Anxiety is very common in dementia, but treatments for anxiety can be hard to come by. Family and non-professional caregivers can help their loved ones deal with anxiety with some knowledge of the condition and how to relieve it.
First, here are some basics about anxiety in dementia.
- Anxiety disorders are about twice as common among people who have dementia as they are in people who do not have dementia.
- Any kind of dementia can provoke anxiety, but persistent symptoms of anxiety are most common in Parkinson's disease and vascular dementia. Anxiety is less common in Alzheimer's disease.
- There isn't any one medication that is always effective in treating anxiety, although antidepressants (both newer SSRI antidepressants and older-style tricyclic antidepressants) sometimes help. It is essential for the doctor in charge of the case to choose the medication because of interactions and side effects.
- Likewise, there isn't any single psychological intervention that always helps to relieve anxiety, but a mixture of methods is usually optimal.
What do you do first when you are confronted with an anxious dementia patient?
The first step in dealing anxiety in people who have dementia is easy to do but hard to remember: Back off. Don't do anything that makes the anxiety worse. "Backing off" doesn't mean leaving the patient alone. That is usually not helpful. But don't rush to offer hugs or hold hands or coo soft words of reassurance, at least not before the patient has an opportunity to express what is troubling them.
Create a calming environment
Noise, odors, scratchy clothing or bed covers, and loud conversations outside all can contribute to anxiety. As much as you can, make the room quiet when your find an upset, anxious resident. If the anxiety isn't severe, offer a pleasant activity to help distract from whatever has triggered anxiety. Don't offer so many choices, however, that you cause more anxiety. Limit the choices to two options.
What to say to someone with dementia who is having anxiety issues
Start by asking for permission to help: "May I help you?" Deliver your offer of assistance in a tone of voice that conveys concern. If the problem is a fight or some other kind of distressing incident outside the patient's room, apologize. Reassure the patient that the situation is now under control. Take a moment to allow the patient to respond. Assure them that you will stay until they feel better.
Then use some combination of the following steps as they fit the situation:
- Let the patient talk. Listen to their frustration. Let them express their concern without pronouncing judgment over its validity if it sounds delusional or it is the result of a hallucination. Remember, the source of anxiety is real to them even if it isn't real to you.
- Repeat assurances. You may have to tell the patient things are alright more than once. You may have to reassure the patient you will stay until they are better (and then stay) more than once.
- Distract the patient from the source of anxiety. That distraction could be reminiscing about happy times, playing music, a board game, a 30-minute television program, or a quick trip to a safe location outdoors. Or take a brief car ride.Give the person something to do.
- Do your best to keep the room in good repair. Leaks and drafts are common triggers for anxiety attacks.
- Check yourself. Don't raise your voice. Don't show offense. Don't argue, corner, belittle, restrain, criticize, or ignore. Avoid sharing your assessments of the situation with coworkers or other family members until not only is the patient out of earshot, but until a time the patient is not aware you are having the discussion.
Bring repeated incidents of anxiety to the doctor's attention. The prescription may be for a psychological intervention, not for a drug.