Caring for Dementia

Agitation is a common and challenging symptom experienced by individuals living with dementia. It can manifest in various ways, including restlessness, pacing, verbal or physical aggression, and resistance to care. Managing agitation effectively, requires an approach that considers the individual’s needs and preferences. In this article, we’ll explore various strategies and techniques that caregivers can utilize to support individuals with dementia who are experiencing agitation.

Physical

Untreated Pain

Tips to manage agitation related to pain:

1. Conduct a thorough pain assessment to identify the source of discomfort
2. Administer appropriate pain relief medication as prescribed by healthcare professionals.
3. Implement non-pharmacological pain management techniques such as heat or cold therapy.
4. Warm baths or showers to relax muscles, improve circulation, and reduce pain associated with conditions such as arthritis.

Constipation

Tips to manage agitation related to constipation:

1. Ensure adequate hydration and fiber intake to promote regular bowel movements.
2. Encourage physical activity to stimulate bowel function.
3. Consult healthcare professionals for appropriate laxatives or stool softeners if necessary.

Urinary Tract Infection (UTI)

Tips to manage agitation related to a UTI:

1. Promptly diagnose and treat urinary tract infections with antibiotics as prescribed by healthcare professionals.
2. Encourage increased fluid intake to flush out bacteria from the urinary tract.
3. Provide comfort measures such as warm compresses for abdominal discomfort.

Emotional

Anxiety

Tips to manage agitation related to anxiety:

1. Provide reassurance and validation of the individual’s feelings.
2. Practice relaxation techniques such as deep breathing and light arm movements.
3. Engage in calming activities such as listening to soothing music, reading or a gentle hand massage.
4. Remove person from the environment to a more relaxing atmosphere.
5. Utilize sensory activities to aid in calming: calming light effects, aromatherapy, tactile stimulation.
6. Practice grounding activities such as: naming the things you can see, things you can hear, count by touching your fingers.
7. Always explain to the person clear and concisely what is happening in their surroundings. (Noises, future activities or appointments, new visitors)

Depression

Tips to manage agitation related depressive symptoms:

1. Offer emotional support and encouragement by attentively listening and empathize with their emotions.
2. Encourage participation in enjoyable activities or hobbies that promote a sense of purpose.
3. Speak to the individual with enthusiastic praise, attempt to motivate person to leave their chair/bed/room/house.
4. Consult healthcare professionals for medication or therapy to address a major depressive disorder.

Frustration

Tips to manage agitation related frustration:

1. Use clear and simple language to facilitate understanding.
2. Employ alternative communication methods such as visual cues or gestures.
3. Practice patience and active listening to encourage expression of needs and preferences.

Cognitive

Difficulty with Routines or Tasks

Tips to manage agitation related to routines or tasks:

1. Break down tasks into smaller, manageable steps to reduce frustration.
2. Provide visual prompts or cues to guide task completion.
3. Only assist if required; pay attention to verbal and non-verbal cues.
4. Offer encouragement and praise for progress and effort.

Confusion and Disorientation

Tips to manage agitation related to confusion and disorientation:

1. Maintain a familiar and structured environment to minimize confusion.
2. Provide orientation cues such as clocks, calendars, and signage.
3. Reassure the individual with comforting words and gestures during moments of disorientation.
4. Try not to argue, but stay in their reality. (e.g. If the person states that someone is coming to get them, you may say “She called and said she’d be a little late” instead of “There is no one coming to pick you up”.

Memory Loss and Forgetfulness

Tips to manage agitation related to frustration:

1. Use memory aids such as memory books or electronic reminders to support memory function.
2. Practice repetition and reinforcement of important information or routines.
3. Offer patience and understanding when memory lapses occur, refraining from criticism or frustration.

Environmental

Overstimulation From Noise

Tips to manage agitation related to noise:

1. Create a quiet and peaceful environment by reducing noise levels.
2. Try to limit different sources of noise and environmental triggers.
3. Remove person from environment and bring into quieter surroundings.
4. Use earplugs or headphones if there is no way to remove from noise.
5. Provide a calm and secluded space for relaxation and retreat.

