How to handle his rages

Question: My husband has moderate vascular dementia and his last stroke caused right frontal lobe damage. He sometimes goes into rages. I can usually calm him, but sometimes I can't. I have had to leave three times as he threatens violence. He will not go into a home, so I keep coming back to care for him. It’s very challenging when my emotions are involved. I am a health care aide and I am working. His doctors tell me not to go back, saying it will only get worse, yet I can't let go. I know he doesn't realize how damaging his verbal abuse is. I do try to keep things positive. I know things are brewing in his mind and he takes it out on me. Why I don't know. I take very good care of him. Any tips?

Dr. Amy: It sounds like you already know that vascular dementia impairs the ability to organize thoughts, analyze situations, and decide what to do next. It can cause memory loss, confusion, restlessness and agitation. Damage to the frontal lobe weakens our ability to understand right and wrong and understand the consequences of our actions. Your husband likely knows he is losing control and, as a result, a host of negative thoughts are brewing in his mind, as you say. He likely sometimes feels frightened, angry, frustrated, or depressed. But because his brain is not working the way it did before dementia, he is not aware of the impact he has when he lashes out. As I think you know, his outbursts aren’t about his feeling towards you as much as they are an expression of his own inner turmoil. I’m glad you stepped away when he threatened violence, but of course you don’t want to let go. You love your husband and want to take care of him. And he is a lucky man. I think it’s wonderful that you can still access so much love for him despite the challenges you are facing.

I recently watched the movie “The Theory of Everything” and found myself weeping for his first wife when, leaving him for another man and clearly wracked with guilt, she tells Stephen Hawking that she really did love him for such a long time. One never really knows what goes on inside a relationship but the way I saw it, the burden of providing care for so many years eventually overshadowed her love.

On a practical note, there are a number of coping strategies you can try. Staying positive is a good approach. Here are a few other tips:

• Express understanding and empathy—demonstrate that you understand what he is saying and how he feels. If he wants something that is not possible, affirm his feelings and wishes. Tell him you understand he would like to do such and such, and you are going to try to see if you can make that work.
• Redirect—once you have expressed understanding and empathy, change the topic to something else he would enjoy, such as music or a walk.
• Communicate simply—since his brain can’t process information the way it used to, speak simply and clearly. Short sentences, one thought at a time. Give him time to think.
• Look for physical causes: if your husband is not able to tell you what’s bothering him, look for physical clues. Is he is pain? Does he have a urinary tract infection? How’s the room temperature? Is he tired? Is there too much noise or clutter? With his reduced ability to process information, it’s important to keep things simple.
• Keep the schedule simple. Know when he is at his best and use this knowledge to plan outings etc.

If you have not done so already, I encourage you to talk to his doctor about the possibility of depression and whether there is any medicine he might take that can make him feel better.

Here are two articles that provide more tips. One is written by the Alzheimer’s Association and the other by the UCSF Medical center. Both are excellent.

That said, let’s talk about safety. Your safety and wellbeing and your husband’s safety and wellbeing are the priorities. You need to make sure you never compromise your own safety. And so you need a plan for your husband’s care now—beyond these simple tips. You also need to look ahead. If at all possible, I encourage you to consult a geriatric care manager to help you build a plan. Geriatric care managers understand dementia and its challenges. They also understand caregivers, and they know all about local resources that can help you. You will feel ever so much better, and less alone, if you have the support of a care manager. You can read more about geriatric care managers here.

I send you strength!