There is no telling when my 90-year old grandmother with dementia is going to throw a temper tantrum. Honestly, anything can set her off at any time. She can be overly tired, overly stimulated, confused, hungry, thirsty, frustrated, embarrassed, feeling rushed or even stuck in a loop fixated on this one particular thing that is only in her mind.  Really, the only thing(s) that I can do is to:

• Ignore what she says. When in a full blown tantrum the meanest things can come out of the mouth of someone you love and who loves you. That happens even when the person does not have dementia as an excuse. But in the instance with my grandmother, I cannot take those words to heart because I know better. My grandmother raised my mother and helped to raise me. Despite her faults, of which there are many, and the fact that she does not remember who I am, I know she loves me.
• Stay calm/patient and breathe. This is hard. This is really, really, really hard. Particularly when my grandmother throws a tantrum or goes into a loop while being bathed, going to the bathroom in general or even as we’re trying to get her ready for the adult day center. It’s like this constant race to beat the clock so she’s not annoyed by the bath, not soiling herself, not feeling like she’s being rushed or who knows what else. So I constantly remind myself that it’s not the end of the world if we have to cut the bath short or she doesn’t quite make it to the commode in time (luckily she has pull-ups and I am fully stocked with Clorox wipes) or even that the van to the day center that picks her up has to wait an extra minute for us to exit the building. Also, I don’t know how or why but my grandmother does pick up on stress and anxious energy of the people around her. I’ve had the most success in calming her down when I remove her from those excited people, allowing her to focus better.
• Redirect. Whenever my grandmother is in a loop – constantly repeating herself, working herself up or fixing/folding anything and everything around her or on her – I find that redirecting her attention to something I know she loves works the best. Sometimes that pictures of us as kids or even pictures of the dog.
• End the conversation or just be silent. Because my grandmother has lost some of her language (both Spanish and English), she gets frustrated thinking we are not including her in a conversation, gets upset when she doesn’t understand us or vice versa. So I just stop the conversation, go back to taking that breath and figure out next steps. At the end of the day, does it really matter that I “win” the conversation or have the last word? Eh, not really. Actually, not at all. She probably doesn’t really understand the conversation anyway and what matters is that she stays calm, happy, clean and with a full belly. Sometimes the thing that works me up the most is the constant repeating of myself when she’s stuck in a loop and not listening to my direction. So I go silent, stop talking, and patiently try to redirect her without words.
• Have a snack. Sometimes my grandmother is just plain old hungry. She snacks in between her breakfast, lunch and dinner so she’s eating almost every 2 hours. So when she’s hungry, she gets hangry. Yes, hangry. I try to have quick meals and snacks available whether we’re home or out and about.
• Be in the moment. It’s easy to do work or cook/clean while I have her sit and color, watch T.V., or even listen to music. And I take it for granted sometimes thinking I can go to another room or let myself get distracted. The important thing to remember is that while I’m with her, if she needs anything, I cannot get upset because she’s taking me away from whatever it is I was doing or even that she’s talking through the movie I’m in the middle of watching. I have to remember that she is limited with what she can and cannot do and especially with how she can or cannot express herself verbally. So when she interrupts, I stop and put all my attention to her and stay in the moment.
• Remember because she can’t. At the end of the day – heck, during the entire day – I have to remember that she has dementia and that I chose to give her the best care by bringing her home with me despite how difficult it would be. Most of the time when my grandmother is in distress, she becomes confused and it’s a guessing game as to what she is asking for so we are stuck figuring it out together.

Finding strength and love in the middle of a tantrum is definitely a difficult thing. I mean, caregivers of family members with dementia should be considered saints and anyone working in a care facility with dementia patients/residents need to be paid more – much more. I find myself constantly stepping away to breathe and remind myself of grandmother’s limitations. After she settles from a tantrum though, I try to make her laugh and put a smile on her face in an attempt to erase the upset she was feeling altogether.