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Caring for a Difficult Older Adult

Try these strategies to remain effective and sane when you're taking care of someone who's difficult

Being a caregiver for an aging parent has its challenges — and the situation can be even tougher if you're dealing with an older person who is belligerent, irritable or just plain difficult. How do you deal with a situation like that? Here are some ideas to help dial down the tension:

See also: 9 secrets of caregiving.

1. Put yourself in his shoes. The changes and limitations of old age can be frustrating and difficult to accept — especially if you don't feel really old inside (and who does?) A society that is as fast-paced as ours makes it even harder. For many seniors, the world can seem abrupt and unkind. So understand that your loved one's difficult mood is not directed at you, but rather the situation he finds himself in. Don't take it personally.

2. Keep track of mood changes. Recognizing any patterns to the outbursts can help you avoid or prevent them. Is he angry and difficult all the time, or is there a pattern to the outbursts? Some seniors, especially those with Alzeheimers or other types of dementia, become extremely confused and agitated in the late afternoons or early evening. Experts call this Sundowners Syndrome or sundowning. [Mary, no need to get fancy. Everything is a bit disorienting when the sun goes down. Which reminds me, is it happy hour yet?] If you notice this pattern, encourage your loved to nap as much as possible during the day and limit visitors and activities in the late afternoon that are too stimulating. Instead: Play music, read quietly. Also remember that anger is often a sign of depression, which can exacerbate existing health issues and cognitive decline. Consult a physician to see if there's an underlying problem.

3. Build a support network. Don't try to do this alone. Every caregiver needs a web of support. Set up a website such as www.lotsahelpinghands.com or a Google document listing what needs to get done as well as names, phone numbers and emails of family members, friends, doctors, pharmacists, housing managers or front desk staff at your parents' apartment building who can help. Everyone can sign up online so you don't need to make 100 phone calls.

4. Remember that how you say something is as important as what you say. Do not be patronizing. Your loved one may need your help, but she is not a child so don't treat her like one. Without raising your voice, speak clearly and kindly. If you think you have been misunderstood, repeat what you're trying to say in a different way, without eye rolling, shouting or impatience. Especially with people who have dementia, give one direction at a time with a kind tone: "Put on your coat, Mom" and then "Let's go to the car." Take plenty of deep breaths as needed.

5. Don't lash out, don't fight back. Yes, it feels terrible to be the target of angry complaints that are neither rational nor deserved. But instead of lashing out defensively — which escalates the confrontation — take a deep breath and, if necessary, step out of the room until you are calmer. When you do respond, choose your words carefully. Make eye contact, acknowledge her frustration and stick with "I" statements: "I want to help you — how can I do that?" or "I know you're upset right now, but do not speak to me that way. I will be right back." Adults, as well as children, can benefit from a 'timeout.'

6. Consider your own role in past conflicts. Talk to relatives or friends, or consult a therapist, about any guilt and anger you may feel. Think about issues that have triggered past arguments — Politics? What you saw in your husband in the first place? — and avoid or ignore them. If you continue to butt heads, delegate caregiving jobs that require personal contact to someone else while you pay bills or handle meal planning. No one gets along with Grandma? Chip in and hire a professional geriatric care manager. If you live far away, the manager can help you coordinate care from a distance. Take the time to find someone that you and the person you're caring for both trust. Nobody's perfect, but we all deserve a dignified old age.

7. Avoid situations that trigger conflict. If you and your mother always bicker when you visit her at home, suggest a drive or going out for lunch or tea. Sometimes, being in public can change the dynamic between you and usher in better behavior. Or bring a project you can do together: Tape an oral history of her childhood, or organize photos in an album.

8. Take care of yourself. Exercise, take time off, join a caregiver support group. Sharing your experiences with people who are living through similar situations will give you the burst of energy and hope to get through the week.

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