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My grandmother has dementia, and carers come three time a day for about 30 mins to help with basic needs, whilst family divide up the other responsibilities. My grandmother has always been someone with a sharp tongue, and able to keep a grudge. It's like she needs to have an enemy to criticise and complain about to other people and make snide observations about and unfounded accusations against. At present her target is one of her carers, a perfectly capable and kind middle aged woman with some mild learning difficulties. She complains about her manner, her clothes, her habits, tells everyone that she thinks she's sneaky and a thief, and subtly insults her to her face in a way that this carer doesn't seem to fully grasp but which I (and other people) do, and then she gives us this happy look, like 'can you believe this idiot,' as though we're in on some joke with her. When this carer tried to encourage her to shower/eat/dress etc she is snide and rude, when this carer leaves the room she rolls her eyes and whispers completely unfounded insults, when this carer looks away she makes a 'can you believe this idiot?' face. I think that due to the carers minor learning disability a lot of this behaviour isn't picked up on by her (which on a practical level is good, but on an emotional/ethical level somehow makes it worse), and the fact that my grandmother has dementia helps explain away her unpleasantness. This behaviour from my grandmother is limited to this one carer, and doesn't seem to spring from frustration/fear/anger etc - rather it is her life long need to have an enemy to b***h about that has been intensified and stripped bare, but this time to a woman with learning difficulties. I think the fact that this lady has learning difficulties may be part of the reason my grandmother focused on her for her unpleasant behaviour. What makes it worse is that my grandmother seems to really enjoy saying all of these horrible things - her face lights up like a sociopathic child pulling the wings off of flies. I accept that we probably can't make my grandmother stop, and I want to protect the carer from my grandmother's hatefulness, but the only way I can think of doing that is to let the agency know that this is happening so that they stop sending her - but I'm not comfortable doing that because I don't want to affect her employment prospects. As the carer doesn't seem to entirely understand that my grandmother is mocking her and thinks she is just another difficult dementia patient it may be a case of no harm no foul. But having seen this side of my grandmothers behaviour, I can't help but be sickened by her. She's sweet as pie to me, but the fact that she revels in subtly bullying a vulnerable person make me not want to speak to or be around her, even though I have responsibilities towards her myself. I just can't look at her anymore, especially since I have this feeling that the dementia didn't so much change her personality as reveal the true depths of the personality traits she's always had. I don't want to feel this way, but her behaviour and the obvious joy she gets out of it make me want to not see her again, and also to protect others from her malevolence. Other relatives feel the same way, but of course none of us act on it. How do you cope when dementia turns your relative into someone it's really difficult to see as anything other than a deeply, horrible person? How are you able to be around them?

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That's an excellent link, Jeanne, thank you.
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Thank you for all of your feedback, which I really appreciate as it’s nice to get out of my head for a while and read new viewpoints.

It does definitely raise some interesting issues about the nature of the self. On the one hand, from birth all we are doing is building up layers of filters and understanding, and then dementia can cause us to go regress back through all of those filters and layers. And at different points in time we’ll be different people depending on how many layers we’ve built up - am I working TOWARDS the ‘real me’ as I learn and grow, or am I moving AWAY from the ‘real me’ as layers build up around me - in which case the 'real me' is an eternal newborn baby with no sense of self. I suppose it’s more that there are millions of ‘real me’s’ who have existed throughout time under different circumstances, and there will be millions more.

Having said that, I do think that there is a certain level of fixed-ness to me at the core. When you look at people like Mel Gibson who blamed alcohol for their bad behaviour and say ‘it was the booze talking,’ I always think ‘I dunno, I’ve never seen a bottle of tequila with ‘warning - may cause anti-semitism on it.’ You have to take some responsibility here - it’s not like a drunk rabbi suddenly hates Jewish people or a drunk black person hates black people. Of course lots of things (depression, sleep deprivation, dementia, alcohol etc) can make us do things we wouldn’t normally do - but they do so in a way that’s specific to us rather than completely random, and so it is still ‘us,’ just maybe the darkest timeline version of us.

I’m not going to be able to resolve what hundreds of philosophers haven’t. Maybe thats part of what makes this so difficult - it raises all of these profound issues that none of us can really ’solve.' Maybe I have to accept that this is the real her, but the her that she was fifteen/thirty/fifty years ago was also the real her, and tell myself that to honour the ‘real hers’ that were easier to love I have to tolerate the current real her, because they are a package deal. Of course it’s easier said than done, but it’s something I can keep repeating to myself.

The practical tips are helpful too. If I could call the agency and say that I’ve seen this carer do a great job but I know that my grandmother has developed an irrational grudge against her due to her dementia, and I just want it on the record that I’m happy with her work, and want to check that she’s OK, that may help.

Countrymouse is right - I’m forgetting that the carer has workplace rights like anyone else and her employers aren’t allowed to punish the carer for my grandmothers attitude to her. If my grandmother were being mean to the carer because she was black the agency wouldn’t hold that against the carer.

