How to Calm Angry Outbursts of People Living with Dementia

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By Valerie FeurichMarch 11th, 2021

How to Calm Angry Outbursts of People Living with Dementia

Strategies to bring back calm and comfort for you both
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One of the most uncomfortable situations for caregivers (or care partners, as we call them here at Positive Approach to Care®) are sudden, angry outbursts by people living with dementia.

Often taken by surprise, care partners are left trying to figure out how to calm and resolve the situation. Without the proper skills and knowledge, this can be a daunting task.

Below are a few tips and techniques that you can try next time to help bring back comfort for you both:
Get into Supportive Stance
Being aware of your body language can make a big difference in dementia care in general. When it comes to conflict, you’ll want to make sure to not stand directly facing the other person, which can come across as confrontational.

Instead, turn your body sideways to the person to get into a non-threatening, supportive stance. By turning your body sideways, you’re giving the other person some visual space, which makes the situation feel less threatening.

Take a look at the images below, and see which one would feel more comforting to you. The one with Teepa looking straight at you, or the one in supportive stance with her body angled to the side?

Confrontational Stance

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Supportive Stance
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Confrontational Stance
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Supportive Stance
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Acknowledge Their Anger

When somebody lashes out verbally or even physically, throwing something or telling you to shut up, what we tend to see is people that are loud and intense. Your person living with Alzheimers or another form of dementia may be swearing, or yelling the same phrases repeatedly.

Depending on the severity of the anger, one of the most important things you can do in this situation is to acknowledge their anger by using a phrase like Sounds like you’re furious! By doing so, you’re sharing your observation and letting the other person know that you have heard them.

Tip: Did you notice the first three words used in that phrase above? To make responses feel less confrontational, Teepa Snow uses labels as It sounds like…, it seems like…, or it looks like… at the beginning of an observation. Doing this will make your comments feel less like an attack and more like curiosity.

Reflect Their Words and Emotions
With your body positioned in a supportive stance, try mirroring your person’s words, expressions, and energy, but with a little less intensity. While you don’t want to get loud with them, do try to get angry along with them so that they can see you got the message and that you are on their side.

So, if your person were to say Ugh, I hate this freaking place!, you may try to respond with You hate it here! in a matching energy yet slightly calmer voice.

By reflecting back your person’s message in a slightly less angry tone of voice, you’re signaling that they’ve been heard and that you are there for them, while also gently bringing down the intensity.
Example:
  • Valerie: “This isn’t fair, none of this is fair.”
  • Teepa: (in a similar but slightly calmer tone) “You’re furious!”
  • Valerie: “Yeah! None of this is fair. I didn’t do anything.”
  • Teepa: (in a similar but even calmer tone) “So, it doesn’t feel fair. None of this feels fair.”
Continue reflecting your person’s words, expressions, and emotions with a softer voice until you can feel them calming down.
See If You Can Identify the Trigger
Once you notice your person taking in a deep breath, making more eye contact with you, and calming down a bit, try bringing in a little curiosity to see if you can find out what’s underneath the anger. Why? Because with dementia, we can’t just assume that emotions are always just emotions.

While an angry outburst can be caused by emotional or spiritual pain, it can also be triggered by a physical, unmet need that the person is no longer able to communicate. It could be something like their bra strap is turned over and causing a discomfort, or they need to have a bowel movement but don’t remember where the bathroom is. 

With a healthy brain, we can either meet those needs ourselves or ask for help. But if a person's brain has been affected by dementia, as explained above, they may not be aware of what is causing the discomfort, let alone be able to describe it.

Take a look at the list below and see if you can find if any of these may have been the culprit:

Emotional Expressions of Need:

Anger

Sadness

Loneliness

Fear

Boredom

Physical Unmet Needs:

Hunger or thirst

Energy level

Elimination (using the restroom)

Discomfort

Pain

Sometimes, anger can also be caused by sensory or social discomfort. Are they missing something that they like to see, or are they seeing something that they don’t like? Are they hearing something that they don’t like, or could their clothes be scratchy? Could it be that somehow, something isn’t feeling okay on them? You may try to move to a different space, or change the social situation (who or what is around them) to see if things improve.

As dementia sets in and abilities decline, remember that a person’s ability to express themselves becomes less and less. To reduce the chance of frustration and anger due to miscommunication, try incorporating visual cues whenever you can.

So instead of taking the empty plate off of your person’s table assuming they’re done, try pairing a visual with your verbal by saying something like Hey John, are you finished? May I?, and reaching out your hand suggesting you’re ready to take their plate.

Slow down, give your person time to process, and remember that they are doing the best they can with the abilities they have in their current state of brain change.

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20 Comments on “How to Calm Angry Outbursts of People Living with Dementia”

  1. I learn something every time I listen to Teppa. I’m also reminded of things I knew and had forgotten to use because the issue hadn’t come up.
    So very helpful! Thank you.

