Most experts agree that the first-line approach for the management of agitated behaviors in older adults with dementia includes non-pharmacological strategies such as exercise, reorientation, validation and sensory stimulation. Once interventions like these have been exhausted over a lengthy period of time, the use of mild psychotropics may be necessary. Since research has shown that both approaches have similar effects, except non-pharmacological interventions have lower risk of adverse events, professional caregivers and those caring for a loved one at home should become familiar with as many non-medication interventions as possible.
Dementia and Agitation
The likelihood of older adults with dementia becoming agitated is pretty high. A number of internal and external cues may trigger agitation. Internally, pain, the need to go to the bathroom or being frightened can cause an elder to yell, strike out or try to leave the environment. External factors like bright lights, loud noises or room temperature may cause frustration, anger or fear. Agitation may also come in the form of:
- Depression
- Anxiety
- Repetitive questioning
- Wandering or elopement
- Aggressive behaviors
- Socially inappropriate behaviors
Breaking Down Agitation
Agitation is a fairly broad term that means different things to different people. In a clinical setting, like skilled nursing homes or assisted living communities with memory care spaces, it is viewed in four different ways.
- Physically aggressive behavior – hitting, kicking, pushing, or grabbing
- Physically non-aggressive behavior – pacing and restlessness
- Verbally aggressive behavior – swearing, screaming, threats
- Verbally non-aggressive behavior – asking for attention, over-talking, complaining, being negative, groaning and making other noises
The older adult with dementia can exhibit one or more of these behaviors at any time of the day or night. Having a well-trained staff is key for observing their resident, watching for signs of agitation and intervening before the agitation builds. Staff can also play an important role in prevention. Something to keep in mind is that staff runs a risk of undermining the dignity of their resident through poor quality interaction and interventions. Caring for older adults with dementia and agitation must be taken seriously by caregivers who are knowledgeable in non-pharmacological strategies.
From Prevention to Calming
When it comes to dementia with agitation, prevention really is the best medicine, and prevention starts with person-centered care. Caregivers should get to know as much as they can about the people they care for, including preferences, triggers, communication abilities, physical health, and more. Caregivers need good listening and communication skills and be able to pick up on something new about the resident that may be different or seem off.
The Importance of Trust
Most interventions may not work unless the caregiver has developed a genuine and trusting relationship with the resident. Once this has been established, the caregiver can help the resident work on some effective coping skills to reduce agitation as well as provide orientation to the situation. Providing reassurance that all is well and there’s no need to be upset may bring much needed relief to the resident.
Watch for and Eliminate Triggers
A great way to reduce the need for medications is to keep an eye on the environment and catch what may be causing the resident to become agitated. Is the hallway crowded? Is the temperature too warm? Do they need to use the bathroom? Sometimes, it is very simple things that will trigger agitation, so it’s important to be aware of the space surrounding the resident.
Get as Much Training as Possible
Maybe the organization provides ongoing training in dementia-related agitation and other behaviors – maybe it doesn’t. There’s nothing like educating one’s self. Read and research Alzheimer’s, dementia and how to handle challenging behaviors. The internet is full of good materials, especially on sites like googlescholar.com.
Use Various Therapies to Prevent and Calm
Well-trained and experienced caregivers can choose from a variety of therapies and strategies to prevent agitation or calm the resident who is agitated. Some strategies include:
- Orientation or re-orientation if possible
- Exercise or physical activity
- Hobbies or crafts
- Music, art, doll or pet therapy
- Food and drink
- Aromatherapy
- Light touch
- Validation
- Multisensory stimulation (Snoezelen Room)
If these don’t provide peace and calm, sometimes de-escalation techniques are called for like the following:
- Speak clearly, slowly and with a lower tone
- Maintain friendly eye contact
- Remove and potential weapons others from the environment
- Provide for unmet needs
- Recognize and address triggers
- Engage with genuine emotions
- Remain with the resident until calm
Final Thoughts on Dementia and Agitation
Dementia with agitation is common, so it’s necessary to be well-trained and educated in ways of preventing it, intervening or de-escalating the situation. Non-pharmacological approaches are the number way to help older adults diagnosed with dementia and agitation. Such approaches are just as effective as medications, without the side effects.