By Aaron Allen, The Seattle Medium
Imagine watching your father—once a disciplined boxer—react violently during a medical emergency, not out of aggression, but confusion. That’s what happened when Sharon William’s father, disoriented by an episode related to dementia, punched and knocked out two medical responders who were there to assist him. The incident, driven by fear and cognitive decline, underscores just how unpredictable and emotionally complex dementia caregiving can be for families.
Such episodes are not uncommon in individuals with mid- to late-stage dementia, who can become overwhelmed by unfamiliar situations, sounds, or people. Though their actions may appear aggressive, these responses are often rooted in confusion, fear, and a loss of control.
Dementia is not a single disease, but a general term for a range of medical conditions characterized by abnormal brain changes. These changes trigger a decline in cognitive abilities—such as memory, language, and decision-making—severe enough to interfere with daily life.
“So actually, one of the definitions—how we define it clinically—is changes in thinking or memory that represent a decline from their baseline adult,” said Dr. Jackie Raetz, associate professor of family medicine and geriatrics at UW Medicine. “It’s a decrease from where they were at their peak as an adult, and it’s severe enough to affect activities of daily living.”
Tasks like managing household finances, taking medications correctly, preparing meals, and following schedules are typically the first to become challenging. In more advanced stages, even dressing, bathing, or feeding oneself may become difficult.
Multiple diseases can cause dementia, including Alzheimer’s disease, Lewy body dementia, vascular dementia, and frontotemporal dementia. Other medical conditions—like thyroid problems, vitamin deficiencies, or infections—can cause reversible dementia-like symptoms.
Despite its prevalence among older adults, dementia is not a normal part of aging. According to the CDC, more than 6 million Americans live with Alzheimer’s disease—the most common form of dementia—and millions more suffer from other related conditions.
“They also lose their ability to solve problems and maintain emotional control, and they may experience personality changes and behavioral problems, such as agitation, delusions, and hallucinations,” Raetz said. “While memory loss is a common symptom, it doesn’t mean a person automatically has dementia. We only diagnose dementia when at least two brain functions—like memory and language—are impaired without loss of consciousness.”
In William’s case, her father’s cognitive decline unfolded quickly and unpredictably. What began as mild forgetfulness soon became a daily struggle to manage simple tasks, followed by occasional confusion about his surroundings or relationships.
Caring for someone with dementia often falls to family members, many of whom are untrained and unprepared for the reality. According to the Alzheimer’s Association, more than 11 million Americans provide unpaid care for people with dementia. These caregivers often juggle full-time jobs, their own families, and emotional burnout.
“Use your own supports,” Raetz said. “This is really hard. So, if you have friends, other family, community, faith community—use your support systems.”
Resources like local Alzheimer’s chapters, online caregiver courses, and support groups can provide tools, strategies, and emotional support. Raetz said that even learning basic dementia care practices can significantly ease the burden.
“Educate yourself about what to expect as someone progresses through dementia,” Raetz said. “There are a lot of great programs out there. The Alzheimer’s Association has a 1-800 number and local training programs. There are also some really neat online caregiving resources.”
Williams said it wasn’t until she connected with other families in similar situations that she began to feel less overwhelmed. Being surrounded by people who understood the unpredictable behaviors and emotional toll helped her adapt.
“To be patient and to find someone in your family or church who has been dealing with a family member with dementia,” Williams said. “Reading about it isn’t going to help you. It’s a hands-on kind of learning experience.”
Daily communication with someone who has dementia can be one of the most difficult parts of caregiving. Raetz advises maintaining calm, clear communication and always including the person in the conversation, regardless of their stage of decline.
“Even if people are pretty advanced in dementia, they understand whether they’re being ignored or not,” Raetz said. “You want to be calm. Talk in straightforward sentences, clearly and directly, facing them when you speak. That can go a long way.”
In early dementia, individuals may still follow conversations but forget them soon after. Repeating questions isn’t an act of defiance—it’s a symptom of the disease. Understanding that distinction is key to managing frustration and fatigue as a caregiver.
Williams also emphasized the need for families to plan ahead—legally, financially, and emotionally.
“It’s a trust experience, trusting the people that are dealing with your family member—including those within your family or friends’ structure,” Williams said. “And the most important thing is to have a power of attorney or make sure whoever is in charge has the power of attorney, if that person is still able to do a will. To make that happen, there’s got to be someone you trust who’s going to communicate with the family.”
