Question: I am caring for my mother-in-law in our home and recently have seen a change in her behavior. She becomes angry and combative when I or one of the personal care assistants (PCAs) are helping her change her Depends and/or clean her up. She shouts and tries to slap whichever one of us is helping her. She will follow the PCAs around and harangue them to "get outta here." She has also tried to push them or kick them. I would appreciate any suggestions you might offer to help us diffuse the behaviors.
Dr. Amy: I encourage you to take your mother-in-law to the doctor for an assessment. Whenever there is a shift in our health or behavior or the health and behavior of a loved one, it's a good idea to talk to a medical doctor to see what's going on. It is possible that something may be causing your mother-in-law pain or distress when her Depends are being changed. Since this is new behavior, it's something to look into.
At the same time, think about the experience of changing Depends from your mother-in-law's point of view. What body movements does she have to do when getting changed and cleaned? Could something be uncomfortable? Is the room too cold when she is undressed? Is the lighting too bright? You might try pretending you are your mother-in-law and perform the whole changing ritual to see what it feels like from her perspective. The goal is to discover why she is reacting to being changed and then adjust how you change/clean her to make it as pleasant, respectful and comfortable as possible. The Alzheimer's Association has put together a great series of tips you may find useful.
I am not sure from your letter if your mother-in-law has dementia or another health condition that makes it difficult for her to tell you if she is in pain, frustrated, or if something in the house is bothering her. If this is the case, it is especially important to study her outbursts—watching for things that act as triggers, so you can avoid them.
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