A catastrophic reaction is a sudden fit of rage that usually comes in response to stress or an overstimulating environment.

Once the out-of-control older person starts cursing, shouting, threatening violence, hitting, biting, or kicking his caregiver, it's hard to stop him.

Avoid catastrophic reactions by following these suggestions:

• Give one direction at a time. Multiple directions such as"Finish your sandwich, wipe your face, put the dishes in the sink, and wait for me in the living room," delivered in a staccato voice, can initiate a rage reaction.
• Never rush your elder. Words like "Hurry up, we'll be late" create anxiety and can tip the confused elder into an emotional frenzy. Allow plenty of extra time to get ready for appointments.
• Don't force your elder to participate in an activity that he's resisting.
• Protect your confused loved one from fatigue, which puts him at high risk for losing control.

Restraining or criticizing his behavior only makes a catastrophic reaction worse. Try backing off, speaking in a soothing empathic voice, and using distraction. In the midst of a catastrophic reaction, be careful not to further upset the elder with any sudden movements he may consider threatening and that may escalate the episode.