How to cope with a challenging or abusive care recipient

CODEPENDENCY AND TOXICITY Despite a toxic relationship, sometimes there’s a codependency involved, says Suzette Abend, a licensed clinical social worker in Long Beach, California. Many care

recipients drink, which she says “fuels the flames” of aggression and vitriol. Caregivers buy the alcohol because they fear what will happen if they don’t. And, she says, sometimes

caregivers are financially dependent on the care recipient’s income. “The adult child is living in the care recipient’s home and does not have a substantial enough income to live on their

own. They’re typically unemployed and themselves could be on Social Security,” she says. Elder law attorney Stephanie Townsend Allala of El Paso, Texas, says she’s very familiar with the

dynamic. “It’s the person who does the most for you and cares for you — that person is the one that takes the brunt of the abuse,” she says. “Whatever bile or anger has been saved up over a

lifetime, something starts spilling out to the nearest person. When people start to lose the ability to hear well, talk and speak and communicate their wishes, they resort to physicality.”

Townsend Allala says, “The law doesn’t say because you have dementia you can’t be charged with a crime, but often it’s the element of intent that you’re not able to prove in a dementia

case.” ‘THIS IS THE DEMENTIA TALKING’ Rob,* 57, of Manor, Texas, is caregiver for both his parents and his partner, in addition to working full-time at a nonprofit and at a part-time job as

well. Although his parents — both in their mid-80s and with health conditions but who can live independently with his oversight — haven’t expressed aggressive tendencies, Rob says his

partner of 24 years has had a personality change because of early onset dementia diagnosed about five years ago. “When he’s very tired, he goes into fight-or-flight mode. His base instinct

is to be very argumentative. Many things become my fault,” Rob says of his 60-year-old partner. “At first, I took it very personally. But then, you start seeing a pattern and this is the

dementia talking. It’s not me.” Christopher’s caregiving “break” is a job. He works two weekend nights at a brewery and pays a neighbor to check in on his mother while he’s at work. He

says having his mom live with him has helped him gain valuable tools to let go of some of the anger he has felt toward her. Still, he takes every day as it comes. “I really don’t know how

much longer I can continue to do this,” Christopher says. “It’s almost beyond what I’m capable of.” _*For privacy, last names have not been used._ EXPERTS OFFER TIPS TO DEESCALATE AN

AGGRESSIVE SITUATION KIM BARNES, COFOUNDER OF PARENTING AGING PARENTS, ONLINE COMMUNITY NETWORK Barnes suggests diversionary tactics, such as asking the care recipient for help with a task

like knitting or sewing or looking for a specific photo in a family album to change the subject. They’ll likely forget about the argument. PEDRO CARBAJAL-MADRID, CLINICAL DIRECTOR AT

INDEPENDENCE AT HOME, A PROGRAM THAT SUPPORTS OLDER ADULTS WITH NO-COST PROGRAMS AND RESOURCE REFERRALS “Number 1 is ‘Don’t challenge the care receiver.’ ” He urges caregivers to “become

aware of your own process. Stay calm as much as possible. Lower your voice and do not engage, even if the behavior coming at you is upsetting.” BRIAN CARPENTER, PROFESSOR OF PSYCHOLOGICAL

AND BRAIN SCIENCES AT WASHINGTON UNIVERSITY IN ST. LOUIS The stage of the disease will affect a caregiver’s actions, he says. In early stages, it’s possible to have candid conversations with

the care recipient about acceptable and unacceptable behavior — what you can and cannot say to me. But in later stages, end the conversation. “Walk out of the room. Try not to get into it

with people.” He also advises caregivers to contact their local Alzheimer’s Association for support groups.