Some of the best content on Facebook is when my daughter posts pictures of my granddaughter's visits to the Hallowe'en aisle of WalMart. Picture a cherubic six-year-old who favours pink and anything with sparkles, wearing the most ghoulish masks imaginable. She loves blood dripping and skin hanging. When she's wearing one of those masks, I barely notice the rest of her. The mask is everything.
Of course, we all wear masks. Those firmly-in-place smiles that hide what lies beneath. I was recently yelled at by a woman who was furious with me. I had forgotten to do something, and she was disappointed. The reasons behind my memory lapse were of no consequence to her, so I didn't try to tell her. I took my lumps and tried to apologise. Inside, behind my mask, I had plenty to say, but it stayed inside.
People with dementia often lose the social masks we cling to so tightly. It can lead them to say exactly what they are thinking. There are times when it leads to anger or aggression. The mask which will keep my mouth shut and my hands folded in my lap when I am angry, doesn't work for them. Anger can be sudden, frightening and violent. Aggression even more so. What is a caregiver to do?
As with everything involving dementia, nothing works all the time, or every time. Every intervention is used with trial and error, and often in combination. Seldom is there one "cure."
One possible intervention is medication. Let me say up front what I feel about this.
Medication is sometimes necessary. I've seen it give relief when nothing else worked. If medication is used, it should be a) not the first solution b) given in the lowest dose possible and titrated up slowly if needed c) closely monitored by a physician who has this same philosophy. Most elderly people are on many medications for other conditions, and their frail bodies react more dramatically to drugs. Careful monitoring is key.
We are going to look at some of the causes for anger and aggression, because although it may seem like it came out of nowhere, the truth is, there is often a trigger. If you can identify the trigger, a solution may present itself.
As caregivers, aggression and anger is exhausting to deal with, and takes a huge toll on you. If this is an issue in your situation, you need support, help, ideas and hope. You may even need to look at alternative care for your loved one.
It's a difficult journey. You are not alone.