Behavior - AGITATION
Good Ways to Avoid Confrontation
One of the behaviors of a person with dementia that is difficult to tolerate is when the person becomes agitated. This can result in violent or semi-violent actions, harsh words, unkind remarks, yelling, excessive demands, constant pacing, stomping, etc., etc., and etc. But, if you pause long enough to remember that the behavior is not the person, it’s the dementia, you will be able to focus positively on calming the situation.
Causes for Agitation
The agitation can come from an individual trigger or a variety of triggers occurring at the same time. If you have a close relationship with the person, you may know immediately what triggered the agitation. If your relationship is not close you may resort to your own version of anger or agitation. In either case, careful reasoning on your part can bring calm to the situation. However, careful reasoning won’t come easily if you haven’t prepared.
A major question that should be asked is “Has there been a sudden, confusing situation?” This can be a sure source of agitation that results from fear of a new environment, concern about how to react or behave in the new environment, or inability to concentrate on, or understand, the new environment.
A Side Story
A recent experience I had with my son was directly due to the environment. He didn’t show any agitation in a new place at first, but in less than five minutes he wanted to leave. There was sensory overload due to loud music and bright lights. Even though I had described the upcoming environment, and he really wanted to go, I knew that if we didn’t leave, he would become difficult to handle. So, we left. Problem averted. Sometimes that is the only solution.
A similar source of agitation could come from meeting strangers. The underlying process of a person experiencing dementia is constantly trying to process a world that is becoming less and less like the world he or she had lived in during the previous years. So, meeting a stranger is an immediate problem.
How to Defuse a Volitive Situation
The absolutely best way to help a person with dementia calm down is to stay calm yourself. If the patient is not in danger, and, I think, even if the person is in danger, stay calm. Nothing good comes from being in a panic and trying to help someone else who is agitated and in a panic. Try to place yourself directly in front of the person you are caring for, and let them see you take a deep breath. This deep breath can an immediate effect on you, and the agitated person will mirror your behavior. As you both become calmer, you can look for what has triggered the agitation.
You may realize that the agitation is caused by too much activity, loud noises, frustration over inability to complete a task, or a mixture of problems that the patient isn’t able to communicate. This is when you want to slow down. Give your full attention to the patient. Let them realize they are being heard, and you want to help.
Always remember the patient is reacting from a different reality; they are trying to behave from their reality while trying to understand why your reality is different. This is never the time to coerce the patient into understanding some fact or try to make sense of a situation they cannot understand. Give validation to his or her feelings. Agree that they are experiencing whatever they claim. Then answer with your intention to check in to the problem or correct a situation.
A Side Story:
When my children were the age where they wanted every toy, cereal, or cookie on the store shelves, I was able to avoid temper tantrums this way: I would take the item off the shelf, pretend to read the writing on the package, and then tell my child the package said it was only for children a year older than my child. I’d then add that we would come back when they were a year older.
The idea was to avoid saying, “No”. For the adult the idea is to avoid denying the existence of their concern or criticizing their behavior.
Dementia patients retain their emotions. That is why trying to debate them or reason with them never works. They are not using facts in the discussion. They are reacting to how they feel about something. To calm them requires that you accept their emotions and leave the facts out of it. And they may also be frustrated and frightened by realizing their behavior is not the same as it used to be. If you have not yet put yourself inside the head of a dementia patient, you will not be able to cope with the person you are giving care to.
A situation you should always consider is this: are they in pain? Many discomforts are not visible: an infection, itchy clothing, hunger, thirst, bright lights, dim lights, dirty glasses, tight shoes, incorrect medication - the list is infinite. They are not always able to clearly communicate the source of the problem. Paying attention to their body language may be your only resource. Never rule out pain.
There are many other ways to ease the tension between the caregiver and the person dealing with dementia.
Some things to try are -
starting a conversation about a pleasant memory,
mentioning an upcoming activity or a visit from a favorite person,
explaining what is on the menu for dinner,
stating it is almost time for a special TV program,
suggesting a walk,
asking for help with a project,
suggesting an outing to get ice cream.
Add to this list some personal suggestions about situations you both have shared. The main thing to remember is that the person you are caring for is struggling to maintain some semblance of understanding of his or her environment while struggling to maintain personal dignity.
Always approach a dementia patient with the understanding that the essence of the person is still there and allowing them to maintain their dignity and showing your respect is a significant method of easing their frustration.
A big plus for you as you try to care for an agitated dementia patient is to be prepared. Think through potential problems before they occur. Or, after you have been through a situation where the patient has been agitated and argumentative, think to yourself, “How can I handle this better next time” because there will be a next time. Train yourself to respond with an attitude of how can I make him or her feel better about this situation.