On the list of the hardest issues for caregivers to cope with, hostility due to Alzheimer’s is one we hope we never have to face. But we can face it. We just need to be prepared.
Loss of the ability to exercise good judgment and control impulses leads some Alzheimer’s patients to become verbally and even physically hostile. If that is the case with your loved one, you must be prepared to keep both of you safe—yourself and the one you care for.First, we must understand once again: not every patient experiences every symptom of the disease. Perhaps your loved one is argumentative at times—or unfriendly or irritable or demanding—but not hostile. Perhaps he or she displays none of those traits, but instead is cooperative and easy-going most of the time. If so, we rejoice with you! If, however, you as a caregiver have experienced hostility from your loved one, you already know the importance of being prepared to handle it appropriately.
The mention of “hostility” in an Alzheimer’s patient can suggest many things. Some people with AD become angry—or, if they’ve always had a difficult personality, angrier. Some use language they never used before, or fuss about the news on TV. But the word “hostility” implies an attack, and it’s that aspect of Alzheimer’s patients’ behavior we’re talking about here. Attacks may be verbal or physical, but all are directed toward a person, not a situation.
My parents were devoted to one another. They argued occasionally, but seldom for long. They always appeared to maintain their respect for each other, even when they disagreed. But after Mom got Alzheimer’s, she was quick to express her anger at my father, without the niceties. She called him “the big man” in a derisive tone, informing us she wasn’t afraid of “the big man,” because “the big man” was stupid. (“Stupid” was a word never heard previously in our home; my mother didn’t allow it.) When Dad told Mom he loved her, he eventually stopped inviting her to reply in kind. His “Don’t you love me, honey?” was usually answered with “I do not.” Or worse, an ugly smile, a stare, and stony silence.
Such verbal assaults can wear on caregivers, on their hearts and spirits and even their bodies. My father reacted to them with a despair he didn’t need to voice; it was visible as his face paled and his body slumped so low in his chair, finally all I could see were his hands clasped around his head. He ate little on those days, and sometimes drank too much. He spent hours sitting with his head in his hands, “too tired,” he said, for the exercise and activity he used to crave.
I knew I had little chance of changing Mom’s mind or attitude. It wasn’t her heart speaking, after all, it was her disease. I couldn’t make her say or do anything to lift Dad’s spirits, heal his heart, or give him back his appetite for life. So I had to do it. At least I HAD TO TRY. Whether it is ourselves or another loved one who is injured by verbal abuse caused by Alzheimer’s, we must fight the consequences as best we can.
With my father, the thing I didn’t do was talk. Not at first. I let some time pass. I didn’t deny his pain or even interrupt it; I knew he needed to feel it and I needed to acknowledge it.
After a few minutes, I used touch. A hand on his shoulder, a pat on his arm, maybe a hug with my front to his back could usually distract him from Mom’s ugly words and bring his attention back to me. I fancy I represented “normal” to him. Or at least the chance for normal. Hope.
Finally I spoke what he already knew. “She doesn’t realize what she’s saying. She’ll be telling you she loves you by bedtime, Daddy. Let’s have some dinner; then maybe you’ll feel like taking a walk. Remember–walking always seems to help.” I made sure he recalled we’d been through these times before and survived, to laugh again and see Mom laugh with us.Physical hostility is a different situation. We’ve said that arguing with an Alzheimer’s patient is worse than useless, and yet there will be occasions when you’ll have no way to accommodate your loved one’s desires—or no way to accommodate them safely. At those times, you’ll need to be prepared to take the action necessary to keep yourself safe as well as the one you care for. Even if you are strong, someone with Alzheimer’s can cause significant injury with an unexpected kick or shove.
My father and I had to exert physical pressure with Mom only two or three times during her illness. We were surprised to discover two things that appear to bolster the strength of those with Alzheimer’s: anger and frailty. Mom’s anger made her utterly unafraid and absolutely fierce in mind and spirit. At the same time, her frailty made our struggle more difficult because we were so afraid of hurting her.
If you feel you would be unable to physically restrain your loved one if it became necessary, be prepared with a plan. Note that Dad and I had a distinct advantage over many caregivers: there were two of us. You’ll want to have a neighbor or friend or family member you can call for immediate help. Or, if all else fails,be prepared to call the police for assistance. Perhaps such a situation will never arise, but you’ll be able to care for your loved one with more confidence and calm if you have faced the possibility in advance and are prepared either to take action yourself or to get help.
You can keep yourself and your loved one safe; your local Alzheimer’s Association, your doctor, and your local senior center can help you get the assistance you need to resolve this problem.
Do not rebuke an older man harshly, but exhort him as if he were your father. Treat…older women as mothers… (1 Timothy4:1,2 NIV).
Lord, we ask You to keep special watch over us and our loved ones when pain threatens to overwhelm us. Please help us to be prepared. We trust You will guide and protect us if the time ever comes when we must restrain a loved one. We praise and thank You for being the great Comforter and our great Help in every situation.