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.

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.

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.

SWC836, is this something new that the dementia patient is doing? If yes, have the patient go to his/her primary doctor, or even to urgent care, to have an Urinary Tract Infection test completed. The test is simple. Such an infection can cause an older person to say mean hurtful things.

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.

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

Mum accused me of sleeping with a close friend; former close friend. Mum gave an ultimatum - "Admit you are sleeping with her or else - get out of this house!" I sort of found it funny, since the "friend" was an OAP herself! I'm single and desperate to get married, but not that desperate for sex. I laughed initially - inwardly. But then mum got louder and more angry.

I've learnt not to do what she wants - which is to get upset at the accusations. Just treat it as a joke; else - you'll cry and cry and then get angry in return; she wins. Not that it's just a game to her. It's very serious; when she accuses you. In her mind - she is settling scores and redressing the balance of justice. It's a vastly twisted sense of right and wrong - but if you let it get to you - then she's won the "law suit."

(So dementia does this. The docs are keeping my mum's diagnoses to Schizophrenia)

That behavior is typical in the later stages of dementia. If you read everything you can find on dementia, that's a common thread. A geriatric doctor or psychiatrist could help perhaps with medication. It worked for us.

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.

Wow, I had no idea. I think my Mom has dementia or alzheimers. I noticed when my Dad first had his stroke (four months ago) that she was so nervous (she's always been a worry wort) that she would constantly repeat conversations. Dad died just a couple of weeks ago. She still constantly repeats stuff. And I know she's had UTIs in the past but I didn't know it could cause similar symptoms. She doesn't want to go to a doctor anymore. I think she just wants to be with Dad. And my oldest brother who has DPOA says he wants her to be able to do as she pleases. I don't disagree but its hard to be with her. When I visit (I live in Houston - they're in Nola) she's so happy to see me and when I leave she's almost crying and telling me she's gonna miss me. But the weird part is during my visits, she makes little comments that hurt. I'm not sure she even realizes. It's very hard. But I just keep telling myself - she's your Mother....you live 350 miles away. Be patient and kind. But its still hard.

I have gone thru the “unfiltered” comments from my very stubborn, independent 96 year old mother with end-stage dementia. I have heard all kinds of stories from her caregivers and the hurtful comments from her. I live far away and have DPOA so I manage her finances and coordinate with her caregivers for her needs but other than that, no contact with my mother. She is extremely hard of hearing so talking on the phone is nearly impossible and why do I need the hurtful conversation. I feel like I have lost her but would rather remember her from the past and not dwell on the negative “now”. It has given me peace of mind and makes it easier to handle the day-to-day care she needs.

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.

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.

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

I try to remember that they will forget the awful things they said within 10 minutes, but I may remember it forever if I don't put the whole thing into perspective and realize it is the disease talking.

Vascular dementia (strokes) and Lewy Body Dementia (Parkinson's disease) can cause unpleasant changes in personality or behavior. Any type of dementia can leave the sufferer feeling frustrated by inability to express himself/herself clearly or feeling loss of control. Frustration usually exhibits as nasty attitude: saying mean things, trying to hurt others, throwing objects... Usually the behavior is worse in the evenings as the person tires and light changes (Sundowner's Syndrome).

The best way to handle this is with a consistent routine. Also make sure the dementia sufferer is given frequent fluids, bathroom breaks, periods of rest, and non-taxing/fun activities.

I know many won't agree with me but my firm belief is that the person is no longer who they once were. Once the behavior and verbal abuse starts to cause big harm and damages to the caretaker, the bad things must be stopped at once. The trouble is nothing gets through to these people - they can't and won't be stopped. In the meantime, they are cruel and vicious. Why on earth do you allow that? I truly believe when behavior and all that goes with that problem starts to cause major problems, they must be removed and placed into a facility. There simply is NO other answer. Get on with your life, move on, never look back - you deserve peace and a life.

SWC: You do NOT take it to heart as the person's mind is broken. They can no longer control what they say.

