My husband is 85 and I am 84 and has some dementia and health issues. We live on our own and I am the caregiver because his health issues are more debilitating than mine. We have 2 daughters who live near and they help us out when they can. Most of the time my husband is sweet, but his dementia causes him to have sudden angry outburst over nothing. It seems directed at me and is hurtful. How can I handle this when I am already trying so hard?

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Hi, I understand the wish to calm the person down, but I find that anticipating some parts of his confusion - even understanding some of the feelings and issues of dementia - add to the possibility of the interaction going well. Sometimes people having an angry outburst can only focus on one thing at a time, so it helps to tell them you care and want to understand, but can't understand if they are telling you what's wrong with you. And that you also say, explicitly, I'll be back in 5 minutes, or will come back if you have a request. Saying one thing at a time, with care, and also leaving, is a way to give both people more chances to try to solve things themselves.

Though medication can often calm someone down, I feel like its use is often like putting in a thumbtack with a hammer - over-kill with longer lasting major effects. My training is in substance abuse, so I have had a specific focus on using medication to alleviate anxiety or improve moods. I tend to worry with a growing number of people that medication adds new side effects, often more sleepiness or sometimes balance issues - and what is not as well recognized, when a person is coming down from various doses, their anxiety can be increased, just by the process of medicine changes inside them, so their behaviors can be more aggressive and demanding, more repetitive and less susceptible to learning.

I usually have managed to work with elders who are not taking mood medications, finding them easier, and issues solved over time. It's not so easy when working with someone already taking such meds, who then repeat issues more insistently.
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You said that most of the time your husband is sweet. I think his outbursts are due to his dementia and aren't personal against you. You just happen to be the closest person to him when he has an outburst. Not that it makes it any easier to deal with.

I agree about getting out of his way when he has an outburst. If you can leave him alone for a few minutes walk into another room and just remove yourself from the situation until he calms down. Check back and if he's still agitated walk back out again.

Have you thought of talking to his Dr. about medication to calm him down?
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I found there can be ways to focus on self-emotional-protection - Say I care and I'm trying to understand, and can I do something for you now? Then if the person just focuses on berating you, repeat, "I care, and I want to understand, but I do not want to listen to lists of what's wrong with me. I will be in the next room, if there is something you want, but I won't stay when you criticize me. I'll be back in 5 minutes." And leave.

Stay within earshot, in case there is something they need, but not in sight and don't respond to shouts or mumbles. Take the 5 minutes and return, with good cheer. Repeat as needed! If they start right up again, affirm again, I love you and I'm glad I'm here, but if you want something, I will try to help, but I won't listen to critical descriptions more than once. If I forgot something, I'll try to see what it is, but otherwise, I'll see you in 10 minutes..."

I found this break in the engagement, if done with reassurance yet stopping the conversation and saying you will return, helps to allow the person to get a grip, on what has been allowed to be a pattern.
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His doctor should do some checking, bloodwork and urinalysis to see if he has any imbalance that could set him off. Watch the sugar intake, limit the caffeine intake if you can. If he is already diagnosed with Alzheimer's, get him the proper medications for it. Good to see you are on top of things.
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