Conflict, anger, frustration

1. Conflict, anger, frustration Elder rage The communicative predicament Anger management

2. anger management

3. Angry brain Harvard 2004 study: A look into the brains of normal subjects revealed that anger increases blood flow to a reasoning part of their brains, an area over the left eye just behind the forehead, technically called the orbitofrontal cortex. This flow inhibits thoughts of rage. At the same time, blood flow increased activity in the amygdala, an almond-shaped knot of tissue deep in the brain that deals with emotion and vigilance. … But in people dealing with both depression and rage, things go a different way. A decrease in blood flow to these areas of the brain reduces both their ability to control impulsive acts and their feelings about the consequences of those acts, say punching someone in the mouth. There is both a lack of emotion and a lack of control. A double hit that adds up to inappropriate, even violent rage. http://www.news.harvard.edu/gazette/2004/08.26/01-anger.html

4. Interactive brain map http://www.bbc.co.uk/science/humanbody/body/interactives/organs/brainmap/

5. John Elder’s Anger Log • 1. Describe the event that triggered your anger & how you responded: • 2. Give a synonym for your anger level (furious, annoyed, enraged, etc.), and rate your anger on a scale of 1 – 10. • 3. What were the first symptoms of your anger—how did you first notice you were angry? • Thoughts/judgments: • Body sensations: • 4. What were the primary emotions that you felt? • 5. What were your unmet emotional needs? • 6. What factors made you more prone to anger in this situation? • 7. What beliefs led you to the anger path in this situation? • 8. What cognitive distortions did you experience? • 9. What anger management steps did you apply? What would you like to do next time? • 10.What amends do you need to make? To yourself? To others?

6. A sample of cognitive distortions

7. John Elder’s Anger Poetry Exercise “Anger is not just a rational, left brained phenomenon. Part of the challenge of teaching anger management is to enroll the right brain and deeper emotional portions of the brain to become more conscious and aware of when anger is brewing. This allows a person to begin managing his or her anger sooner and to have an easier time maintaining calm behavior. • The Anger Poetry Exercise is designed to stimulate visual and emotional portions of the brain, as well as echoes of childhood memory. It brings them all together a beautiful piece of poetry that raises awareness of the emotions and feelings that preceded anger.” http://www.jelder.com/

8. Marcell: Elder Care & Elder Rage http://ezinearticles.com

9. Morell’s Elder Rage BEHAVIOR MODIFICATION I started behavior modification on my eighty-three year old father. By using the techniques of "tough love" reward and consequences, he learned how to behave and control his temper most of the time, even with the onset of dementia. When he is on good behavior he gets rewards of praise, affection, attention and extra dessert. When he is asserting his life-long need to control and boss people around, he gets negative consequences: no dessert, minimal communication, no attention, no affection. He has finally learned that there is no "pay-off" for pounding his fists and screaming and yelling. He will not get his way period, and no one cowers. We walk away 100% of the time.

10. Elder rage – Jacqueline Marcelle

11. Caregiver burden scales Burden is typically defined as * the extent of workload measured in terms of the number and types of care tasks performed (e.g. assistance with household chores, banking tasks or personal care tasks) and or the number of hours spent performing these tasks. * the caregiver's judgment concerning the distress or difficulty associated with performing the care tasks. * the "perceived" impact of this workload on the caregiver's life.

12. New caregiver burden: early onset dementias “Today's baby boomers are all too familiar with the agony and havoc wrought by AD. They care for ailing parents while wondering if the disease will derail their own expectations of a strong and lucid old age. Most are vaguely aware of the public health crisis that looms in the coming decades, with 12 million U.S. cases and 81 million worldwide by 2040 if preventive therapies are not found. But lost amid these vast numbers is a rarer form of the disease that remains largely unknown to society. It is early-onset familial Alzheimer disease (eFAD), a particularly aggressive version that strikes in the prime of life, often just as its victims are raising their own families. Some begin to deteriorate in their early thirties. Worst, this form of AD is inherited, afflicting one generation after the other. “

13. Reducing agitation Substitute for interactive workshop, for 2 CE Landreville et al, 2005. Gerontological Nursing