How do you cope with the angry side of dementia?

[Frazzledinmyforties]

My (relatively young) mum was diagnosed with Alzheimer’s around a year ago. We lost my dad 4 years ago and she’s not been the same since.
In the last 6 months or so she’s become increasingly angry. Shes really vicious and nasty with her words and she spits at me and throws things at me.
I am her only carer, though I don’t live with her and the nastiness is always directed at me. We’ve had police and social services involved but no one will do anything because “she still has autonomy over her care and can’t be forced to have any”.
I genuinely don’t know how to cope with it. I’m pretty thick skinned and work in Learning Disability which has massive cross overs with Dementia.
I know all of the factual side; I don’t know how to cope when she’s hysterical at the sight of me and I’m the only one who can help her.

Any advice will be gratefully received.

Have you had any support from the Alzheimer's Society OP? I'm guessing they might have some advice and ideas: https://www.alzheimers.org.uk/

Yes I’ve been in touch with them. They offer carer talk therapies and support groups which are lovely but I don’t have the time for. They also gave me a list of available emergency services. We’ve had a few occasions where paramedics have come out and then she eventually calms down after they’ve listened to her. But it’s the same thing on repeat and because there isn’t anything physically wrong they can’t do very much.

So they consider your mum has capacity and she can make her own choices? There will come a point when it becomes obvious that she doesn't, but that doesn't help you at the moment. Do you have LPA for when that moment comes, so you can make decisions on her behalf?

In the meantime, ensure you keep yourself safe, and step back as far as you are able to. I don't know what care you have to undertake at the moment, can she make herself a cup of tea, wash, dress etc?

Sometimes medication can help, but she would need to see at least a GP and probably the memory clinic, and agree to take the meds. It doesn't sound like she'd be amenable to that?

Info in case it helps, about drug and non-drug approaches.

https://www.alzheimers.org.uk/about-dementia/treatments/dementia-medication/antipsychotic-drugs

Try and do less for her if you can, look after your own physical and mental health. Things will escalate and social services will be involved more. The more you help the more this delays the inevitable.
You can say no to things and tell her you don’t like how she is talking to you and then leave.
I am so sorry you are going through this, I worked in care my whole life and thought I was prepared until it was my own DM.

I found the Older Person’s Mental Heath crisis team very good when I was at my wits end.

Dementia UK have been incredibly supportive of my mum and I since my father was diagnosed (Alzheimer's and Vascular Dementia). He hasn't become aggressive ... yet (well, some nasty word and threats of self harm if he doesn't get his way, but TBH that's nothing new), but I am sure they have a lot of experience of these types of situations.

@catofglory ironically no, all medical professionals, bar one social worker have deemed that she has lost capacity. I’ve had LPA (both) since my dad died and it has kicked in. BUT because she still has moments of perceived lucidity, at that moment she can make all decisions and legally I have to follow. For example, even though she has lost all concept of money, I still legally have to give her what she asks for even though logically it makes no sense.
She’s under the care of our local hospital Memory Service who have been great up to diagnosis and prescribing the medication but not much since.

@ForBusyOliveBear that’s what I’ve been trying to do the last few weeks actually, thank you for your kind words.
@inigomontoyahwillcox thank you, I’ll try them too.

It took four capacity tests before my mum failed one even though she clearly didn’t have capacity or was able to look after herself. During the fourth one she started showing the doctor that she could a handstand up the wall as a way of proving how well and healthy she was!

Genuine question OP: if she has “lost capacity” and has “lost all concept of money”, I am not sure why you have to carry out her financial wishes - at least if you do not deem them reasonable? Isn’t that one of the points of having financial power-of-attorney? I wouldn’t have thought “moments of lucidity” count if the general picture is loss of capacity and dementia. But perhaps I am missing something?

When I asked my mother‘s bank, about what would happen if my mother lost financial capacity because of dementia or cognitive decline, I was told that I should immediately invoke my power of attorney.

@PippingPanther you are absolutely right, on paper.
But according to the police and social workers the LPA is only valid in her “insane” moments. So if she seems calm and tells me she wants £100 a day, I must give it to her because “she has the right to make unwise choices”. I’ve explained countless times that it only applies as long as someone has capacity but they claim that in that particular moment she does have capacity. It’s so messy.

I have to say that the bank has been one of the easiest companies to deal with and actually really helpful.

My lovely, gentle, kind dad became very aggressive with his Alzheimer’s advanced. His GP prescribed antidepressants and they calmed him a lot.

My grandad is on a medication called Memantine for his Alzheimer’s. It was prescribed by a psychiatrist for his moods/anger. It hasn’t totally got rid of the aggressive behaviour but I think things are better than they were without it.

