Changes in mood
Everyone was sat down ready to go on an outing as Mrs. Bolton approached the minibus. Suddenly she started shouting and threw her handbag onto the ground in a rage. The driver tried his best but she would not calm down. Finally after a few minutes he said, “Shall we go and look through those photos then?” She let him lead her back into the day centre and the others followed. The outing was cancelled but everyone seemed to enjoy looking through the photo albums.
You may be surprised by the way the person with dementia sometimes reacts strongly to what may seem like a trivial event or setback. They might scream, shout, become agitated, make unreasonable accusations and stubbornly refuse to move. It can be quite disturbing to witness such a violent reaction, particularly when you have no idea what triggered it. You may even feel a little shaky, particularly if the reaction took you by surprise. However, over-reactions, or catastrophic reactions as they are often called, are part of the disease. They are not caused by you or anyone else. You should therefore try not to feel too disheartened or upset. You might not be able to prevent these reactions from happening altogether, but there are various precautions you can take which may reduce their frequency.
How to prevent over-reactions
Avoid making demands on the person with dementia that they cannot handle
Over-reactions may tend to take you by surprise. Even seemingly simple tasks, such as putting sugar in a cup or passing a book, may prove too difficult and result in an over-reaction. This is also why it is important to try to avoid the person with dementia coming up against situations that they cannot handle. Examples include : too many people talking at once; too many questions; problems understanding; being surrounded by too many people; being faced with a difficult task; and physical difficulties.
Look out for signs of stress and avoid triggering an over-reaction
There is often a few minutes’ warning before an outburst during which the person with dementia becomes agitated. You may be able to distract them successfully during this time or offer reassurance, thereby preventing the reaction.
Try to maintain a simplified, familiar and unstressed environment
Over-reactions, like other problems such as disorientation or frustration, can often be prevented by maintaining a simple, familiar and unstressed environment. If the person with dementia frequently has over-reactions, it could be that they are finding life increasingly difficult or confusing. You may find that by simplifying the environment and offering more help, it becomes less frequent. You could, for example, find a calmer place for the person to sit, cut down on noise and check more often whether they need something.
How to cope with an over-reaction
Handling the situation
When an over-reaction occurs, there is little you can do to stop it, but you can perhaps avoid aggravating the situation. Remain calm and speak gently to the person and they may gradually calm down. You could also try to gently hold their hand or put your arm around them. Of course, this could be extremely difficult if they are shouting and screaming abuse at you - apart from the fact that you may feel hurt, they might simply not hear you. Nevertheless, by trying to keep your cool, you may be able to avoid becoming drawn into an argument or provoked to respond. It might also happen that the person with dementia becomes violent for a short time. In this case, it is best not to restrain them. Leave the room in order to protect yourself and give them time to recover. (Please see chapter on aggressive behaviour for more details on how to cope.) Once they have calmed down, you could then try to reassure them.
Medical advice and outside support
If during the over-reaction you feel unable to cope, you could perhaps call in a neighbour or friend for support. Although you know that the reaction is the result of the disease and is not personal, you may nevertheless lose your temper and respond angrily. If this happens, try not to dwell on it or feel guilty. The person with dementia will probably forget about it soon after. But, if it happens regularly or you often feel that it is going to, it would be a good idea to contact your doctor, a social worker or a local carers group. Your doctor will also be able to check whether there is a physical problem such as pain, infection or discomfort, which might be leading to the reaction and could be treated. He or she may be able to provide treatment or give you advice on how to handle the situation. However, sedative drugs should be avoided - they will only increase confusion and may contribute to further outbursts.
Last Updated: Thursday 06 August 2009