Outsiders do not understand. You are so right.

Everyone loses their temper once in a while. People say things to each other that they don't mean under far less stressful situations. Caregivers are under an incredible amount of pressure, and they are not immune to letting their emotions get the best of them. Dementia adds yet another challenge to the mix.

I suppose I could say a dementia patient won't remember what you say to them in haste, because they won't. When this happens (and in truth it happens far more than is ever admitted), I am sure the family member or caregiver feels even worse afterwards than the patient does.

I am certainly not condoning yelling at a patient, but let's be honest here. We are all human. No one understands what a person caring for a dementia patient goes through. Yes, the patient is constantly dealing with the disease, but their loved ones are, too.

To say that family members or caregivers do not and should not ever lose their composure is simply untrue and unrealistic. What is important is that we are able to recognize our limits and take things down a notch.

Anyone who has been married for any length of time will tell you it's not always a bed of roses. Some couples have civil disagreements, while others may have knock-down drag-out fights. In the end, most feel sorry for what was said. Again, I am not condoning this behavior, but we deal in reality here. To think this never happens is just being dishonest with yourself and everyone around you.

The patience of Job—that's what it takes to be a caregiver. Even then, there are times you simply can't handle it, whether it is at 3:00 AM from another sleepless night or something as simple as answering the same question over and over.

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Please don't beat yourself up over this. I have always been an advocate for the patient. As one, I know what they go through. But I am not naive enough to think that tempers will not flare.

Trying to get an agitated, confused person under control and calm the situation down is an endless job for a dementia caregiver. They use redirection, music, medication, changes in environment, whatever may possibly work to pacify them. When nothing seems to do the trick, this is when the anger, frustration and stress begins to build. Beyond feeling exasperated, many begin to feel powerless. These well-intended efforts to soothe a distraught loved one fall flat. That is the nature of dementia, and with some patients, this distress never ends.

Whether you are cut out to be a caregiver or not, there comes a point when the pressure is just too much. Respite, medications, placement in a long-term care facility—there are many options available to the patient and their caregiver.

I hold our caregivers in the highest regard, but I also hold them to the highest standard. I know most hold themselves to even more stringent standards, simply because of how much they care. But if occasional snaps begin to turn into larger, more frequent episodes, it is time to look into other options for care. This is burnout peeking through, and there is no room for a frazzled, burnt out caregiver. There's just not. It's bad for the caregiver, and it's bad for the patient.