FINDING CALM IN THE CHAOS: NAVIGATING CARE-RECIPIENT ANGER WITH COMPASSION

“Chronic illness often brings out anger in people because it can be a multifaceted issue. It might stem from the disease process itself, difficulty communicating need, or even side effects from medications,” says Badr Ratnakaran, M.D., chair of the American Psychiatric Association’s Council on Geriatric Psychiatry and assistant professor and division director of geriatric psychiatry at Virginia Tech Carilion School of Medicine in Roanoke, Virginia. “Additionally, the loss of independence and changes in daily life that come with chronic conditions can lead to immense frustration and anger.”

A 2021 study in the journal Neurology Clinical Practice found that 18 percent of caregivers reported physically aggressive behavior among people living with advanced Parkinson’s disease. A separate analysis of 17 studies found that about 28 percent of people with Alzheimer’s disease show aggressive behavior, such as hitting and yelling, compared with about 7 percent of those with mild cognitive impairment.

Often, anger is a secondary emotion, a reaction to something deeper. It can mask feelings of fear, anxiety, sadness, or a sense of helplessness. “Taking a moment to identify what’s truly triggering the rage can be empowering,” says psychologist Deborah Derrickson Kossmann, author of Lost Found Kept: A Memoir. “Understanding the source of the anger and frustration is the first step toward addressing it effectively.”

Common causes of anger

Ratnakaran, Derrickson Kossmann, and other caregivers recommend paying close attention to these eight causes of anger issues.

• Anxiety: When someone feels anxious, they may experience heightened stress and frustration, which can make them more easily irritated or prone to angry outbursts. 
• Cognitive decline: Dementia and memory loss can lead to frustration and outbursts, especially when individuals struggle to express their needs or understand situations.
• Communication challenges: Some people may struggle to find words to express what’s wrong because of their condition. This frustration can lead to aggressive behavior.
• Infections: Pneumonia or urinary tract infections are well known for causing irritability and emotional outbursts.
• Loss of independence: The loss of control over their life and body is a significant and understandable source of frustration. 
• Medication side effects and interactions: Being on multiple medications can lead to unforeseen side effects, including grogginess, agitation, irritability and anger.
• Preexisting traits: People who were prone to anger before becoming ill may react more strongly when faced with the stress of a chronic disease, making their anger even more pronounced.
• Physical pain: Unmanaged or chronic pain can be a significant source of irritability and anger, especially when individuals cannot communicate their discomfort.

Caring through the conflict

Anger and aggression are among the most challenging behaviors caregivers face. It’s easy to feel overwhelmed or even mirror the anger when reacting. But staying grounded is key. Derrickson Kossmann shares the following practical tips to help caregivers defuse tension and protect their own well-being while supporting a loved one with compassion.

Rule out physical causes first. Before addressing anger as a behavioral issue, caregivers should always investigate potential physical causes. 

Recognize behavioral issues. Know that anger, especially in individuals with cognitive decline, can be a manifestation of unexpressed needs, like hunger, or discomfort. It can also stem from grief and loss over diminished independence or be a symptom of depression or anxiety.

Practice de-escalation. When faced with anger, caregivers should focus on toning down the situation rather than engaging in conflict. This involves staying calm, taking a breath, speaking gently, and steering clear of arguments or power struggles. It may even mean walking away without saying a word. 

Adapt the environment. Modifying the living space to support your loved one’s independence can greatly reduce frustration and anger. 

Validate Feelings and avoid correction. When a loved one with dementia or cognitive decline expresses anger or frustration, it’s essential to validate their feelings rather than arguing, correcting, or engaging in confrontation. 

See a therapist. When someone is struggling with anger and aggressive behavior, it’s important to see a mental health professional, such as a psychologist, psychiatrist, or specialized therapist. This expert guidance helps them understand the underlying emotional issues rather than just reacting to outbursts. 

Medication options. Antidepressants and antipsychotics may help manage aggression in individuals with neurological conditions. If non-drug approaches don’t work, discuss these options with a doctor. If medication is prescribed, make sure to tell the doctor if the person taking it experiences any side effects.

Don’t forget self-care. Caregiving can be emotionally, physically, and spiritually bankrupting, especially when dealing with anger issues. It’s crucial to implement self-care rituals, like meditation, eating well, pursuing hobbies, or therapy — not as a luxury but as a must-have to prevent burnout and effectively care for your loved one.​

Understanding anger in long-term care

What happens if your loved one directs their anger toward staff at a long-term care facility? Will your loved one be asked to leave or thrown out without warning? In most cases, the answer is no. Except in extreme, violent situations, when a resident may be admitted temporarily to a hospital, most facilities work closely with families.