Researchers have identified six main causes of agitation in dementia. As caregivers, it is our job to do the detective work to find out what the cause might be. We need to imagine ourselves in his or her shoes to help figure out the trigger. If at first you don’t succeed…be persistent, keep digging! And always consider a combination of factors.
Fatigue: Most of us tend to be more irritable when tired and people with dementia are no exception. Did the resident get enough sleep last night? Has he had more activity than usual today? You can ask, “Would you like to rest now?”
Change: People with dementia usually like routine—everything done the same way, at the same time, every day. What’s different today? Think of anything new: maybe a new caregiver, clothes, holiday decorations or a change in lunch time or bath time.
Perception of loss: If the resident is reliving a loss such as the death of a loved one, empathy followed by distraction may work to divert the person’s attention. If the loss is the perception that something has been taken, help the resident to look for it. If the loss centers around money, it may help the resident if the family will bring in some loose change to keep in the resident’s pocket so he can be reassured that he has his money or his wallet.
Stimulus levels: Consider the environment. What is going on around the resident? Some people react negatively when there is too much noise, too many people or too much activity. Others may tolerate this normally, but react badly when they are more tired. This might be a time to walk the resident to a quiet area or his or her room where they have a chance to feel calmer.
Is it possible the resident is under-stimulated? Could he be bored or restless? Perhaps he or she needs physical activity such as a walk outside. Could she be lonely? You can ask family members to make a video of themselves doing routine activities for the resident to watch when she misses them.
Excessive demands: With dementia comes the loss of the ability to process multiple thoughts at one time. People with dementia can’t multi-task or multi-think. So we need to be careful in our communications that we only make one brief request of them at a time. Saying “Brush your teeth, then you can get into your pajamas and ready for bed” may simply be too many concepts. You may be more successful breaking it into bite-sized chunks: “Now it’s time to brush your teeth.” When that is accomplished: “Now it’s time to put on your pajamas.”
Physical stressors: Rule out pain: it could be a headache, a pebble in the shoe, a stomach ache, a urinary tract infection or clothes that are too tight. Look for signs of injury: red spots or bruises, limping, a bump on the head or holding a body part. Look for signs of infections such as a rash, redness, runny nose or strong smelling urine. Could the resident feel cold or hot and unable to tell you? Is he or she uncomfortable due to wet briefs?
One of the greatest frustrations of having dementia is not being able to clearly communicate your wants and needs. But we can do a lot to facilitate better communication. First we need to make sure the resident is ready to communicate: are his glasses clean? Is her hearing aide in, turned on and does it have a good battery?
Now the resident may be ready to communicate, but are YOU? You should identify yourself every day, sometimes more than once a day. Don’t assume the resident will remember you just because he knew you last week.
It is essential that you know what the person’s limitations are. If he or she has had a stroke it is important to know what parts of speech and thinking were affected. Sometimes a stroke leaves the person unable to understand speech, other times he understands but cannot get the right words out.
Remember that agitation is a symptom that means something else is wrong. It is the job of caregivers to figure out what the real cause is. So when the resident is agitated, put on your detective hat and see if you can’t solve the mystery at the bottom of the behavior.