Also - I agree with the tips to never reward the bad behaviour from my grandmother, overpower it with my own good behaviour towards the carer, and use distraction is necessary.

I don’t want to discuss this with my grandmother too specifically because her mind works unpredictably, and I’m worried that if she does remember what I say it will come out in a twisted way like ‘oh, I’m not allowed to talk about how that carers stealing from me, just because she’s r******d’ (I would never use that word but as I said, she can put her own spin on things and it isn’t nice). And then she would probably keep repeating it, which is another thing she does, and that would make things even worse.

Thank you again for your time, and I wish you all the best in caring for your friends and family with dementia. Any further feedback welcome, of course!
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Gen, assuming you've haven't been living in a cave for the last eighteen months you will be aware of how hot a topic bullying in the workplace is right now.

Your grandmother is bullying this carer at the carer's place of work.

Well, now.

Your grandmother has dementia. Uninhibited unpleasantness is symptomatic of her disease. So would pinching, spitting, hitting and other kinds of antisocial behaviour be. That doesn't mean her behaviour should be accepted but it does mean it's unreasonable to expect your grandmother to mend her ways. So you will have to tackle it from the carer's end.

The carer's apparent lack of awareness *could* mean that she genuinely doesn't notice the insults and therefore isn't bothered by them.

Sadly and more soberingly, it could be that she's used to it because this happens to her all the time. She might actually think this is normal. God help us.

Or, it could be that she does notice but is too professional to allow it to interfere with her work.

You have at least a couple of options.

You can express your strong disapproval of bullying to your grandmother and encourage other family members to do the same. You will all have to be subtle about how you do this, though, in order to avoid causing further embarrassment or hurt to the carer.

You could also speak to the carer's line manager, outline the problem you're concerned about, and ask for guidance on how the authority/agency implements its anti-bullying strategy. If the carer comes from an NHS trust or local authority they should have a zero tolerance approach in place.

And other than that, lead by example. Which means treating this carer not *specially* kindly, you don't want to patronise her; but as you would treat a caring professional doing a good job. Which is what she is.
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Rosses003- I have exactly one experience with a person with dementia but my loved one was what my Nana would have called "a real piece of work" before dementia. Now, she is the sweetest thing. She is like a nice child. She appreciates everything that is done for her, is rarely critical, giggles...she's adorable. Unfortunately, there are people close to her who could provide support now but are steering clear because of her past behaviors. I said to one of them "the lady you are mad at doesn't live here anymore." I think JoAnn's neurologist's comment that a nice person with dementia will be nice and that if they are nasty, they were always nasty but covering it up might not be 100% right. Teepa Snow does an interesting talk about the area of the brain that stays more active longer in dementia is the area that contains social chit chat, rhythm and nasty talk. I think framing bad behavior as "that isn't my LO, that's the dementia" might be the kinder way to look at it.
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jeannegibbs May 1, 2018
I think you are right, Marcia. Mostly people retain core attitudes. My nice husband was a nice man with dementia. But I certainly heard in my local caregiver support group of many cases where a loved one changed -- in either direction. A critical nay-sayer mellowed out. A gentle man became belligerent.

I think how dementia changes people depends on the exact place in the brain is damaged.

This short video was extremely helpful to my understanding: youtube.com/watch?v=Eq_Er-tqPsA This is specifically about how ALZ develops in the brain over time. My husband had Lewy Body Dementia, not ALZ. But the message that dementia is physical damage in the brain and where that damage exists determines what the symptoms are applies to all kinds of dementia.
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When I asked Moms neurologist about personality changes he told me this. A previously nice person will be a nice person with Dementia. A previously nasty person will be a nasty person with Dementia. A person who was nice previously and gets nasty once they have Dementia, was nasty before just was able to cover it up. Not that there won't be times a person can be mean that is usually nice. That is part of them dealing with what is happening to them. I agree that Gma sees a weakness in this person. I don't see why you can't discuss this with the administrator at the agency. Explain that the person is doing a great job but you are concerned about how your Gma's treatment is effecting her. Maybe the administrator can bring the subject up to the employee, just in general, "how are things going with Mrs. G?" I would think as an employee with challenges, this question is asked often. I really Don't think she will be fired, just explain you are concerned.
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I was thinking and wondering recently if for everyone dealing with dementia, dementia equates becoming angry or angrier and mean. Isn’t out there one case when dementia made someone sweeter and mellower? Very curious.

Also curious as if dementia means loosing your filters and all learned good behavior and just letting go and letting loose! That means your “real self” is exposed, and depending on who your real self is, that can become an ugly picture. Or deep inside you can feel you are loosing control of yourself and that makes you react in an angry way, to protect yourself and make yourself “relevant”? Really truly curious as to how medically dementia is explained when it comes to mean behaviors.

