Agitation is common for many people as dementia progresses—often presenting as restlessness, worry and even aggression. But while behaviors triggered by agitation can be challenging, caregivers have plenty of ways to soothe a loved one and help them return to a calmer physical and mental state.
Agitation can cause your normally sweet and mild-mannered loved one to act out in unpredictable and surprising ways, and can present through any number of actions and mannerisms:
- Shredding paper or tissues
- Verbal outbursts or aggression
- Physical aggression
- Emotional distress
- Fixating on tasks or objects
Triggers for agitation
Being in pain or feeling depressed can set off agitated behaviors in someone with dementia, as can changes in routine, loneliness, grief and confusing situations. An environment that’s too noisy or crowded can also be the culprit.
Seasons consulted Jessica Fredericksen, MSW, brain health program manager at Virginia-based Goodwin Living, for tips on how to recognize and manage agitation in dementia.
“Often, when individuals living with dementia are showing agitation or challenging expressions, it’s because they have an unmet need,” she explained. “Since the brain is impacted with dementia, it can be difficult for individuals to communicate what they need. Learning about the individual and about the disease progression can help us determine what the unmet need is so we can change the environment and reduce the agitation.”
She explained that individuals with dementia have the same needs and desires as everyone else, making it important to view them through that same lens:
“If we look at Maslow’s hierarchy of needs, we know that people need to have their physical needs met first, followed by safety, connection, belonging and the need for purpose. Not having these needs met is what can cause agitation in individuals with dementia.”
Many common triggers are based on basic physical needs, such as hunger (or feeling too full), uncomfortable clothing, toileting needs, or simply being too cold or too hot. Yet, the source of agitation can also be a mystery:
“Actions like wanting to exit the home or community, refusing assistance with care, or hoarding food or other items are all examples of safety needs being triggered,” she said. “Repetitively asking to talk with parents or siblings who are no longer living or seeking intimate contact with others can be triggered by the needs of love and belonging not being met.”
While these behaviors can be taxing, Fredericksen explained how they stem from people wanting to belong in the same ways they did before they experienced cognitive decline:
“As the individual’s dementia has progressed, they have lost the ability to do certain things they used to take pride in,” she said. “And that desire to be purposeful and make meaningful contributions to their own life and their community has not gone away.”
Preventing agitation in older adults with dementia
When it comes to agitation in dementia, an ounce of prevention is truly worth a pound of cure. Prevention involves anticipating what your loved one needs and providing for them before those unmet needs cause frustration. Some tips include:
- Create a routine and stick to it.
- Keep tasks simple and remain patient.
- Ensure a comfortable environment that isn’t too hot, cold or noisy.
- Anticipate physical needs ahead of time, such as hunger, thirst and toileting.
- Maintain a calm and soothing demeanor.
- Be cognizant and understanding of fears even if they seem irrational.
- Watch for signs of pain and tiredness and take appropriate action.
- Keep an eye on skin integrity and watch for sores and infections.
- Give your loved one outlets for exercise and ways to feel like they’re contributing.
- Curtail caffeine consumption.
How to soothe agitated behavior
Of course, you’ll not be able to prevent all instances of agitation in someone with dementia, so it’s important to know how to soothe behaviors when they arise. Depending on the cause of the agitation, you may have to try various techniques:
- Redirect behavior with another activity, snack or distraction.
- Take a break or give them time alone.
- Give them time to adapt and respond.
- Say you’re sorry and practice empathy.
- Play soothing music.
- Offer a back rub or other gentle touch.
- Try reading aloud or taking them on a walk.
- Provide sentimental objects and photographs.
- Remain positive.
In addition to the aspects listed under prevention, it’s also important to identify and fix any other obvious causes, such as noise, clutter, glare, crowded rooms or confusing activities.
“Depending on what the specific unmet need is, we can try different interventions and techniques,” Fredericksen noted. “For example, if an individual is too hot, they may not be able to communicate that clearly and might start taking their clothes off. Our instinct in this situation might be to quickly tell the person to put their clothes back on because they are in a semi-public place; however, that will not solve the individual’s need and so the action will likely continue. Instead, we can help the individual change into cooler clothing or set them up near a fan.”
What about an older adult who, in their rush to the restroom, forgets their mobility device?
“Instead of telling them to sit back down so they don’t fall without their assistive device, we can get their device for them and help them to the bathroom so they can take care of the physical need.”
“If the individual is verbalizing their agitation and stating they want to go home or to another place, that they need to go to work, or other statements of distress, this is often a sign that safety or belonging needs are not being met,”
In this situation, Fredericksen suggests:
- Stand to the side instead of in front of them so as not to appear confrontational.
- Match their tone or urgency.
- Say something like, “Wow, I can tell this is really bothering you!” or “I am so sorry this is happening right now.” This tells them they’re being heard.
- Return to a calm voice and demeanor as they feel heard.
She explained that if you match their energy and intensity first, the individual will likely match our tone and calm down as you do.
A variety of activities and products can also help with soothing agitation:
- Sorting mail or unimportant paperwork
- Folding laundry
- A fidget blanket
- Fidget or sensory toys
- Crafts like knitting or coloring
- A favorite wallet or purse to rummage through
- A weighted blanket to soothe anxiety
When dealing with agitation in dementia, safety must be at the forefront of caregiving—your own as well as that of your loved one. This may mean removing yourself from reach if there’s physical aggression. Always consult with a medical professional if drug interactions are suspected. While pharmaceuticals are an option that may help control agitation, studies have shown other interventions work better.