Managing a Crisis (Credit: https://csomaycenter.uiowa.edu/geriatric-mental-health-training-series)

Caring for a person with dementia and problem behaviors can be challenging and stressful. The purpose of this document is to help caregivers learn to manage difficult situations, especially when the person with dementia is upset, angry, or scared.

1. First, tune in to your own ATTITUDES and FEELINGS about what is going on.

   • Getting angry won't help and will probably make things worse. Being caught off guard puts you at risk for "fueling the fire" (e. g. the first time it happens you "fight back" vs. assess and problem-solve through the crisis). Likewise, if you are angry or resentful about past experiences with the person, you probably won't be effective.

   • Try to remain calm, cool, and collected.

   • Use positive self-talk to get yourself under control. For example, remind yourself:

     • • "This person is uncomfortable and needs my help."

       • "I can handle this. I don't need to get upset too."

       • "They're not really angry with @. They're just upset and I'm in the way."

   • Avoid words or actions that might threaten the person even more.

   • If you can't get your own feelings under control, leave the area immediately, alerting other staff if needed.

2. Keep track of what you are doing with your body and what that might mean to the person.

   • Don't surprise them; move slowly and steadily.

   • Keep your hands out where they can see them, palms up and open, which is non-threatening.

   • Respect their "personal space;" the more threatened they are, the more distance you should give them.

   • Don't stand squarely in front of them (which is very confronting and threatening); turn slightly to one side.

   • Be careful to not stare, glare, or otherwise challenge the person with eye contact.

   • Don't turn your back on the person.

   • Always leave yourself an escape route.

   • Avoid standing over the person (if they are sitting or reclining), which can be very threatening.

3. Think about WHAT you say and HOW you say it.

   • Speak in short, simple phrases.

   • Use a normal tone of voice and talk at a normal rate.

   • Communicate concern and caring.

   • Avoid sarcasm, insulting remarks, and even humor (which can easily be misinterpreted).

4. Use DIRECTIONS or EXPLANATIONS that are APPROPRIATE for the person and the situation. For example:

   • "I'm sorry if I upset you. That wasn't what I meant to do."

   • "Your behavior worries (frightens, upsets) me."

   • "How can I help you be more comfortable?"

   • "Mr. Smith, let's go to your room (a quiet place, etc.)."

   • "It's all right now. You are safe with me. I won't let anything bad happen to you."

5. Listen carefully to what they are saying and try to respond to the message they are trying to communicate.

   • Check for meaning, "You're saying that ..."

   • Avoid giving advice.

   • Respond to the content of their message (the actual meaning), not the way it's being said.

• • • Try to understand what they are upset about.

    • Respond to that unmet need or feeling.

5. • Don't assume that they have heard or understood you.

• • • Our focus becomes very narrow when we're anxious.

6. Try to calm or soothe them, remembering that the first priority is to protect yourself and others.

   • Leave the room or area if they continue to threaten you.

   • Get assistance, even if you aren't sure if you really need it.

   • Use physical control only as the last resort! Try everything else first!