But back to the situation presented, have you tried talking to your grandmother and, since she’s sweet to you, make her aware that she might be hurting the feelings of someone that has a disability? She seems cognizant enough to realize (she even seems to enjoy) what she is doing, so, she might be able to understand she is bullying or taking advantage of a “disabled person”; she might even feel ashamed. very ashamed actually, that her granddaughter is pointing out that she is having a cruel attitude towards a person in disadvantage, I would even add something along the lines of “it really saddens me grandma, because it makes me feel you are not acting like the grandma I love so much, and who has a really good heart. Let’s try to be more patient, ok?” And try sealing it with a kiss :)

If no one has made her aware of her behavior, then I think you should try.

After that, I’d just let it be as long as it doesn’t become a serious issue. But I think she might become aware of the wrongness that she is doing by mocking a person with a disability that is trying to help her.

As a side note, feel blessed that she is nice and sweet to you, as so many of us deal with the opposite from our loved ones, when we are really just trying our best! Good luck with grandma!
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jeannegibbs May 1, 2018
Building filters is part of the socialization process. I think my filters are part of the real me. If I lost my filters from disease, that would be truly sad, but I don't think that would reveal the "real" me. I've had a little experience losing filters in a depressive episode, and believe me, I did not consider those lapses my "real self!"
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'Nasty Side to Personality', is unfortunately a common issue with demented patients. The problem is compounded when the insults are personal such as accusations of infidelity, stealing of money, etc at spouses or children. One strategy that may help is to redirect. There is no point in arguing, trying to 'reason'. You are reasoning with someone who is no longer the person you knew. It will only make you frustrated. But what you have as an advantage is their short attention span.

Next time there is a angry outburst. Simply redirect in the most nonsensical way.
For example. 'Your Cheating on me'
You. Isn't it sunny outside. Wow look at those pretty birds.

You get the picture. redirect and they will often move on. It won't solve it completely, but may reduce your stress by reducing the arguments.
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Dementia means the brain isn't working quite right anymore and all kinds of new behaviors can pop up. My parents kept a Christian household: no smoking, drinking, or cussing. I was 14 years old before I heard a single cuss word from them. Although my father had always been controlling and a bit of a bully, TIAs and dementia did truly awful things to his personality. One clear example was how his language turned very foul - almost every sentence includes at least one crude cuss word. He also goes into "attack" mode most of the time. My father grew up in an abusive home and had paranoid personality disorder before the dementia but he had managed/chosen to build a very difference live for his family. I believe the dementia stripped away his ability to be the person he wanted to be. I think the "record" of what he heard in the house he grew up in got loaded up and starting playing most of the time. Most of the time I cannot recognize the man I grew up knowing in the shell that is now present. Ahmijoy's advice may work for a while but your grandmother may continue to deteriorate into someone you don't know too. I find it easier to cope by holding the imagine of the man my father was in his 50s (my real father) and writing off his worst behaviors as just the dementia - not really my dad at all.
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You're right about not being able to change your grandmother. Since she's always had a nasty personality she won't and probably can't change at this point.

Perhaps someone will have a better solution but my suggestion is to ignore her. Ignore her triumphant looks when she gets one over on the caregiver. Don't acknowledge her comments or looks of satisfaction after she has subtly insulted the caregiver.

Your grandmother gets some kind of sick payoff to her behavior and it may be the reactions of the people who witness her horrible behavior. Don't satisfy her with any kind of a reaction to her nasty and rude comments. Don't give her the satisfaction of an audience. Don't admonish her. Ignore her behavior.

Because you participate in her care this is going to be difficult to do so just remember that she's a mean person. You said she was mean before the dementia and she's even more mean now so just get in, do what you have to do, and get out.
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In my experience with my sharp-tongued and negative mother, I’ve always thought that when people act like this towards other people, it is to make themselves look good. When Grandma looks at you and rolls her eyes, she’s looking for commiseration and validation. In no way should you agree or show any reaction to Grandma’s foul treatment of this caregiver. Instead, sincerely PRAISE the caregiver in front of grandma. Do not acknowledge Grandma’s treatment in anyway other than to tell the caregiver how much you appreciate her caring treatment of Grandma. And you know, if Grandma doubles her efforts to denigrate this caregiver, it’s okay for you to say, “Grandma, that’s not nice! Sally is doing a good job for you!” I don’t believe we need to tiptoe around people with dementia when they get nasty for fear they’ll spontaneously combust. Don’t show anger to Grandma, but it’s ok to quietly reprimand her. My mother insisted on sex as the main subject of her conversations with me. I don’t know whatever happened to her that when she had dementia this all came to the surface and don’t want to know, but once when she was particularly lewd, I told her “Mom, be a lady! Ladies don’t talk like that!” She looked shocked that I showed annoyance and a bit embarrassed and after that, the sex talk diminished quite a bit. If you don’t validate Grandma’s unacceptably rude behavior, it might work for you too.
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