. I’ve found Mom can get angry in an instant, or sad in an instant, but happy takes longer. I’ll have to be patient. Wait for her to give me the next cue. It could take 5 minutes or it might take an hour or more. But if I watch and listen, I’ll catch her cue.
This time it’s hunger. Mom glances toward the kitchen a couple of times, so I get up, retrieve her sandwich, and set it in front of her again. I smile, but don’t say anything. The quiet calms her, I think, and her brain can rest instead of trying to make sense of what I say. If she wants the sandwich, she’ll eat it. If not, she’ll leave it alone or push it away.
In this instance, I wasn’t able to give Mom what she wanted. All I could do was stay close by and let her anger play itself out in a safe place. I had listened; because her request was impossible to grant, I tried to distract her with other activities; but at the end, I could only wait with her.
- Sometimes you can’t wait for the mood to pass.
As difficult as it is when we can’t do what our loved ones want, it’s far more difficult when the option to wait is also taken away. For example, when Mom stops in the middle of the street, saying she’s tired, she wants to sit down right here, I don’t have the option of waiting until she decides to take another three or four steps to the curb. I must get her moving right away, and that means I have to take physical control. Keeping up a steady stream of calm conversation about anything at all, I stand with my shoulder behind her shoulder blade, put one arm around her waist, and hold her elbow with my other hand. I’m bigger than she is, so when I start walking, slowly, my body pushes her’s along. The element of surprise is also in my favor.
Of course we would never knowingly ask our loved ones to do something they’re too weak to do, but if we’re in a spot where they could be injured and they suddenly decide not to cooperate any more, we must have a plan to get them to safety, whether they help us do so or not.
It’s another sad truth caregivers must accept: we can’t keep those we’re caring for from experiencing feelings of anger, fear, sadness, suspicion. But having accepted that, we must also understand that there are ways to help them deal with those feelings. Focusing on what we can do keeps our own feelings more positive, our minds more creative, and our spirits attuned to gratitude instead of dread and fear.
Even to your old age and gray hairs I am He, I am He who will sustain you. I have made you and I will carry you; I will sustain you and I will rescue you (Isaiah 46:4 NIV).
Give us patience and strength, Father, as we care for our loved ones. We watch with faith and hope as You fulfill Your promise to carry and sustain them. Please give us wisdom as we work with You to rescue them from the pain of dementia.