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Dealing with angry dementia patients can be challenging and a sensitive matter considering their cognitive condition. What makes it even more of a struggle is when episodes of anger, irritability, and uncontrollable frustrations happen; in the middle of the night!
How is sundowning related to anger outbursts in dementia patients?
Sundowning is a phase that leads to confusion among the elderly
As a result, this state of confusion or delirium can cause emotions to go out of balance
Since Sundowning happens during the day and can last until night, it is natural for confusion to lead to irritation.
When elderly patients suffering from irritation go to sleep at night, they are doing so in a frustrated state.
Hence, being in an uneasy state of mind, dementia patients can wake up angry or have an outburst due to the Sundowning effect.
Though dementia patients getting angry from time to time is known amongst caregivers, families must specifically understand why dementia patients get mad at night and how to deal with such a situation effectively.
What is Sundowning?
Some known and straightforward explanations exist for why some dementia patients become agitated or even aggressive at night. Sundowning syndrome is one of them. A simple explanation for sundowning is when a senior enters a state of confusion or delirium in the morning, and often stays that way thought the night. Several factors, including fatigue, hunger, and changes in lighting conditions, can trigger Sundowning.
Signs of sundowning:
- Irritation and nervousness
- Confusion or delirium
- Wandering without cause
- Diminished awareness
- Restlessness
- Arguing or screaming
Anger and dementia: What is the relation?
There is a strong connection between anger and dementia. Discomfort, disorientation, and environmental factors often give rise to scenarios of anger in dementia patients.
How is sundowning related to anger outbursts in dementia patients?
- Sundowning is a phase that leads to confusion among the elderly
- As a result, this state of confusion or delirium can cause emotions to go out of balance
- Since Sundowning happens during the day and can last until night, it is natural for confusion to lead to irritation.
- When elderly patients suffering from irritation go to sleep at night, they are doing so in a frustrated state.
- Hence, being in an uneasy state of mind, dementia patients can wake up angry or have an outburst due to the Sundowning effect.
What triggers anger in dementia patients?
Dementia can make it very difficult for patients to communicate their needs significantly as the condition worsens. As a result, they often become frustrated and act out in response to such pain or confusion. It is essential to know that dealing with an angry dementia patient who has Sundown syndrome can be stressful, especially if you are not a trained caregiver.
Changes in the sleep cycle are often attributed to dementia patients getting angry at night. But let us look at the prime causes of such triggers.
1. Physical suffering
Physical triggers are perhaps the most common causes of anger and aggression in dementia patients with Sundown syndrome. It is stated according to the Alzheimer’s Association that a patient’s ‘loss in cognitive function signals their inability to identify the cause of the physical discomfort and, as a result, expresses through anger or aggression.’
At the same time, discomforting situations like nausea, dizziness, and even exhaustion can also contribute to physical suffering. Physical discomfort is not always related to pain but to physical competencies. As we age, our bodies begin to feel a physical strain. What was easy to do at 30 will become even more difficult at 60.
2. Loss of recognition
One of the main issues with dementia patients is that they may not recognize their loved ones. This can cause, in turn, lead to fear, anxiety, and typically aggression. For example, a husband with dementia may try to attack his wife out of sudden loss of recognition, out of fear and shock at seeing a sudden stranger, especially in the middle of the night.
3. Paranoia and hallucinations
Hallucinations and paranoia have always been common illness traits in seniors with dementia. People with such cognitive illnesses may experience distortions of reality. This may actually cause older adults with dementia to act out based on what they are seeing. Hallucinating at night is even more troublesome, which is why it is likely to happen in dementia patients. Even people with Lewy body dementia are prone to such aggressions and anger at night.
4. Misunderstandings
Dementia affects communication severely and can often come out the wrong way. It is due to the dementia patient’s inability to understand a simple matter due to maybe loss of recognition, for example. A person with dementia may have trouble understanding what their caregiver or family member is saying or doing. Hence the person being cared for may not know that they are being helped, and it could lead to them feeling bossed around, and it may act as a trigger.
5. Poor food intake
Many studies and data suggest that poor eating habits and sudden attributed weight loss may be linked to behavioral problems in people with dementia. This can actually even affect their sleep cycle, thus keeping them up at night, making them frustrated and even angrier.
In people without dementia, poor nutrition can affect mood, energy, and in the long run, their cognitive function. This will eventually lead to sudden outbursts of aggressive actions. That is why angry dementia patients are usually properly taken care of in memory care facilities that deal with and assist with cognitive health problems in seniors.
Dealing with the anger of dementia patients at night
It is not uncommon for dementia patients to experience sudden outbursts of anger, especially at night. This can result from the disease itself or medication with side effects. Regardless of the cause, calming angry dementia patients is the top priority.
There are a few things you can do to help ease the situation. First, try to understand the cause of the anger. If the cause is recognized, you can work on finding a way to remove or alleviate it. For unknown causes, you can still help the patient by providing a calm and supportive environment. Communication is key. Sometimes even dimming down the lights can help. Distractive techniques like their favorite topics or activities like reading a book can be beneficial.
