dr-deb-forrest-older-alzheimer-patient-family-holiday-dinnerIf you are someone who lives with or cares for a person who has dementia, you know it can be painful, confusing and stressful without any behavioral disruptions.   One behavioral disruption that can become a very distressing complication of any form of dementia is agitation. The presence of agitation in a person with dementia only makes daily caregiving harder for everyone. Often caregivers and family members are taken by surprise when the person with dementia becomes agitated and begins to display more aggressive types of behaviors.  When these behaviors become increasingly more difficult to handle, outside support- e.g. the local police – may have to be called in to help manage the aggressive behaviors.  When such actions are required the caregiver and/or family members get upset.  Often, they feel guilty because they lose patience with their loved one and have to resort to such drastic actions.   Before circumstances surrounding the agitated person with dementia escalate to a level requiring outside assistances, there are things that you can do to help you and your loved one.

The person who is suffering from dementia is very sensitive to his/her surroundings. Any changes in the immediate environment are much harder to handle.  An ideal environment for the person with dementia is one that is structured, calming, comforting and safe.  An established routine helps to facilitate such an environment.  Any break in an established routine can cause feelings of confusion, fear and frustration.  The holidays are an especially stressful time for everyone. For any one suffering from dementia, the normal chaos that surrounds any of the holiday celebrations will cause a break in his/her daily routine.  This break can lead to feelings of confusion, fear, frustration and disorientation. Over time, they can lead to agitation and aggressive behaviors.

Treatment For Agitation

Early treatment is the best when dealing with agitation, because it won’t go away on its own.  Some research has shown that agitation can persist for 2 or more years.  If safe and effective treatment is started early then it is less likely to pose safety or health risks to the patient or to others. There are a number of options that family members and clinicians can employ to help manage the behaviors of  an agitated person with dementia.

Agitation Treatment

  • Providing the right environment
  • Supervising activities
  • Learning how to talk with a person who has dementia
  • Getting support for families and caregivers and improving coping skills
  • Medications

Providing The Right Environment

The caregiver needs to evaluate the environment of the dementia patient and determine if there is something in the routine that is contributing to the agitation.  Here are some things to look for that can lead to increased agitation:

  • Thirst and hunger. A person with dementia may often forget to eat,  Frequently offer them drinks and snacks.
  • Physical discomfort. Are they suffering from constipation or need to use the bathroom?  Have they been sitting to long do they need to take a stretch break.
  • Getting Dressed. Is the person having a difficult time dressing?  Are there too many buttons, snaps or zippers that it is making it hard to get dressed.  Provide clothing that is easy to pull on or off and does not have too many fasteners.
  • Regular exercise. Try to incorporate a simple walk or stretches.
  • Does the room they are in have adequately lighting?  Good lighting can reduce disorientation or confusion.
  • Chaotic environment. Having too many people around with noise from talking, loud TV or music or changing seating can also lead to aggravation for the patient.

Supervising Activities

Someone who is starting to get agitated can often feel better if they have something to do that makes them feel useful or is interesting.  Please keep in mind that they may need direction to find an appropriate activity to prevent frustration and agitation.  Here are some suggestions to help you:

  • Structure and routine. Remind the person that everything is going to be ok.  Make sure the routine is regular and predictable.
  • Pleasant activities. Make time for things the person will enjoy, like listening to music, coloring or watching TV.
  • Keep things simple. Break overwhelming or large tasks into smaller ones. For example, while preparing Thanksgiving dinner have the person stir the gravy.  This way they feel like they are contributing without having to prepare a full meal.
  • It may help to provide the agitated person with a substitute activity from what is making them frustrated.  If someone is restless or is fidgety take them for a walk.
  • Offer  the person a snack, put the TV on or their favorite music to interrupt the agitated behavior.
  • Be flexible. Behavior that you find bizarre may actually soothe the patient.  As long as the behavior does not interfere with their safety, it may not problem.
  • When a person becomes agitated it may help them to do a repetitive activity or give them a massage or brushing their hair.
  • Help the person with demanding tasks.  Don’t put the person in a position that will be too demanding and one they cannot handle.

Learning How To Talk With A Person Who Has Dementia

People with dementia will often forget the meaning of words or how to respond during a conversation.  The person and the caregiver can both become frustrated.  Here are some tips that can help you communicate more effectively with the person who has dementia.

  • Use simple concrete language.
  • Use simple sentences. Persons with dementia cannot process complex sentences or abstact concepts
  • Count to ten before getting upset. If you feel like you are about to lose your temper try counting to 10.  Try and remember that it is the disease – not the person – that is trying to make things difficult for you.  It is not personal.
  • Talk about feelings
  • DO NOT argue with the person with dementia.
  • Identify yourself and call the person by his/her name. Remember, the person may not remember you!  Do Not Ask Them: ” Don’t you remember me?”
  • When you are approaching the person do so from the front and give them time to get used to your presence. Make sure you maintain eye contact.  A gentle touch on the hand or shoulder may help.
  • Find a quiet place to talk. Try to limit background noise, such as TV or other people who are in conversation.
  • Speak slowly and coherently. Use familiar words and phrases.
  • Maintain a positive attitude and offer positive choices.
  • Use questions that require only a yes or no response or one word answers.
  • When someone is frustrated and you can’t determine what they want, keep the conversation limited to simple sentences.
  • Using gestures, visual cues and verbal prompts during with conversation. If you are going to go for a walk, then grab the person’s coat etc. and prompt them for the activity.
  • If the conversation is increasing the agitation, then drop the conversation and move on. It is likely the person will forget the issue and will start relaxing in awhile.

Support and Coping Skills

When the person with dementia – be it your loved one or a patient – starts exhibiting behaviors that you find uncomfortable, exhausting or frustrated it is important to remember that this is part of the disease.  Caregiver’s often struggle with feelings of guilt.  They need their own support system. They need to be frequently reminded that it is the dementia-generating disease that is responsible for the behaviors being exhibited and not the person they once loved or cared for.  Reaching out to local support groups will help you share ideas with others who are in a similar situation.  You can find the nearest support group by contacting organizations like the Alzheimer’s Association, the Lewy Body Disease Association, Traumatic Brain Injury Associations, Association for Frontal Temporal Lobe Degeneration, Parkinson Disease Organizations, Huntington Disease Organizations, Vascular Disease & Stroke Organizations or even a senior center or local hospital.

Medication

In some cases, an agitated person with dementia cannot be calmed down despite your best efforts.  If the level of agitation becomes severe,  it is important to consider using medication to help calm them.  Keep in mind that medication will not cure the agitation or dementia but will minimize the frequency or severity of the behavior.

Final Thoughts

dr-deb-forrest-older-alzheimer-patient-family-visitWhen agitation appears in the person with dementia – be it your loved one or a person in your care  – always remember that it is the dementia-generating disease that is causing the behavior.  Providing that person with a calming, structured, safe and caring environment can be helpful.  When you – the caregiver – begin to feel frustrated, keep in mind that there are support groups available to help You!  Learn as much as you can about the diseases of dementia and agitation. Understand that there are treatment options available to you that will make a difference in the quality of life for your loved one with dementia/ your patient with dementia AND for yourself.