Agitation is a catch-all term used to describe excessive movement and speech. Agitation is sometimes but not always aggressive. It is not intended to harm other people. However, agitation is disruptive to care routines and burdensome to patients and caregivers alike.
Agitation is more common in "major" neurocognitive disorders than it is in "minor" neurocognitive disorders. It usualy occurs in the middle stages of dementia, when it is clear that the person who has the disorder is no longer capable of self-care. Agitation may manifest as pacing, masturbation, twirling hair, doodling, wandering, aggressive speech, out-of-character use of profanities or racial slurs, and sometimes physical combativeness.
Where to start in dealing with agitated behavior in people with dementia
One of the most helpful approaches to dealing with agitated behavior in people who have dementia is to start by considering the environment, not the patient. Some care situations increase the likelihood of agitation in ways that can be corrected:
- Caregiver's bedside manner. When caregivers tell patients that they are rushed, patients become anxious that they will receive the care they need. It's OK to be quick in doing some tasks of patient care, but it's essential to convey calm and completion of the patient's needs.
- Excessive stimulation. Some care environments are just too busy for patients to process. When there are multiple visitors, or loud background noises, or multiple TV sets blaring, dementia patients respond with agitation, anxiety, anger, frustration, and/or withdrawal. When it is obvious that there is too much stimulation in the patient's room or ward, it's a good time to get some fresh air or visit another part of the facility. Make sure that holiday visitors don't come all at once.
- Early morning activities. Dementia patients usually are not people who rise and shine early in the morning. When the routine is to wake up at eight o'clock, spend an hour on toilet and washing, and then eat a hot breakfast around 9:30, getting up at 5:00 to make a doctor's appointment at a distant location will provoke agitation. Schedule appointments in the afternoon whenever possible. Make sure family members give the patient and staff time to take care of their morning routine by not visiting too early in the day.
- Lack of personal space. Different cultures have different concepts of personal space. Some people need an invisible fence around their living area to feel secure. They may not share hugs or handshakes with people they do not know well. Some people are touchy-feely. They may want to hug and kiss everybody, even people who need to keep professional distance. When they are deprived of touch, they get agitated. It is important to know the patient's need for space and to respect it to avoid agitation.
- Unfamiliar environments. The first few days or weeks in a new care facility are almost universally traumatic. There is a balance between providing the dementia patient their space and "being there" enough to reassure the patient of continuing, adequate care. It can also be hard to adjust to new sounds and smells. The more familiar objects and familiar faces that can be provided for the patient, the better.
- Contact with other patients. Agitated patients agitate other patients. It's best at least to close the door when patients "lose it," and not to gossip about problems with patients when other patients are present.
Dealing with personal issues that cause agitation
There are other predictable sources of emotional distress in dementia. Someone who has dementia may feel humiliated by their need to accept help with bathing, eating, dressing, or going to the toilet. They may feel overwhelmed by their inability to provide for themselves. They may panic when they can no longer recognize people or places. Even worse, they may retain enough self-awareness to know that they have behaved in ways that embarrass them or embarrass their families.
With these sources of agitation, the key to success is to distract rather than to escalate. Find a way to "change the subject" with the dementia patient to take them out of the downward spiral of fear, anxiety, and loss of self-esteem. And with the help of professionals, consider these interventions for decreasing agitation:
- Aromatherapy. Lavender reduces pain perception. It is especially helpful when the source of agitation is medical. Lavender is inhaled, not taken by mouth or rubbed on the skin.
- Massage. If the patient trusts you, therapeutic massage can relieve anxiety that leads to agitation. However, if the patient can no longer respect personal boundaries, you may want to avoid this.
- Music that the patient knows and likes often reduces anxiety and agitation. But a mismatch between music and the patient can make matters worse.
- Room decor, mementos, knick knacks, photos. You don't want to use objects that are easily lost. It is best to put copies of photos in the patient's room, not irreplaceable originals.
- Food. A favorite dish that is permitted on the patient's diet can be a welcome change of pace. But you may have to manage expectations and portion control.
Many nurses use therapeutic touch as a way to reduce agitation. It works, but agitation tends to get worse when it is discontinued.