  2. Great information. Very practical and today very timely. Thank you for what / how you teach.

    L M Doupe MD

  3. Yee Gads!!! I could have used this on tuesday when I took roger to a denture visit….. Poor guy, it takes about 4 visits to get the lower dentures manufactured and he becomes anxious soon after settling into the dentists lounger.
    This last visit, he threw a tantrum and just walked out. Four staff members and me were gathered around all trying to convince him they were almost finished.

    I now have a new strategy for the next visit, Adivan AND a new beloved friend to accompany him . I hope it works. I don’t even care if he wears them once we get home, but I have already paid the 1500$ and would like him to have more time enjoying real food!

  4. How can you adapt some of these techniques to dealing with a loved one who is physically separated from you? Are there some good strategies to de-escalate anger or frustration when you are only able to be on the phone with someone?

  5. Whew!!!Having been a nurse, this is so personal with my hubby and his vascular dementia has broaded sided me, but, as my Mom, also a nurse said years ago, play the cards you are dealt, so I’m reading, reading, thinking, thinking as to how to care for my almost 60 year marriage to by bestest main squeeze. Having gone through the challenges of an autistic child, and his Dad is his biggest hero, there are many facits to our lives. Out daughter, our “bulldog’ child is a get it done, (she didn’t fall from my tree!) is totally engaged with all of our family dynamics as well as her husband’s parents’ issues.. I recently participated in your webinar at the Brookberry facility and it was most informative. I’m also reading the 36 Hour Day to glean more insight with our situation. I wish I could look back and access how this probably has built over the years as we have been self employed with many endeavors over the years, me with my skills and him with his gifts and skills. Just a thank you for your ongoing guidance and I look forward to following your expertise!

  6. Awesome!! So needed this today!!
    My mom is this person!! She has all 5
    Emotional needs every day!
    Thank you

  7. I tutor two 4 year olds. Their 2 year old little brother was angry
    because they got a snack for “school,” and he wanted one too. He was screaming. So I used your approach. “You are mad! You want a snack, don’t you?!” He calmed right down when I acknowledged his anger, and we were able to come up with a solution together – so it works with 2 year olds too, lol.

  8. These are all good ideas– smart ideas. They work. Most of the time. Sometimes they don’t work. Especially with male dementia partners being cared for by a female, or parents being cared for by a female child, sometimes it helps to make it clear that the caretaker is in charge and will do what is right whether the partner with dementia is angry or not or agrees or not. Violence will not be tolerated. Threats or temper tantrums will not force the caretaker partner to do what is wrong just because it will end a conflict. I hate having to out- yell or out- bluster my husband when he is angry beyond emotional reach, but sometimes I have had to do that for his benefit as well as mine. It is a last resort. I don’t like doing it. But if it helps my husband and helps me, I will act with courage and speak the language of “Testosterone” instead of the language of “Estrogen”.

  9. Thank You. I’ve never looked at it like this. I will definitely pass this information on to my team

  10. You don’t address the terrors that a spouse can reduce to as they have totally been agitated to the point that they first want to go home and then jump into the rabbit hole with the devil taking control and yelling that you are trying to kill them and demanding you call 911 and get the police involved. I have had one son and one daughter talking with her at same time, housephone on one ear, cell phone on other and son has had to get out of bed, make 45 minute drive and walk into room still talking with her. This has happened a half dozen times and i am now familiar with the onset and give her about 5mg of Seroquel which keeps her from jumping into that damn rabbit hole with the devil!
    When she is in that rabbit hole it is not her speaking and she remembers NONE of it!
    What you are talking about in this article is strangers in nursing home dealing with slight agitation!

  11. Empathy is always the way I work. I try not to blame them. I work as a full time carer in a home with dementia residents. YesTeepa that is great advice too.

  12. Thank you, Teepa. I’ll try to be more aware of stance etc in the future. My husband has LBD. The rare times he gets mad at me don’t usually ‘make sense’ to me, but I always apologize right away now if he does get angry, which helps a lot. Thanks for all your tips and insights. Do you have any tips and insights on how to deal with care partner sadness? Taking ‘time out’ doesn’t seem to help me, I am usually in a more upbeat mood when I am taking care of my husband than after he goes to bed and I have more time to myself. That’s when I feel the worst. This is becoming a real problem not just because I feel bad, but also because I can’t seem to get anything done, even important things that HAVE to be taken care of!

  13. Very similar to what is recommended for dealing with a person with an emotion dysregulation disorder, interesting.

    Matching a person’s tone can be tough – easy enough for tone or body language to read differently to the person unless you can get it right – takes acting skills… tips on this?

    Like another person, I am interested in your thoughts on being a female caregiver to a male person. The risk of tragic outcomes is tremendous.

    Finally, any thoughts on self care after dealing with absorbing anger?

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