In 2005 a movie was released that touched the hearts of those who saw it. But to the families of a loved one with Alzheimer’s disease, The Notebook has become a classic. In gripping narrative it recalls the tender, yet stormy love story of Noah and Allie. The setting is a rather upscale (and a bit prophylactic) nursing home with lovely amenities, a grandiose view, and manicured gardens.
Allie is always dressed exquisitely and her hair is never shabby. But her appearance cannot conceal her emptiness and her reel of broken memories.
In the movie, Noah reads to Allie from a notebook. The movie dramatizes their lives together: intense young love, misunderstandings, separation, other loves, rediscovery, marriage, children and the devastation of Allie’s Alzheimer’s disease. Noah faithfully reads to her from the notebook, but rarely does she recognize him or connect with him. When she does, the moment is astoundingly beautiful, and Noah’s loyalty is devotionally inspiring.
But in the blink of an eye, without warning, Allie becomes fearful, anxious, and enraged. She screams, hits Noah, pushes him away, attacks aides who approach her, and is finally restrained and sedated.
What happened? Could this have been avoided? Probably not. But the movie was masterful in the presentation of what I have found to be true in experience and supported in literature on Alzheimer’s. The escalation of emotion for no obvious reasons, and the suddenness of mood change from placidity to aggression is textbook behavior. Causes can only be conjectured, but must be strewn somewhere in the wide terrain of an awareness of lost human qualities: role, relationships, meaning, understanding, identity, independence, and freedom.
The vague awareness of such losses must evoke the most violent response possible – the need to break through the losses that threaten, confuse, restrain and encumber. Do it with abandon and with force.
Some caregivers will face violence, even life threatening aggression. But this is the worst case scenario, and some common sense approaches can sometimes help sidestep physical aggression.
· Recognize that aggression can be unbridled anger, brought on by feelings of isolation, loneliness, and powerlessness. Being present often to a loved one may help avoid frequent outbursts.
· Do not take unkind words to heart and respond in kind; avoid confrontation and arguing.
· Speak calmly, reassuringly, and with understanding.
· Listen with “a third ear” to what the loved one is saying, e.g. “You are trying to take my money.” Does he feel powerless, left out, distrustful about your activity, or worried about the future? Remember, we are unsure how much an Alzheimer’s patient comprehends. It is helpful to talk with him/her often about how things are going with the family, church, etc.
· Remove yourself and others from harm’s way if the loved one’s behavior becomes threatening.
· If aggressive acting out occurs often, clear the living space of potentially dangerous objects.
· Restraint should be a last resort; it escalates violent tendencies.
· When the episode is over, try to figure out what brought on the aggressive responses. These cannot always be determined; but if they can be identified the precipitating causes may be avoided in the future.
· It is important to have optional plans in mind; calm reassurance doesn’t always work; reason rarely does.
· Since aggressive behavior is often powered by subconscious neurological signals, a doctor’s help may be needed and medication regularly administered.
Sometimes the energy expended by a caregiver to balance his/her own emotions leaves little resource to handle excessive aggression from a loved one. Conditioning one’s mind about what to do in such a situation is helpful. However, sometimes it is apparent that even a “silken cord” cannot harness strong, irrational behavior. Plan ahead so that both the loved one and the caregiver are safe. Total care by professionals may be the kindest, most merciful conclusion.