Changes in the Environment or Routine

Tips to manage agitation related to transitions if the person is cognitively aware of the change:

1. Offer advanced and repeated notice for any anticipated changes or transitions.
2. If change is inevitable, play through the changes step-by-step, and often, until the change takes place.
3. Provide reassurance and support during periods of adjustment to new environments or routines.
4. Attempt to make the change as least disruptive as possible. (e.g. moving to a facility – take pictures of the current living/bedroom areas and attempt to make the environment look similar)

Tips to manage agitation related to transitions if the person is not cognitively aware of the change:

1. Provide lots of distraction, if moving to a facility, attempt to make the transition blend in with the day.
2. Don’t explain beforehand if you know it will make them upset, or if they will fixate on the change.
3. If moving to a new facility, do not just drop the person off and leave. Instead, set-up their room with them, take them to an activity or for a walk introducing yourself and your loved one to others. Explore the floor, look at the dining hall and relax in a lounge, allow the person to feel that this is their home and they can feel comfortable.
4. Facility staff are extremely well trained to transition your loved ones into their new environment. In my professional experience, it takes a couple weeks to a couple months for most people to feel comfortable.
5. Attempt to complete any changes when they are not present (moving furniture, retrieving items they’ve taken, cleaning)

Lack of Stimulating Activities

Tips to manage agitation related to lack of stimulation:

1. Provide purposeful and meaningful activities a couple times a day.
2. Leave self-initiating activities around their living area. (colouring, reading, musical instrument, unfolded laundry)
3. Provide easy access to items they can engage in throughout the day.
4. Set the environment up for success. (clear clutter, remove unnecessary items, keep self-initiating activities in the open or near the person)

Resistance to Activities of daily living

Refusal to Eat

Tips to manage agitation related to eating:

1. Offer a variety of appealing foods and beverages to stimulate appetite. (Tip: People with dementia seem to love sugar)
2. Provide finger foods or soup in a cup.
3. Provide small healthy snacks throughout the day. (Keep them accessible and in the open if your situation allows you to)
4. Create a relaxed environment free from distractions or pressure.
5. Consult a physician to inquire about alternative meal options such as nutritional supplements.

Refusal to Shower or Bathe

Tips to manage agitation related to bathing:

1. Respect the individual’s autonomy by offering choices regarding bathing preferences such as time, assistance level, bath/shower, and privacy.
2. Use soothing and familiar scents such as lavender or chamomile in bath products to promote relaxation.
3. Break down the bathing process into smaller, more manageable steps to reduce anxiety and resistance.
4. Allow them to feel the water before you get them wet.
5. Do not attempt to force or fight someone into the shower, this almost always results in injury to either the person or the caregiver.
6. If unable to bathe, give person a wet cloth with soap and ask them to wipe their bodies. Focusing on the genitals, skin folds, under the breast, and underarms.
7. Re-approach, using different techniques until successful. If unable to safety bathe or clean and individual, contact your healthcare provider and they may be able to provide something to reduce agitation.
8. Learn more about tips for bathing here.

Resistance to Changing Clothes

Tips to manage agitation related to changing their clothes:

1. Offer clothing choices that are comfortable, easy to put on, and suited to the individual’s preferences.
2. Use distraction techniques such as engaging in conversation or listening to music during clothing changes.
3. Pretend the clothing you want changed into is new, and ask them to try it on. Once the person has it on you can take away the old clothes.
4. Put clean clothing around the living area, in hopes they may pick it up and put it on. (Watch for this one because sometimes they will just put the clean clothing over the dirty clothing)

Social

Loneliness and Social Isolation

Tips to manage agitation related to loneliness and social isolation:

1. Encourage regular social interactions with family members, friends, or peers through visits, phone calls, or video chats.
2. Arrange group activities or outings to promote social engagement and connection.
3. Consider enrolling the individual in an adult day program or support group for a sense of community and belonging.

Feelings of Abandonment or Neglect

Tips to manage agitation related to fears of abandonment:

1. Provide consistent and attentive care, reassuring the individual of your presence and support.
2. Build trust and a good rapport, ensure to check-in consistently with the person.
3. Engage in meaningful activities together to strengthen bonds and reinforce feelings of security.
4. Encourage open communication and express empathy for the individual’s feelings of vulnerability or insecurity.

Medical

Medication Side Effects

Tips to manage agitation related to side effects of medication:

1. Consult healthcare professionals to review medication regimens and consider alternative options with fewer side effects.
2. Ensure medication is given with food when required.
3. Always give the appropriate dosage at the correct times.
4. Monitor for signs of adverse reactions and adjust dosages or medications as needed. Speak with a Physician to ensure your loved ones are receiving the best care.
5. Implement complementary therapies such as relaxation techniques or herbal supplements to alleviate medication-related agitation.

