Both of my parents have dementia. How can I handle their outbursts?


Q: My elderly stepfather and mother both have dementia. They have become verbally abusive and paranoid. When Mom gets agitated, she bangs walls, clenches fists and screams. How should I deal with this behavior?

A: It sounds as if you have a very difficult situation since both parents have dementia. I urge you to seek as much support as you can find.

First, I suggest that you seek the advice of your parents' doctor(s) to find out if he/she recommends any new medication or a different dosage to help control their agitation. Medication is sometimes the only way to manage the extremely stressful combination of paranoia, agitation, screaming and sometimes physical violence. Banging walls can quickly become hitting people, and you need to be safe, primarily.

I do not suggest that you get your parents drugged into a zombie-like state. There are ways to manage behavior that is out of control other than overmedicating people. Medication that is properly prescribed should help modify the problem behaviors, not cause the elder to sleep all day, be unable to communicate or seem drowsy all the time. You will need to be your parents' advocate to speak with the doctors, to ask for the right amount and kind of medication to maintain safety, but to also see that if their conditions change, that the medication is adjusted to meet the changes.

You do not mention your parents' financial situation. If any funds are available to seek the advice of a dementia care specialist, that could be very helpful to devise an activity program for your parents. Sometimes, agitation and outbursts are due to frustration and anxiety, among other things. Research has shown that "tailored activity programs" specifically geared to persons with dementia help calm them and increase their sense of security.

If funds are not available, seek information from the Alzheimer's Association, an excellent resource, even if the dementia your parents have isn't Alzheimer's. Read all you can about what works for others in your situation. You can learn a lot from the Association and from other caregivers with difficult loved ones also.

With enough information and guidance from experienced others, you may be able to create a different structure for what your parents do in their waking hours, to lessen the agitation by distracting them.

Above all, know that yelling back at agitated persons with dementia is ineffective and can make things worse. Art, music, and gentle movement, as well as tactile stimulation (touching various objects of different textures and sizes) can all be effective in helping to reduce agitated behaviors in persons with dementia.

Finally, as is sounds as if you are a primary caregiver for your parents. I urge you to get any relief from the job you can. Ask for help! Recruit volunteers from your community, religious organization, club, service organization or other resources available to you. If possible, find out if respite care is an option. Placing your parents in a care facility for a weekend or a few days can do you a lot of good, and help you keep your own health intact.

You need a well-planned strategy about how you are going to get through this time. It can wear you down to nothing, causing you, the caregiver, depression and causing you to face a health crisis yourself. Protecting your own well being is as important a part of the plan as is taking good care of your parents.

Bless you for the commitment and concern you show in your question. Please seek others to share this burden with you, and know that you are not alone.

Carolyn Rosenblatt is a registered nurse and attorney who has 40 years of experience. She is the author of "The Boomer's Guide to Aging Parents." Read her full biography

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I too am not dealing with dementia. My mother, who is 84 and lives alone refuses to discuss alternate living arrangements. She is very difficult, throws up every conceivable road block, when we try and give her some options to her situation. She falls, and is not in a safe situation, but steadfastly refuses any help, and even throws us out of the house! What am I to do? Sit there and take abuse. She wants me to fix things that I am not able to fix. I can't bring my dead father back to life. I can't move her entire neighborhood closer to where I live. I can't wave a magic wand and make her 20 years younger. It's almost as if she resents the fact that I can't do any of those things. She just keeps telling me she wants to be "left alone!" This is not a viable option and I am at my wits end!
Texas, You sound like a fighter, a resourceful person, and a survivor. You will get through the holidays.

I don't think an attempt to block your conservator request by your brothers with criminal records will be very impressive. Good luck to you!

I don't understand why the doctors won't give your mother something to calm her down. Did they explain that? Can't the doctors refer her to a geriatric psych ward? Are the wards too crowded or too expensive or what -- why is a court order necessary? I really feel sorry for you.

Sincere best wishes to you as you struggle with this painful challenge.

Thank you for your kind words and best wishes! I have spoken to her neurologist and In Internal Medine Doctor many times about the issue. The Internal Medicine Doctor says the neurologist should prescribe something, but he refuses. The neurologist states she can only get the proper medication ONLY if she is admitted to a Behavioral Unit at a special hospital for geriactics. She has several other doctors, lung, etc that all tell me she needs to be put in that ward. The neurologist states that he cannot give her the meds while home "because they can cause sudden death.". I have even spoken to the hospital and there's definitely beds available, but NO doctor can forcefully admit her! She must go willinglly. The other recourse is if she harms herself or anyone else, but the violence must be so intense that it would cause hospitalization to her victim. So, the very last recourse that everyone has advised me is with neither of the first available, then it must be by court order. I was shocked when I discovered that one or more of her physicians could not have her admitted by force! The neurologist also explained that the drugs to combat this violence must be administered by a psychiatrist. Knowing this, even a referral to one, I'm told (even if we could convince her to see one, which is definitely NOT something she would do willingly) the doctors still say that no meds unless hospitalized in that Behavioral Unit. I used to be under the impression that if not one, but two doctors could force psychiatric care. I guess the laws changed. I also fear that even if she does hurt one of physically, the responding officer may not do anything, as trying to stop her many times from running down the road half naked in the cold, I get such disapproving looks as if I am the one causing the problem. Plus society thinks we must put up with abuse from our parents once we are adults. I know it is the right thing to do to be their caregiver and that words can hurt regardless of the dementia illness; and although I love both my parents, I just cannot tolerate anyone physically harming my daughter or anyone else. Mom has always had a temper and gone too far when I was younger. She beat me so badly when I was around 5 years old with a coat hanger that my back was tore up and covered in warm blood. So, it scares me what she may do next.

I had hoped someone from Texas could tell me why we have such little control over our demented parents(?). I am able to tolerate a lot, but I still must worry about my own family. I should not have to make a choice between them or my folks. Many times my daughter has asked me to do so, later calming down realizing its the disease. And as tolerant as my husband is, he has told me I need a plan B