Older adults with dementia (a disease that causes problems thinking and remembering) are frequently confused. Sometimes, this confusion becomes more problematic than usual, and the person with dementia can become agitated. This can be a frightening and stressful experience for both you and the elder! Today, we'll go over some of the causes, and caregiver tips to help.
What do we mean by "agitation"?
Doctors often refer to agitation as “behavioral disturbance” – a change in the way the person is behaving into something that wouldn’t be considered part of normal emotions and reactions. "Agitation" can take a lot of different forms, including:
- Crying uncontrollably
- Cursing or yelling at people in everyday situations
- Screaming the same words over and over again, such as “help me!”
- Hitting, punching, slapping or scratching
- Using a cane or walker as a weapon
Why does agitation happen?
Agitation happens when the elder with dementia is in some kind of distress but isn’t able to express themselves and fix their problems. In many ways, an agitated older adult is similar to a crying baby – there could be many reasons why, and it’s up to caregivers to figure out what’s wrong this time.
In order to help stop the problem, it takes a little bit of detective work.
Physical problems. Agitation can be a result of:
- Thirst or dehydration
- Needing to urinate
Emotional problems. Agitation can also be an expression of:
- Feeling overwhelmed
Psychological problems. In some cases, older adults with dementia can experience problems with how their brains process what is happening in the world. This can include
- Hallucinations – seeing or hearing things that aren’t really there
- Delusions – believing things that aren’t true. Some examples include that their belongings have been stolen when they are still in the house, or that their family members are impostors.
If you think that the elder is having delusions or hallucinations, it’s important to discuss it with the person's doctor.
Caregiver Tips: 4 Steps to Relieving Agitation
Step 1. Determine the pattern.
Tease out when, where, and under what circumstances the older adult becomes agitated. Some common examples include:
- During bath time or with clothing changes
- In noisy surroundings
- Evening hours
- When startled
It often helps to keep a log or journal of agitation, including what time it happened, what had been going on right beforehand, what the person was doing, what other nearby people were doing, and what kind of agitated behavior resulted. You might also include anything you tried to calm them down, and whether or not it worked.
Step 2. Think about what you already know.
Racking your brain for what you already know about the elder will help you put the agitation into context. Ask yourself:
- What health problems does the elder have? Do they have had knee arthritis that might be causing them pain? Did they complain about constipation when they were younger? Is their eyesight very poor, and might they not be able to see someone who is standing to their side?
- What were their habits? Was this person a night owl who always stayed up late, but now has to go to bed early because of the family’s schedule? Was this person a loner who never liked to be in large groups?
- What did they like to do for fun? What would calm them down when they were upset as a younger and healthier person? Did they like to listen to music, spend time outdoors, or cuddle with a beloved pet?
Step 3. Ask more questions.
When the older person is agitated, try asking them what’s wrong. If you don’t get an answer, ask more specific questions, like:
- Does anything hurt? If the answer is yes, but they can’t show you where try gently pointing to different body parts that might hurt. Common spots include knees, back, and belly.
- Do you have to go to the bathroom?
- Are you scared? You might follow this up with What are you scared of?
- Do you want a glass of water?
- Do you want your ______? Some favorite objects might include glasses, particular blanket, remote control, or book.
Step 4. Put 2 + 2 together.
The best caregiver tips I have to help stop agitation are for you to figure out what’s causing it, and to change that situation. Here are two examples.
Donna always got upset and started crying whenever her daughter brought her to church, even though she had loved going every Sunday when she was younger. It was particularly bad when the organist started playing. Her daughter then tried having her watch church services on TV and found that she really enjoyed these.
She realized that Donna was overwhelmed by the crowds of people and loud noises. Her daughter started bringing her to the mid-week services on Wednesdays, which did not have any organ music and only a few attendees. Donna brightened up during these services every week.
Walter would start howling and swinging every time his home health aide would try to give him a bath, particularly when she was getting him into the bathtub. His son looked through Walter’s medical records and noticed that his doctor had recommended getting a hip replacement for bad arthritis, but Walter never had it done.
The home health aide and son realized that Walter’s hip probably hurt when he had to lift his leg to get into the tub. His son started giving him Tylenol an hour before scheduled baths, and Walter was much calmer.
If you try these caregiver tips without any luck, it’s a good idea to get help from an expert. Some resources include:
- The elder’s doctor. The doctor might make suggestions, change medications, or refer you to a specialist, such as a geriatrician, psychiatrist, or neurologist.
- A geriatric care manager. These are usually nurses or social workers who specialize in caring for older adults.
- Support groups of other caregivers. The Alzheimer’s Association runs many of these all over the United States.