As well-intended and seemingly experienced as nursing home staff is they are not always right. Much more training and knowledge of dimensions are needed throughout all nursing home staff. Perhaps it is the disease causing loved one to be so hateful and in fact it's not intentional or something she can control. How unfortunate though for those she's lashing out at. Prayers for wisdom and patience.

Ignore it! If it is dementia related, the person is in "survival" mode and feels that his or her "independence/freedom" is being threatened, even if they are not independent, they think they are. They are not living in reality, and can only focus on themselves. Dad is 91 and is in his 4th year of dimentia. He was never a really nice guy, but now he behaves like a 4 year old brat, arguing about everything , throwing fits, and even becoming physically violent (only rarely so far). It is not personal, and it will not get better! Eventually, they lose their ability to communicate and cannot say hurtful things any longer.

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.

Thank you all for your answers. She is on anti depressants but they do not seem to be helping much -- hard to know what she would be like without them!

Depends how hell bent they are on killing you - sort of meant literally. If it's really bad, just step away. They need to let the moment pass. If you can see the agitation rising but it's not totally taken them, you can apologize. Thank them for their patience and understanding. Apologize again. Promise to do better. Etc. Or even laugh and thank them. I found it helpful in diffusing situations later on. When Mom was at her worst though, best to get out of the way! Agreed with all the posts about lack of training for facility staff. Doesn't matter though, you need TIME to talk to these folks and make them comfortable. If you don't have TIME, you can create a calm setting for them and you can't soothe them. Hugs.

Ignore it. Turn away, think of something pleasant that makes you happy- anything to get the episode over.
My mother, in the last year of her life, was a hellion. A spitfire. I was taken aback by a lot of things she would simply blurt out.

Divert if you can, otherwise when it happened to me I just sucked it up and kept quiet to not escalate her any more.

Don’t take it personal whatever you do.

Please ignore it. Dementia patients can not help it.

J2johnson...
This is why being a caregiver is so difficult.
When you were a child when you asked for a toy at the store, a candy, a new bike and mom or dad said no! Didn't you ever say..."I hate you". And you meant it at the time.
Do you honestly think that your mom or dad with dementia consciously says hateful things when they can't remember who you are, who their spouse of 45 years is? They can't remember that the house they are in for the last 60 years is "home"?
Yes the hurtful things that are said hurt.
But what really hurts is the fact that they are not the loving parent they once were, they are not aware of self and surroundings. You see the person that raised you decline and it hurts. They are but a shell of what they used to be.
You can no more get angry at your mom, your dad, your spouse than you can at an infant that bites your finger, pulls your hair or smears peanut butter all over the table.
That is what this forum is for, that is what a support group is for, to vent, to be able to cry and for others to say...you are doing the best you can.

And you have every right to be angry.
But be angry at the disease NOT the person with the disease.

I have suffered greatly from people with dementia and now I have made up my mind I simply will NOT ever again tolerate it. I don't care why or who or what - if they are abusive, watch out. I need to keep my self-sanity and self-respect or I will be destroyed. When I have done all I can possibly do for them and problems start, there are two things I have to do. First, I stop them dead in their tracks and put them into their place very strongly so they become so shocked they will stop. If they do not stop, they will be told they will immediately be removed from my presence, put into a facility, and they are on their own. Mentally ill people have nearly destroyed me and at one time I needed police protection. No longer am I miss nice guy - I fight back and remove myself forever from their presence. That is how I managed to survive.

My dad lashes out at me all the time and then, like on Tuesday, he tells another resident at the AL how wonderful I am. I've had to just get used to it and I'm pretty thick-skinned so I don't let it bother me anymore. It's been too many years. My sister takes everything personally but lives out of state. If dad starts on her over the phone, she calls me all upset about what he said and what if he truly never wants to see her again (he's told me that many, many times). I think part of the reason he treats me the way he does is because I am his guardian and I hold all the control. And yes, any little personality idiosyncrasy you have when you're younger is AMPLIFIED when you get older. I see that all the time in my dad. I feel sorry for my kids..............