If you are experiencing such sudden outbursts from your elderly dementia patient and are thinking about memory care facilities, then get in touch with BoomersHub and let our advisors help you find the best community for memory care.
6 Ways to prevent anger in dementia patients
Though you cannot always control the outcome, you can try and prevent it from happening at times.
Accept their limitations
Avoid nudging seniors with dementia beyond their limitations by expecting them to undertake activities they’ve been struggling with. Know there are many things they will not be able to like you remembered them doing before dementia. Understand that they aren’t refusing to do things because of laziness or refusing to recognize. It is just the condition they are living with now.
Reduce complicated decisions
Making choices about every part of their day is only sometimes necessary, but there are some decisions your older adult may still want to make. So let them make it, but guide them as efficiently as possible. Keep their right to choose, but simplify to make choices easier, as long as it is manageable.
Ensure they are still participating in an activity or helping out in their own way. For example, the lunch you could offer during meal hours can be a choice between two entrees you know they enjoy.
Keep a calm and quiet environment
Being in a noisy, hurried environment can overwhelm the senses and make it hard to think, especially when someone with dementia and an aggressive Sundown syndrome. For example, if you’re driving to an unfamiliar location, try to turn down the radio so you can concentrate. Similarly, think about how worse it is for patients with dementia. Their everyday tasks can be overwhelming. That is why they require extra concentration but in a calm environment.
Sometimes even the sound of a ringtone or alarm at night can set them off. And most students seek out quiet places like libraries when they need to learn complex new concepts. Hence it is natural for them to feel frustrated and stressed and get angry.
Try to treat them with respect
Everyone, no matter their age or abilities, needs to be respected. Seniors with dementia are no different. Irrespective of cognitive issues, they still understand the world around them. That is why they can sense deep down when they are being mistreated or without respect. For example, say they act out angrily at night, and instead of calming them, you react poorly. Patients with dementia will know, feel and get even more aggressive.
Speak plainly and simply
Alzheimer’s and dementia affect the brain’s ability to process information. Therefore, short, simple, and direct sentences with only one thought per sentence are easier to understand for them. The purpose is to give your older adult with dementia less to think about and less to remember.
If you’re giving instructions, try to take it one step at a time (slowly). If you’re sharing information, keep it to one thought. Fewer words and a warm and positive tone make things easier and less frustrating for them.
Avoid fatigue
Getting overtired isn’t good for anyone’s mood, especially if they are seniors. So imagine the strain it can put as pressure on an already exhausted person with dementia. Just like most normal people are more likely to snap when exhausted, someone with dementia is more likely to have an angry outburst when they are fatigued. Avoid strenuous activities throughout the day so it does not reflect poorly on their mood, especially when it is time for bed.
Final thoughts
The best way to deal with anger and aggression in dementia patients with effectiveness is patience. When you understand the causes and the reasons behind what their illness necessitates and the likely outcome of living with such a person, there is a perfect chance you can deal with their outbursts at an odd hour of the day.
Read our take on supportive care for dementia patients to better understand their situation and effectively treat or prevent scenarios written in this article.
FAQs
Is there a dementia anger stage?
Technically no, there is not. What most people get wrong is that dementia patients do not typically get angry but may have rounds of frustration that lies more with functioning. This is often confused with anger. But they can still get angry.
What is the best way to learn the DAWN Method?
The DAWN method is a type of e kind, strength-based, people-involved approach to dementia care. It helps train families or caregivers to understand dementia and the normalcy dementia patients retain during such mental illness. The best way to learn it is to take a private class with dementia care trainers or attend workshops regarding the matter where training is provided.
How to Manage Your Anger When Caring for Someone with Dementia?
The best way to approach and deal with anger and aggression in dementia patients is through patience. Try not to get upset or worked over, and try to limit any distractions. Relax and focus on the dementia patient and use a calming voice to communicate. Suggestions of a relaxing activity often help.
What to do if you think they might hurt someone?
If you first try to understand that a dementia patient may get angry because they are not of sound mind as they would be without the mental illness. Always be calm and know that they are confused or irritated, hence their reaction. Once you understand that, it is easier to communicate.
How to help someone who is Sundowning?
Try to ensure a calm environment and reduce as much noise as possible, including the crowd or clutter of objects. Distracting the person with their favorite food or activity is also helpful. Also a quiet evening is also good as it evokes a calming environment. Try to also adjust the lighting in your home to a softer hue.
How long does the Sundowning phase last?
A Sundowning episode can typically last for many hours, if not the entirety of the night. When this stage of dementia occurs when SundowningSundowning occurs, patients often experience it even during the day, particularly in the afternoon. It occurs more during the mid-stages.
What are the early signs of Sundowners?
Undoubtedly confusion is one of the main signs that show a person with dementia is experiencing the early stages of Sundowning. Restlessness and agitation are also other signs. However, as the day moves on, and the person becomes even more irritated, particularly after evening and into the night, then it is best to know the possibility of them having sundown syndrome is high.
