One of the most difficult aspects of caring for someone with dementia is coping with difficult or conflictive behavior.

All the literature says don’t take this personally, they can’t help themselves; it is their condition. But it affects us when someone screams at us or says ugly things. We immediately react before we can rationally understand this isn’t them saying or doing those hurtful things.

In normal life, we define people by their behavior. It starts as children; the good or bad child label is directly related to whether or not they are obedient or defiant. As adults we get labeled nasty, hard-headed, demanding, problematic or kind, charming, funny, or respectable. Whether bad or good these perceptions are directly linked to how a person behaves.

I worked with street children for many years here in Central America. These were not easy kids and usually, the worst behaved was the most sensitive. At first, I had to learn to see the child beneath their difficult conduct but later it became automatic. I stopped judging the children by their behavior and this understanding carried over to the rest of my interactions with all people.

My ability to see beneath the surface behavior of a person has helped me considerably with my work with individuals with dementia and their families. Getting to the “heart” of a person is my number one priority with all of my interactions with everyone. I have no interest in surface small talk and many people see me as a complicated and hard-headed person; for the most part, I often am. But I’m kind, loyal and a fierce advocate for those in need. When we can go beneath the outer appearances, we encounter the real person.

Behavior is a communication that is often misinterpreted especially when a person with dementia is acting out. Anger is usually a frustrating result of an inability to communicate a need. Sometimes the things they say or do are connected to their past experiences. It isn’t even about you, it’s an old tape that’s been triggered and running again. The underlying fear is a constant for them and anger is often an outer manifestation of it. They have no control over the fight or flight reflex; it’s primal and automatic.

When you define the person with dementia by their behavior you will most likely feel you have lost the person you knew and in eldercare facilities, the difficult resident is seldom understood and quite often avoided by staff.

It takes practice to step outside of your automatic reactions to someone being nasty and understand its not them. It isn’t easy but it is necessary if you are going to be a truly effective care person. They need you to really “see them” and love who they truly are beneath the storm of emotions the dementia brain damage causes and controls them.

Always remember, “They are not giving you a hard time, they are having one.”


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