I don’t know whether you’ve heard of it or if it’s been discussed as an option for your mum.

She’s on Memantine and Sertraline.
@TerfOnATrain my mum used to be loving and gentle too. The sweetest, kindest person. Sadly I haven’t seen that side for a while.

It doesn’t help you now but she may mellow a bit later on as the disease progress’ .

@ForBusyOliveBear I hope so 🙏

Another vote for medication… so sorry OP. But yeah if you explain about the violence there are definitely things they can prescribe. Getting her to take them though might be tricky. So sorry OP

I have the same OP. Even the LD background. DM is even on the same drugs which make no discernable difference. She trashed the house, throws boiling water, bites, throws crockery and even tries to secret knives on her person. She has attacked my DDad so many times. At 88 I don't think he would have imagined he would be covered in bite marks.She has capacity too! Obviously capacity is situation specific and she still does have capacity to make lunch or clothing choices, but she doesn't agree to accept care or a care home so she won't be made to go. Dad called an ambulance when she was completely psychotic one night and it took four police officers and two paramedics to get her out of the house.
We are not coping. All of us are ill with stress. We have every service listed above involved, but she won't engage at all and they seem to have all washed their hands of her. Oh and she is physically really well. She climbs over six foot fences to escape into the neighbours gardens. Sorry. She has multi infarct dementia. I just hope she has a big stroke soon which puts her beyond all this.

Gosh I resonate with every part of this. So sorry you’re going through it too. It sounds so awful when you read it, yet we live it every day. I get what you mean about the stress making you ill. It’s all consuming and takes it’s toll on the whole family.

I'm sorry for you too, and sorry to offer no solutions!

had this with my mum. She lived with me and would pick horrendous fights for the fun of it. She ended up in hospital with a bump and they did a ct scan and confirmed brain shrinkage. Was a few years later she actually got diagnosed. Anyway during her time in the hospital they were trying to arrange for carers to come out 4 times a day while she lived with me. She was really affecting my mental health and i worked full time so couldn’t keep an eye on her all the time. She would want to leave the house etc and had no idea where she was. Would try it at night etc. They kept pushing for her to come home with me. I literally had to say to them i disagree about you thinking she has capacity and as a result i have to walk away as i cannot take on this caring role full time. Was only 34/35 at the time and worked long hours. They then changed their tune but they will try as much as they can to push it on family members even when they cannot cope and harm could have came to her. As others have said, step back. They will have to do capacity tests but a few will be done over a period of time. X

My mother was like this with my father and my youngest son (six at the time). It truly was the most awful time of my life. Oddly enough my presence calmed her enough to stop her lashing out at my poor dad. She d literally be shouting in my father's face and the second I said hello she d morph into a meek little lamb. I have no advice but I do know there definitely are techniques for dealing with the anger. The Alzheimer society run courses with modules on dealing with anger. Big hug for you x

I think these mental capacity tests are being incredibly poorly done - particularly the weighing up of information and using it to make a decision. Of course even if someone’s mental capacity eg to make a financial decision has been lost, what’s in their best interests might vary. I’ve seen very skilled people doing capacity assessments and they do take into account someone’s abilities over time.

@Bunnyofhope has your mother ever been sectioned? The idea of someone throwing boiling water and biting their partner is terrifying for you all.

No never sectioned. Never even close. She's been in hospital for eight days once, general geriatric ward, on one to one care as she was aggressive to other patients. But tbh they couldn't get rid of her soon enough.

@Frazzledinmyforties 'according to the police and social workers the LPA is only valid in her “insane” moments. So if she seems calm and tells me she wants £100 a day, I must give it to her because “she has the right to make unwise choices”. I’ve explained countless times that it only applies as long as someone has capacity but they claim that in that particular moment she does have capacity'.
Seems to me these police and social workers are talking nonsense. Once a LPA is enabled and you take control of health and financial decisions that's it surely? You can't be deemed 'insane' one minute and not the next. Not to mention how would they check up on this? If your DM is demanding cash and you decline how could they know and as you have LPA what could they do after the fact as they weren't there. And what if your DM had a lucid moment,you then had to follow her wishes and she told you to stop paying her bills. Would the police and SW then go 'ah well that decision is clearly not the right sort of 'unwise choice' and you should ignore her'.
They either don't understand LPAs or are just trying to make their lives easier.

I walk out of the room and leave her for a few minutes. I don't shout back or get angry . Very often when l return to the room she is all over me . I also do something like clean her nails or put hand cream on her hands and that does settle her down as well.Good luck @Frazzledinmyfortiesl know how upset you must be .