HOW TO ADDRESS AGITATION AND AGGRESSION
What are loved ones trying to tell us?
Loved ones with dementia frequently become restless, anxious, or upset. Often this will manifest itself through constant pacing, moving the furniture, rearranging objects, talking to themselves, yelling or swearing at imaginary people, or even persons in the same room. This might escalate into aggressive behaviors like threatening language or causing harm to another by pushing or hitting, or even throwing objects or food. Unfortunately, aggression among people with dementia can happen suddenly and seemingly without warning.
If you pay attention and try to figure out “what are they are trying to tell me?” you may be able to diffuse the situation and prevent it from escalating.
Making sure you've met the needs of someone who is hungry, thirsty, tired, bored, lonely or in pain is paramount. Remember that the agitation is likely there for a reason, look for ways to meet the need it may be expressing. Sometimes a good detective can figure it out. Other possible causes of agitation and aggression could be:
- Chronic medical condition
- Acute pain
- Drug or prescription interaction
- Missed medication dose
- Sundowning syndrome
- Frustration due to inability to communicate
- Overstimulation
- Change in the environment such as a recent hospitalization or transition home from a rehab facility
Not every person is the same so not every intervention will be successful and what works for one individual may not work for others. Ultimately, the person with dementia is biologically experiencing a profound loss of their ability to negotiate new information and stimulus.
How do you decrease agitation and diffuse aggression? Try these steps:
- Create a calm environment. Remind yourself to stay calm too! Do not raise your voice, show alarm or offense. Do not corner, crowd, restrain, criticize, ignore or argue with them. Use calming phrases and watch your body language as well. Offer to stay with them until they feel better.
- Reassure your loved one they are safe and secure. Remove stressors and stimulation. This may involve moving the person to a safer or quieter place, or offering a security object, rest or privacy. Try soothing rituals.
- Remember all behaviors stem from something, figure out what might the trigger be. Noise, glare and background distraction can act as triggers. Simplify tasks and routines. Slow down, add light, focus on pleasant memories.
- Ask yourself if there are any unmet needs that need to be addressed. Check for pain, hunger, thirst, constipation, full bladder, fatigue, infections and skin irritation. Make sure the room is at a comfortable temperature.
- Distract with activities (see below). Try using art, music or exercise to help engage the person and divert attention away from the anxiety. Offer something to do like take a walk.
Be sure to see the doctor or neurologist to rule out any physical causes or medication-related side effects. In addition to medication, new research suggests engaging in these non-pharmacologic interventions for agitation and aggression:
Sensory Interventions
- Music Therapy
- Light Therapy
- Pet Therapy
- Multisensory Stimulation
- Hearing or Visual Aids
Active Therapy/ Structured Activities
- Dancing
- Exercise
- Social Interaction
- Art Therapy
- Outdoor Walks
Complementary Alternative Medicine
- Aromatherapy
- Reflexology
- Massage
Psychological/ Therapy
- Validation Therapy
- Reality Orientation
- Reminiscence Therapy
- Psychosocial Therapy
- Cognitive Behavioral Therapy
- Relaxation Training
- Structured Support Groups
Do you have a loved one suffering from cognitive impairment that might benefit from a trained and experienced caregiver familiar with aggressive behaviors and how to handle them? Being a family caregiver can be exhausting in the circumstances outlined above – perhaps you and your loved one would benefit from respite care? If you seek homecare services on a more regular basis, we offer a customized plan of care to fit the needs of your loved one, your schedule, preferences and your pocketbook.
Till next time!
Irv Seldin, JD
Owner and CEO, Visiting Angels of the Palm Beaches
***This article not intended as medical advice