What do you do when a dementia patient says mean hurtful things?

Well, you can always walk away.

If they truly don't know what they're saying, the filter is GONE, and the comments are cruel and cutting, or too 'close to the bone'...you can either attribute it to the dementia and continue on or you can set better boundaries.

My MIL has mild dementia--I think. She has always hated me and has kept her horrid hurtful comments on the sly--just pinching my upper arm and hissing in my ear....w/o a witness, nobody believed me. I just ended up crying every time I'd be around her for any length of time. It was like being in a cage with a snake---you were always on guard.

Couple years ago, she just 'lost the filter' and in front of the whole family. Just let it all rip. She is quite deaf so she talks LOUDLY. She started in on something that I had done well over 30 years ago---and wouldn't shut up. My niece was standing there crying saying "Grandma, shut UP! Stop it!" I was just stunned. She wouldn't stop and it got funny/ugly. I took my plate and dumped it in the trash and went in the house and said to my SIL, 'take me home, I cannot do this'. He hugged me so hard and said "You go, she wins. Go out and I got your back".

I DID go back, she had quieted down and I think my BIL had spoken harshly to her, she left shortly thereafter.

For all my DH has stated she isn't 'responsible' for what she says, as he thinks she has dementia, I said "So, for the past 40 years she's had dementia? No, sir, she's MEAN". The dementia she now exhibits is probably legit, but still very hurtful. She doesn't even TRY to cover it up.

All it has done for her is cause her to have zero friends. She is housebound and an angry, hateful woman. Sadly, I think many dementia patients become just MORE like they were before. Sweet people get sweeter, mean angry souls get angrier. Just my opinion.

Hard as it is, the 2 choices you have are to deal with the dementia, the whole ball of wax that it is, or you cut ties. I sound mean, but why should I continue to take hatred and vitriol from a woman who has hated me with a passion for 44 years??

And she is going to. live. forever.

Well, lots of good answers . For Midkid58, You are absolutely correct, about people just becoming "more" of whatever they were before. That is exactly was I was taught in my Growth and Dvelopement Psych class in college years ago. Aggressive folk become more aggressive. Cheap and stingy folk become more cheap and selfish, timid become more timid and frightened. That part is fairly "normal" or at least expected. It's when dementia sets in that they lose control of it, and start behaving in socially unacceptable ways.

When I started nursing , I quickly learned to just shrug off the horrible things the demential patients said. ( "Get your ugly face out of here.", "You're FAT", "I'll bet your sleep with all those men.", and worse, much worse. ) But even after years of such abuse, (which nurses are expected to tolerate) one elderly woman really got to me, when she growled at me: " I hope your find your children dead in the street ! " Wow. That felt like someone had punched me. (Which other patients actually had done, without bothering me much at all.) This knocked me for a loop. I had to ask one of the other nurses to step in and take my place, to finish cleaning up her incontinent mess in the bed.

So don't expect so much of yourself. Sometime even folks with years of experience handling this kind of thing, have a hard time with it.

A good education on Dementia will help you deal with bad behavior in a loved one. I am sorry but nursing home staff are not fully educated on Dementia. Short term memory is usually the first to go, and can snowball from there. It is extremely frightening for someone suffering from this disease. Imagine that you suddenly find yourself in the middle of a pond and are being dragged under the water an inch at a time. you can see the shore but it is fading and you think you are yelling for help but everything is coming out scrambled. Now your getting mad because you see people you know and they are just letting you drown. Why don't they do something? Now all of a sudden you are somewhere else and you can't remember where you just were and it is disorienting, what is going on? Oh no your in the middle of a pond slowly drowning. You can see people next to you and hear people you know.( you get the picture>) It is hard when your body starts to trap you in your own mind.
Live in their reality, be patient, don't react to bad behavior and don't take it personally. It is the disease that you are dealing with not them. Change the subject. Or simply walk away.
My mom would get mad at me for all kinds of stuff, I would walk around the corner, put my hair up or change my shirt and come back and she would think that I was someone else and complain to me about That Other Woman. So when I had to do something she didn't like I would put my hair down and wear that same shirt. Then and come back with my hair up and she would be all happy again. It is a mater or trial and error for everyone. Hang in there and never stop loving those who need you. Make sure you take long breaks.

I went through this. My mother passed earlier this year.I personally think that it's in them, and when the filter has holes caused my dementia, that all rules go out the window. Thoughts and feeling they have come full circle, thoughts come up and come out. I won't tell you not to take it personally ( my skin wasn't that thick either), because it is. Just love them the best you can, and love yourself too

As difficult as it is you have to remind yourself that it is the broken brain that is saying these things.
And dementia will cause people to loose that "filter" that prevents us from saying things that we would later regret or doing things that you would not normally do. But age can do that somewhat as well.
Some strategies you might try...
If you are not occupied with direct care at the time just get up and leave the room.
Ignore what is being said and just pick up a book or a magazine.
If you can try earbuds and listen to music or a book that might block out some of the "nasty". This might work because you can still hear if something is amiss but the music filters to some degree.

I am surprised at the comment from the Nursing Home employees. I would not say any dementia patient is aware of what he or she is saying at any given time. Or them may know WHAT they are saying but not WHO they are saying it to. If this person is saying that you are beating them and lying and stealing from them it may be possible that someone in their past has beaten them, lied to them and stolen from them and they think YOU are that person and they are reliving the experience again. If the person said you have been pinching them it might be that when they are being helped from the bed to a wheelchair or toilet that an aid grasped them and it hurt. This might e the way they are trying to communicate that they have been hurt by a caregiver in some way. There is no telling what the meaning behind an outburst is. But if it has nothing to do with you ignore it and try not to let it get in your head. Just tell yourself this is coming from the broken brain of someone you care for.

Dealing with a dementia patient is much different than with a family member -

dementia has not exacerbated my mother's prior personality - it has flipped it upside down -
this was a woman who loved to laugh and talk with everyone now she's afraid of everyone - her best defense is her mouth and what comes out of it isn't too pleasant

yes, there are some folks who turn into sweet lil old ladies but most do not - they do hit, pinch, kick, hiss, spit and bite and cuss like sailors and say mean hurtful things - why?
their brains are not working properly, they're afraid, hurt and frustrated

after two years now of being bedridden, my mom still thinks she's being assaulted during diaper changes -
the experienced staff who know her will either laugh or say you can kill me tomorrow, or I can't hear you or give her a minute and try to soothe her
and when the job is done, mom will look at them and say you're lovely - I love you

First ignore it. Do NOT take it personally or let it hurt your feelings.

That may be hard at first, but if the person has a level of dementia that keeps them from "knowing" what they're saying, then you really can't listen to the crazy talk.

Sounds like a normal stage to go through. As you say when social filters are lost reality comes out. You can try the child treatment of simply saying "that is not acceptable" every time she says something, otherwise choose either to ignore it or to walk away.

We remind our mother that what she has said is hurtful, and not a nice thing to say. When she further states that she doesn't care, we say that we care about her and wouldn't say or do anything that would in kind, hurt her.

Nothing you can do except walk away and give her some space until she calms down. My mom used to control her anger when she was young, but when her dementia/Alzheimer’s set in, she was taking her anger out of my dad mostly. If your mom know what she was doing, she would be apologizing to you or the aides. So, I think aides are wrong.