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Tips for Dealing with Agitation in People with Dementia

Frustration, stress. Headshot senior woman screaming

When you are caring for a patient or loved one with dementia, it is very likely that you will have to deal with periods of agitation that were not typical of the person before his or her memory started to fail. Like other behaviors that are common in people with dementia, understanding the causes for agitation and how to cope with it can be helpful. We refer you again to The Alzheimer’s Association website and their specific information on Agitation. In this blog we will summarize some of the helpful information found on that website and others. Careful consideration of the person’s routine, medical requirements and social needs can curb many of the problems before they begin.

Possible Causes of Agitation

A dementia sufferer may become agitated for physical, medical, psychiatric, or environmental reasons, or because of a lessening ability to think. As a person with dementia experiences a loss of their ability to process new information and environmental stimulation, frustration can cause agitation. Those who display physical or verbal aggression as part of their agitation may require a combination of drugs and other types of treatment. Medications can sometimes cause undesirable side effects, so it might take a lot of trial and error to get the right medication and the right dose. Work closely with a qualified physician or psychiatrist.

Agitation tends to get worse over time and is persistent. Some behavior issues you might encounter include:

  • Demands for attention
  • Pacing, searching, or rummaging
  • Hitting, biting
  • Yelling, threatening
  • Stubborn refusals to participate in activities
  • Irritability and frustration

Situations that may lead to/trigger agitation

  • Illness or injuries
  • Changes or disruptions in environment, routine or comfort zone
  • Changes in caregiver arrangements
  • Fear of perceived threats
  • Fatigue caused by lack of sleep or trying to make sense out of what’s happening
  • Pain and discomfort from sitting in the same position for too long
  • Overstimulation or, conversely, not enough activity
  • Loneliness
  • Being too cool or warm
  • The inability to communicate one’s thoughts or needs
  • Hunger and thirst
  • The need to void

Tips to help prevent or lessen agitation

Approaches that have been helpful in the past should be tried first. Distract aggressive patients rather than trying to reason with them. Closed-ended questions (e.g., “Would you like soup for lunch?”) instead of open-ended questions (e.g., “What would you like for lunch?”) may be less confusing and stressful. Focus on responding to the emotion rather than the content of what is said. Other tips include:

  • Listen to the frustration. Find out what may be causing the agitation, and try to understand.
  • Provide reassurance. Use calming phrases such as: “You’re safe here;” “I’m sorry that you are upset;” and “I will stay until you feel better.” Let the person know you are there.
  • Create a calm environment. Remove stressors. Simplify routines. Move the person to a safer or quieter place. Offer a security object. Recount pleasurable experiences.
  • Avoid environmental triggers. Noise, glare and background distraction (such as having the television or radio on) can act as triggers.
  • Monitor personal comfort. Check for pain, hunger, thirst, constipation, full bladder, fatigue, infections and skin irritation. Make sure the room is at a comfortable temperature. Be sensitive to fears and to frustration with expressing what is wanted.
  • Provide an opportunity for exercise or other distractions. Go for a walk or a ride in the car. Try using art, music or other activities that engage the person.
  • Use low lighting during the day and night-lights to help with fear and confusion at night.
  • Keep your emotions in check and your voice calm and steady. Avoid arguing or criticizing.
  • See the doctor to rule out any physical causes or medication-related side effects. If you can’t stop the agitation on your own or the problem is very severe, the doctor may recommend medications that can help.

Behavioral approaches

How you speak with the loved one suffering from dementia matters. Try to avoid confrontation and too many questions coming too rapidly. If you must ask a question, keep the phrasing simple and leave plenty of time for the person to answer. If the person is easily confused, avoid slang terms, and try to keep the sentences short (7 words or less). Always offer reassurance, and be prepared to repeat statements and questions as needed. Engage the person in conversation regularly to help curb loneliness.  Offer choices, (e.g., Do you want to wear a blue shirt or a red shirt?) If you see a pattern, remove triggers, distract and redirect. It’s best to prevent agitation before it happens.

As you and the dementia patient get to know one another better, you will start picking up the signs that can help to set an agitation avoidance plan in motion. Meet them where they are; be in their moment. You will find that certain things almost always set the patient off, so those are the things you correct first. Soothing the patient is important if nothing else works. Soft tones, touching or hugs if welcome (approach the person from the front and slowly) or simply talking is sometimes enough to prevent agitation.

DTN Home Care’s Director of Skilled Services, Allison Palmer, reviewed and contributed to this blog. She has had extensive experience and training in memory care. She managed a memory care unit in Bismark, ND, for years. When you use the services of DTN Home care for a loved one with dementia, Allison’s experience will be a resource you can draw on.

Additional advice can be found on these websites:

http://www.psychguides.com/guides/dementia/

http://www.webmd.com/alzheimers/guide/treating-agitation

http://www.aafp.org/afp/2006/0215/p647.html

http://www.psychguides.com/guides/living-with-a-family-member-with-dementia/

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