Sleep Disturbances

Tips to manage agitation related to sleep disturbances:

1. Establish a calming bedtime routine to promote relaxation and prepare for sleep. Attempt to keep the same routine each night.
2. Monitor person for signs of delirium.
3. Attempt to keep physically stimulated during the day so they are hopefully more tired at night.
4. Give a cup of warm milk at night or speak to a doctor about giving magnesium.
5. Create a comfortable sleep environment with appropriate bedding, lighting, and room temperature.
6. Consult healthcare professionals for strategies to address underlying sleep disorders or disturbances, such as insomnia or sleep apnea.

Nutritional

Hunger or Thirst

Tips to manage agitation related to hunger and thirst:

1. Offer regular meals and snacks throughout the day to maintain adequate hydration and nutrition. Keep snack foods accessible if hunger is an on-going issue.
2. Always have water accessible to the person.
3. Provide a variety of appealing food and beverage options tailored to the individual’s preferences and dietary needs.
4. Use visual cues or reminders to prompt the individual to eat and drink if forgetfulness or apathy is a contributing factor.

Dietary Restrictions or Preferences

Tips to manage agitation related to dietary restrictions and preferences:

1. Respect the individual’s dietary preferences and cultural or religious beliefs when planning meals and snacks.
2. Collaborate with healthcare professionals and nutritionists to develop a balanced and satisfying meal plan that meets nutritional needs while accommodating dietary restrictions.
3. Serve hot food hot and cold food cold.
4. Offer choices and flexibility in meal options to provide a sense of control and autonomy over their diet.
5. Allow flexibility to the dietary suggestions if not a imminent restriction or risk.

General Tips to Prevent Agitation

Create a Calm and Comfortable Environment:

• Minimize noise, clutter, and distractions in the environment.
• Ensure adequate lighting and maintain a comfortable temperature.
• Establish a consistent daily routine to provide structure and predictability.
• Offer familiar and reassuring items such as photographs or favourite music.

Effective Communication Techniques:

• Use simple and clear language, speaking slowly and calmly. Learn more about effective communication strategies here.
• Maintain eye contact and offer reassurance through verbal and non-verbal cues.
• Avoid arguing or contradicting the individual; instead, validate their feelings and concerns. Once they feel validated, then you can attempt to re-direct to another task or activity.
• Listen actively and acknowledge their emotions, even if you cannot resolve the underlying issue.

Engage in Meaningful Activities:

• Provide opportunities for engagement in activities that the individual enjoys and finds meaningful.
• Tailor activities to their abilities and interests, focusing on sensory stimulation, relaxation, reminiscence, music, or creative expression.
• Encourage participation in gentle exercises, such as walking, stretching and deep breathing to reduce agitation.

Don’t Argue/Try to Correct

• Do not try and argue with the person, as their perception is not always based in reality. Instead, attempt to enter their mind to guide and re-direct away from situations that may cause agitation.
• Saying “No” can cause a person to become defensive. Instead, offer alterative solutions to avoid shutting down the persons wants.
• If the person is engaging in a high-risk activity and you need them to stop, offer gentle re-direction away from the harm, and provide an activity/task that is similar but not high-risk. (e.g. attempting to stand to wash the dishes – provide a basin with soap and water while person is seated to avoid falls)

Offer Distraction and Diversion:

• Redirect the individual’s attention away from the source of agitation to a more calming activity or topic.
• Use soothing sensory experiences, such as aromatherapy, massage, or gentle touch, to promote relaxation.
• Offer favourite snacks or beverages to provide comfort and distraction.
• Do not try to re-direct person right away, as that may increase agitation. Instead, listen to the person and try to understand the source of agitation. Re-direct with your main focus on providing comfort or security to the person.

Utilize Medication When Necessary:

• In some cases, medication may be prescribed to manage severe agitation that poses a risk to the individual or others.
• Work closely with healthcare professionals to determine the most appropriate medication and dosage, taking into account potential side effects and risks.

Monitor for Triggers and Patterns:

• Keep track of environmental triggers, stressful situations, or changes in routine that may exacerbate agitation.
• Identify patterns or triggers through observation and communication with other caregivers or healthcare professionals.
• Use a behaviour tracking tool to make sure observations are accurate and timely.
• Develop strategies to prevent or minimize the impact of known triggers, such as scheduling high-stimulating activities during times of day when agitation is less likely to occur, and relaxing activities when agitation is more likely to occur.

Conclusion

Managing agitation in individuals with dementia requires patience, empathy, and a personalized approach. We can assist by creating a supportive environment, utilizing effective communication techniques, engaging in meaningful activities, offering distraction and diversion, considering medication when necessary, and monitoring for triggers and patterns, caregivers can help reduce agitation and improve the quality of life for individuals living with dementia. It’s essential to collaborate with healthcare professionals and adapt strategies based on the individual’s changing needs and preferences over time.