Dementia and anger: Why does my parent have outbursts?

The emotional changes caused by dementia are unpredictable. Your parent may be easygoing one day and uncharacteristically angry the next. It’s difficult to understand why they are acting out or how to provide care in tense moments – especially when it seems the target of that anger is you. So, is anger just a sign of dementia? Did you do something wrong? How can you fix it?

If your parent is in the later stages of dementia, their anger or agitation could be a reaction to pain or confusion coupled with frustration from communication challenges.

“While dementia does cause mood swings, anger isn’t always ‘just the disease.’ The person could have an unmet need that they can’t communicate,” says Catherine Schneider, Director of Resident Well-Being Curriculum at Atria Senior Living.

Angry outbursts, intense combative behavior and emotional moments of confusion can seem almost impossible to manage, but with the right information, you can.

“Disease education is power,” says Schneider.

Watch this video for information about helping a parent with dementia or continue reading below.

How do dementia symptoms affect my parent’s ability to communicate?

Different types of dementia present different communication barriers. Alzheimer’s disease is one form of dementia. It helps to understand your parent’s specific diagnosis and how their dementia symptoms may progress. In addition to amnesia or memory loss, your parent may experience one or more of the following:

• Apraxia, or loss of motor skills
• Agnosia, the inability to recognize faces, objects, voices or places
• Aphasia, trouble speaking or understanding what’s said
• Anomia, the inability to identify names of objects

What you’re experiencing as a random emotional breakdown may be a reaction to the temperature of the room being too cold – and your parent is frustrated that they can’t remember where they placed their blanket (amnesia); can’t unfold the blanket to put over their legs (apraxia); can’t recognize the blanket (agnosia); can’t verbally ask you for a blanket (aphasia); or can’t recall the word “thermostat” to request that it be adjusted (anomia).

If you notice sudden changes in your parent’s ability to talk, understand conversations or properly engage with everyday objects, speak with a geriatrician. A proper diagnosis and further insight on your parent’s unique forms of cognitive impairment will help you set behavior expectations for yourself and provide better care for your parent.

How can I determine the cause of my parent’s anger?

Ask yourself these questions: Is this behavior new? If so, when did it start? How often does it occur? If the behavior isn’t new, how is it different? What happened right before the outburst occurred? Observing your parent’s behavioral patterns will help determine if an unmet need is truly the root of their anger.

Many memory care professionals use a simple assessment called PIECES. Designed to determine unmet needs in critical categories, PIECES. stands for: physical, intellectual, emotional, capabilities, environmental and social.

• Physical – Is your parent hungry, thirsty, in pain, not feeling well or in need of a bath? Have they started or stopped any new medications?
• Intellectual – Are they having trouble speaking, in a state of confusion, or having issues hearing, seeing or identifying objects and people?
• Emotional – Are they experiencing depression or grief over a loss or major life change?
• Capabilities – Is your parent frustrated because they need help handling daily tasks such as eating, bathing or getting dressed?
• Environmental – Are changes in their surroundings triggering? Assess the space. Is it too noisy? Might they find the temperature uncomfortable? Is it dark or cluttered?
• Social – Are they bored or isolated? Are they overwhelmed by too many people around them? Do they feel as if their care provider is moving too fast, ignoring them or showing impatience?

Multiple factors can contribute to your parent’s behavior. Use your observation skills to help narrow down causes. Rule out pain first.

“A lot of people who are angry or scream are in pain. Something's hurting. Pain is the most underdiagnosed symptom in people with dementia,” says Schneider.

Check for infections such as a urinary tract infection (UTI), which can cause discomfort and worsen dementia symptoms.

Focus on feelings, not facts. If your parent believes they are in another time and place, go along with it. When you live in their moment, it may be easier to find the meaning behind their words or actions.

“A woman in our community would often wander off. We learned that she – like my grandmother – always kept her purse by her side. She needed her purse,” says Schneider.

“Once we gave her a purse, the behavior improved. We even put fake money and coins inside. She felt secure and safe at that point. If anything happened, she was ready. Small things like that can address an unmet need.”

Redirect their energy to diffuse agitation. If your parent is suddenly agitated and shouting while around people or during an activity, they may feel overwhelmed. Try moving to a quieter spot and play music for them.

Overall, make it a habit to exercise the highest level of empathy possible during an outburst. You have the cognitive functions to regulate your emotions, control your body and communicate your needs to the world, your parent does not. Practice patience with your parent and yourself. Some unmet needs are obvious, others take time to figure out.

How do I cope during difficult moments?

There is an undeniable pain and grief that comes when you no longer recognize your parent because of dementia. What is the best way to help your parent and – equally as important – how do you help yourself?

If your parent with dementia often reacts combatively, or you’re overwhelmed by their anger, it’s okay to step away. Make sure, above all else, that both you and your parent are in a safe environment to avoid harm. Don’t try to restrain them. If you do need to call 911, make sure to notify emergency responders that your parent has dementia.

Replacing the main caregiver – even if that caregiver is you – may be the appropriate intervention for ongoing anger.

“They recognize that their son or daughter, who they used to take care of, is now taking care of them. It might be time to bring somebody else in to provide care. There's nothing that you're doing wrong,” says Schneider.

Lean on your support system when you can. Beware of caregiver burnout, and consider counseling when your own emotions are too overwhelming to manage alone.

We’re here to help

We understand the complicated dynamics of caring for those with dementia and how they impact the relationship between parent and adult child. It isn’t easy. We can point you in the direction of support groups, counseling and other senior care resources available for families coping with the effects of dementia and Alzheimer’s disease.

If you’d like more information about the ways we can help – from geriatric care managers to short-term stays – we’re here when you need us. Find your local memory care community to get in touch with our staff.