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My husband and I are live-in caregivers for my parents who are in their late 80s. Dad has moderate dementia. He still maintains his sweet personality and has not expressed any combative behavior. Needless to say it's exhausting to care for him. He still feeds himself but needs help with everything else. When asked why he can't do a simple task he will answer "because I'm lazy." Obviously that's not true, he just can't remember but my mom, who is still somewhat sharp, takes that answer as truth. She has always had a temper and as a child, I got my share of spankings and worse. Over the years I've made it clear that she can't behave towards me like she did when I was a child. In other words, when she starts in on her tirades I shut her down by saying I don't have to put up with it and leave the room. As my father falls farther into his disease, my mom is resorting to her parent/child relationship behavior with him. She screams at him, and at times will raise her hand back like she might slap him. I'm always there to de-escalate the situation and protect him but this whole dynamic is adding stress on top of the already stressful life I lead trying to take care of them both. The idea that my mom would treat my defenseless dad this way is heartbreaking. At the same time, I see her struggling with age-related memory issues, I know she's got big health issues, like congestive heart failure, high blood pressure and low back pain from a bad fall but obviously those aren't excuses to be abusive towards my dad. I constantly remind her that dad's disease is damaging his brain and what seems to be "laziness" is actually memory loss and confusion; even from one moment to the next. My mom desperately needs some sort of instruction, from someone that she respects on what to expect from dementia and how you can't treat a dementia patient as if they're purposely trying to defy their caregivers. I just don't know how to find this sort of instruction. And if it were available we'd need to be able to participate via the internet since my mom is very leery of going anywhere where there are strangers and the virus exposure. I could get her to at least listen and watch. She's too proud to ask questions though because that would mean she doesn't know everything. One final thought. Dad is very emotionally dependent on my mom and if she passes first, I believe he would pass very soon afterwards. My mom, on the other hand, would be just fine if my dad passes first.

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This may not go down too well, but it’s one thing to think about. People who have a temper and are quick with their fists are often authoritarian themselves, and knuckle under to someone further up the pecking order. You are now in a position to pull rank on your mother, both physically and probably in other ways too. Think about what you could use as a realistic threat delivered at shout volume. Or a reminder of what she used to do to you, whispered ‘if I ever see you raise your hand at him …..’. It can come as a big shock for people to realise that they are no longer able to call the shots, and they now need to mind their Ps and Qs.

I’m sure this is not what you want to do. However it is quick and easy to experiment with, and it might possibly work.
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cherokeegrrl54 Sep 2020
Brilliant!!!
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You say she's struggling with age-related memory issues. In other words, she, too, has dementia. You can't expect to reason with her if that's the case.

Get her in to her doctor for an assessment. That should be your first step, and until then, you can always look at the Alzheimer's Association website for all sorts of useful information -- alz.org. Print some of it out and leave it sitting around if you think she might read it.

Also, sign up for Dr. Leslie Kernisan's emails and read her website -- https://betterhealthwhileaging.net/geriatrics-for-caregivers-blog/. This has been the single most useful resource for me since my parents started going downhill.
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There are quite a few free online courses offered by very respectable universities in managing both caregiver stress and challenging behaviours. Have a good browse around what's out there, and see if you can't find a course that your mother would find informative. You'll want one that addresses her as a caregiver and acknowledges her needs and emotions and the challenges she is dealing with.

Once (we hope) you've engaged her interest in the whole theme of dementia and what a hard row it is to hoe, you can then widen her "training" into self-management. Should she also stumble across other relevant subjects, such as the close association of heart disease and vascular dementia, be ready to help her think and talk about that, too.

I was musing about shock tactics such as recording a difficult (but don't let it progress to abusive) interaction between them, and playing it back to her. Ask her what she would think of it and what she would do if somebody else treated her husband in that way. But I would regard this *as* a shock tactic. I'd try hard to find better approaches first.

The thing is. Safeguarding is safeguarding, and it is everybody's duty, but especially yours when you are the competent adult in the room. And also, abuse is abuse even if it is unintentional. This has to stop. Your mother has to recognise where the boundaries are. You might want to think about looking up your local elder services to find out what kind of support and counselling and advice might be available. Being read the Riot Act - or at least having it explained to her - by a social worker might not be the worst outcome for your mother.

PS Nobody does know her husband better than your mother does. You can't expect her to accept advice graciously on that point. But sometimes you can't see the wood for the trees and it's a good idea to listen to someone else's directions.
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It sounds as though MOM is the one who needs help right now.

Has she been evaluated for vascular dementia? Cognitive decline? Is her agitation related to depression and/or anxiety?

Get her to a geriatric psychiatrist if there is time before the next episode. If she threatens dad again, absolutely call 911 and have her evaluated in a senior behavioral health unit.
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I think I would start with a cognitive eval by her primary care doc (or a doc you trust). You don't need to tell her that's the purpose of the appointment, you can request an annual physical and come prepared with a note to pass to staff requesting this test AND also check to a UTI since the elder get these quite often and they frequently have no other symptoms other than confusion and changes in behavior. Antibiotics will solve it.

Once you get a bead on her cognitive levels then you can know just how much energy to spend on teaching, discussing, trying to change any of her current behaviors. If she is already down the path of memory loss, dementia or ALZ your strategy to change her behaviors through talk or video may be fruitless and just stress out your mom further. Hopefully you have your mom's medical PoA. Make sure you request the Medical Representative form at the doc's office so they can discuss your mom's issues with you without her present, and you can give them input the same. With this in place you can then discuss medications that may help your mom's behaviors so that you can buy some time keeping her at home until you figure out the future of their care, by whom and where. It is helpful for YOU to watch the Teepa Snow videos but not sure how much your mom will retain or receive without distressing her. I wish you success in helping her come to a more peaceful self and wisdom as you make decisions for their care.
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It sounds like mom would be better in AL (Assisted Living) and dad would be better in MC (Memory Care)
There are videos that your mom could watch that explain a lot about the behavior of a person with dementia BUT it will not change her behavior if this is the way she has always been.
Teepa Snow, there are videos that others have found useful and informative.
Has your mom seen a doctor about her behavior? There are medications that might help with her anger and anxiety. But under no circumstance should your dad be subjected to any type of abuse physical, emotional, psychological. I would suggest the next time your mom becomes violent call 911 and they can transport her to the hospital where she can be evaluated if she will not go to the doctor on her own. Tell her this is what you plan on doing if she does not begin to change her way of reacting
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