Care Techniques
Introduction: In the Eye of the Silent Storm
As anyone caring for a loved one living with dementia knows, some days are harder than others. Especially when your loved one suddenly experiences a moment of crisis... These episodes—sometimes sudden outbursts of anger, intense agitation, or surges of anxiety—can be incredibly challenging for both the patient and the caregiver. If you are reading these lines, I want you to know that you are not alone. During those stormy moments, your heart races and your hands tremble too. This article aims to be a guiding light in the midst of that silent storm. Along with scientific recommendations, it offers emotional support, because in moments of crisis, you need to touch both the mind and the heart.
What is a Dementia Crisis? Types and Causes
In medical literature, the term "crisis" is often used to describe a sudden and severe change in behavior or mood. In individuals diagnosed with dementia, a crisis usually appears as intense restlessness, aggression, stubbornness, extreme anxiety, or hallucinations that suddenly arise and leave the caregiver struggling. Although each type of dementia comes with its own risks, research shows that about 40% of people with Alzheimer’s will experience at least one crisis or agitation episode during the course of their illness.1
Agitation: Restlessness, aimless wandering, throwing things, stubbornness.
Anger/Aggression: Shouting, swearing, sometimes a tendency to hit.
Hallucinations/Delusions: Seeing or believing in things that aren’t real.
Intense Anxiety/Panic: Inability to express oneself, sudden crying, fears.
Although crisis moments usually have a cause (physical discomfort, communication problems, environmental stressors), sometimes there is no apparent trigger. This can make the situation even more difficult.
Scientific Approach: Understanding and Managing Crises
Scientific studies show that managing crisis moments in people with dementia first requires a focus on the underlying cause.2 Knowing that the person's behaviors arise involuntarily and as a result of the disease can relieve some of the caregiver’s emotional burden during intense episodes.
The most recommended approach in crisis management is the so-called “Emotional Integrity Model”, a method focused not on suppressing a person’s emotions but on making sense of and accepting them without judgment.3 Some scientifically proven steps are listed below:
Ensure Safety: First, check whether your own safety and the patient’s safety are at risk.
Identify the Cause: Investigate possible reasons such as hunger, pain, the need for the restroom, environmental noise, or a room that is too hot or cold.
Approach Calmly and Slowly: A calm voice, slow movements, and short sentences make a big difference.
Distraction Techniques: A favorite song, a familiar photograph, or a tactile object often helps.
Accepting and Gentle Language: Instead of trying to change the patient’s emotions, saying things like "I see that you’re scared" or "It’s completely normal to feel alone right now" can be reassuring.
In Practice: Crisis Phases and Methods
Here’s a summary of steps you can take during a crisis, blending scientific understanding with real-life experience:
1. Calm Yourself and Breathe: They are watching you: the calmer you are, the more they will feel your emotion. The 4-7-8 breathing technique (inhale through the nose for 4 seconds, hold for 7 seconds, then slowly exhale through the mouth for 8 seconds) can be effective for both you and the patient.
2. Evaluate Physical Contact: A person with dementia may feel threatened. Ask for permission before gently touching their arm or holding their hand.
3. Observation and Eye Contact: Speak face-to-face, at eye level. A steady and compassionate look provides reassurance.
4. Short and Clear Instructions: Avoid long sentences. For example: "Let’s sit together now."
5. Remove Environmental Stimuli: Noise, excessive light, or crowded spaces can intensify the crisis. Move to a quiet and safe area if possible.
6. Focus on Emotions: Instead of “Why are you doing this?” say “I sense that you’re anxious.”
7. Familiar Objects and Photos: Recognizable objects or photos with loved ones can help some people distinguish what’s real.
8. Take Brief Breaks: Sometimes leaving the room for a short time or taking a breather can allow both you and the patient to reset and start fresh.
Getting Through It Together: A Story
I remember a client sharing an experience in which her mother, in the evening, started having a rage crisis for no apparent reason. Her mother suddenly thought she was someone else, lost trust, and began yelling. The first thing I recommended was to take a step back and gently repeat, “I understand that you’re scared right now, and I’m happy to be here with you.” That night, by humming her mother’s favorite song together, the crisis gradually faded away. As you can see, sometimes small but meaningful steps can calm even the fiercest storms.
Don’t Forget Physical and Environmental Causes
Crises in people with dementia are not always psychological. Studies show that infections, pain (like toothaches or headaches), urinary tract infections, hunger, or constipation are responsible for more than 40% of behavioral changes.4 Here’s what you should do if a crisis is particularly severe:
Observe body temperature, pulse, and respiration
Evaluate restroom habits and fluid intake over the last few days
Check for skipped meals, missed medications, or recent medication changes
See if there are new objects, unfamiliar people, or unusual noises in the environment
If the crisis points more to organic causes than emotional ones, reaching your doctor quickly can be vital.
When Should You Call for Help?
Sometimes, despite all your efforts, a crisis may be intense. Be sure to seek professional help in situations such as:
If the individual is at risk of harming themselves or someone else
If there is loss of consciousness, severe shortness of breath, fever, or confusion
If agitation occurs for the first time and there is no known reason
If there are major behavioral changes and any new medication or dosage adjustment
At such times, do not hesitate to ask health professionals for help—it’s not a weakness, but rather a sign of courage to reach out.
After the Crisis: After the Quiet Storm
Remember, even after a crisis has passed, both you and your loved one need emotional rest and recovery.
Take a deep breath together after the incident
Note what worked and what didn’t in handling the episode
Say a few kind words to yourself: you did your best—you tried to cope
Having a glass of water or going for a short walk can sometimes help
It’s not easy to accept that some days will bring more crises. But with every episode you manage, you’ll become stronger and gain deeper understanding of both yourself and your loved one.
Some Statistics & Scientific Observations
Type of Crisis | Frequency (Alzheimer’s) | Main Contributing Factors |
|---|---|---|
Agitation | 30%-50% | Pain, hunger, change of environment |
Anger/Aggression | 20%-40% | Misunderstanding, fatigue, anxiety |
Hallucinations, delusions | 10%-25% | Medication side effect, infection |
Source: Compiled from data by the World Alzheimer’s Association and the Turkish Alzheimer’s Association.
Show Compassion to Yourself Too
While you are doing more than your best for a loved one with dementia, do not forget yourself. Remember, your emotional strength is the foundation of good care. Don’t hesitate to seek support. You don’t have to resolve a crisis by yourself. Try to build your days around small victories; sometimes, just helping your loved one take a spoonful of soup counts as a big achievement.
Final Word: Stronger Together
Dementia is a journey. It’s a long road where the storm sometimes rages and sometimes the sky shines bright. Crisis moments will not always be as dark or frightening as the day before. When you approach these challenging times with knowledge and compassion, you can get through them together. Remember at every step—you are not alone.
Resources
Livingston G, et al. (2017). Dementia prevention, intervention, and care. The Lancet.
Turkish Neurological Society. Guidelines for Dementia and Behavioral Disorders (2020).
Cohen-Mansfield J. (2008). Nonpharmacologic interventions for agitation in dementia: A review of the literature. The American Journal of Geriatric Psychiatry.
World Alzheimer Report 2022. Alzheimer's Disease International.
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