Coping with Catastrophic Reactions

As a Care Manager, it is not uncommon to get calls from our caregivers stating that their client with dementia “turned angry” or “aggressive” in an instant. He or she threw a tantrum or they “lost it”. These tantrums can be vocal and or physical – they can involve shouting, becoming upset, throwing things, physically pushing you away, or even causing bodily harm to themselves.

These meltdown behaviors have a name: Catastrophic Reactions. These reactions are an emotional outburst of fear, stress, or other suddenly overwhelming emotions. It is not uncommon behavior for moderate-stage dementia.

How to Deal with Catastrophic Reactions in Dementia Patients

If it happens to you, do not panic. Instead, retreat for a few moments and allow the patient to calm down – it is difficult for your patient to process messages (even if they are calm) when he or she is emotionally “hot”. Stay calm yourself. Sometimes, this is a very difficult move to make but staying calm means staying in control.

Next, see if you can identify the trigger of the outburst. Run a mental review of what just happened. By mentally reliving the scene, you can usually trace the trigger to something you said or did (or maybe didn’t do). It could be as simple as something in the environment: light shining in the patient’s eyes, a loud noise close by, or even an unwanted surprise. Recognizing the trigger is of the utmost importance.

Start over again with the patient without mentioning the incident. Remember to stay calm  and to announce your intentions in a reassuring way (be calm and reassuring).

If your patient continues to seem “not right”, know that the outburst may not be strictly emotional, but physical. A sudden change in behavior, especially cognitive reasoning skills, can be caused by delirium. Delirium is a common complication of infections or other systemic problems in older adults, especially those with dementia. Above all, be sure to contact another family member if you have one – it always helps to journal the incident, review it, and identify the triggers.

Remember: do not try to be dominate! Stay calm, reassuring, safety conscious, and stay in control.