A person with dementia may feel anxious or agitated. He or she may become restless and need to move around or pace. Or the person may become upset in certain places or focused on specific details. He or she may become over-reliant on a certain caregiver for attention and direction.
Agitation may be caused by a number of different medical conditions and drug interactions or by any circumstances that worsen the person's ability to think. Situations that may lead to agitation include:-
• Moving to a new residence or nursing home
• Changes in the environment or change in caregiver
• Misperceived threats
• Fear and fatigue resulting from trying to make sense of a confusing world
A person with agitation should receive a thorough medical checkup, especially when it comes on suddenly. The treatment of agitation depends on a careful diagnosis, determining the possible causes and the types of agitated behaviour the person is experiencing. With proper treatment and intervention, the agitation symptoms can be reduced.
There are two distinct types of treatments for agitation: behavioural interventions and prescription medications.
Behavioural treatments should be tried first. In general, steps to managing agitation include:-
(1) identifying the behaviour
(2) understanding its cause and
(3) knowing how to respond.
To prevent or reduce agitation:-
• Create a calm environment. Remove stressors, triggers or
danger; move the person to a safer or quieter place; offer rest or
privacy; limit caffeine use; provide opportunity for exercise;
develop soothing rituals; and use gentle reminders.
• Avoid environmental triggers such as noise, glare, insecure space and too much background distraction, including television.
• Monitor personal comfort: check for pain, hunger, thirst, constipation, full bladder, fatigue, infections and skin irritation; ensure a comfortable temperature; be sensitive to fears, misperceived threats and frustration with expressing what is wanted.
• Simplify tasks and routines.
Identifying what has triggered agitation can often help in choosing the best response to the behaviour. Often the trigger is a change in the person's environment:-
• change in caregiver
• change in living arrangements
• presence of houseguests
• being asked to change clothing
Listen to the frustration. Find out what may be causing the agitation, and try to understand.
Provide reassurance. Use calming phrases such as: 'You're safe here.' 'I'm sorry that you are upset.' 'I will stay until you feel better.'
Involve the person in activities. Try using art, music or other activities to help the person relax.
Modify the environment. Decrease noise and distractions, or move to another place.
Find outlets for the person's energy. The person may be looking for something to do. Take a walk, or go for a car ride.
Check yourself: if the person is agitated, do not raise your voice, and do not corner, restrain, criticize, ignore, argue with or shame the person.