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.

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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.