According to an article by King (2012), the prevalence of agitated behavior in older people with dementia is substantial. The most common types of aggression are verbal and physical. Managing these behaviors creates multiple challenges for caregivers. Disorientation, fear, and/or unmet needs, such as hunger, thirst, pain, feeling too cold/hot, feeling sleepy, and needing to use the toilet can cause individuals with dementia to exhibit agitated behaviors in an attempt to be calm and reassure themselves. It is always important to remember: A person with dementia who can no longer articulate his/her wants and needs, will seek attention through behaviors. Due to the complex reasons behind agitation, finding strategies to keep the person with dementia safe while providing the needed care to relieve negative behavior is crucial. Below are some illustrations of the different types of aggressive behaviors:
- Joe has Alzheimer’s disease. He kicked one of the caregivers during lunchtime and tried to bite and scratch his wife while she was putting his seatbelt on to go home after his first day at the Activity Center. His physical aggression was a plea for help: He may have felt frightened or worried when his wife left him in a new environment. Routine is important to maintain, and in time, Joe will learn to love his days, complete with good friends and fun activities, at Aspen Senior Center.
- Sue has dementia. She still lives at home with her husband. Sue’s home health companion documented in the daily chart “Sue paced restlessly today and pulled tissues out of the box, throwing them all over the floor. She also rummaged through kitchen drawers after dinner. I don’t know what she was looking for and she couldn’t tell me.” Sue displayed physical non-aggressive behavior. It may have been the only way she knew to express fears due to confusion (not knowing the name or use of an item, such as fork or soap) and/or fatigue.
- Bob has dementia. He called his caregiver in the assisted living facility where he lives names and accused her of taking his wallet. He threatened to call the police. Bob used verbal aggression to express himself due to his misperceived and confused understanding of personal space and safety. He may also be experiencing some disorientation in the assisted living home.
- Mary has Alzheimer’s disease. She sought attention at the Adult Day Care Center by complaining loudly and asking the same questions over and over. She used verbal non-aggressive actions because she could not ask for help with words. This may have been the result of her recent stay in the hospital or due to pain.
In each case, the individual with dementia expressed themselves in the only way that would attract attention. They did not use negative behavior to hurt or annoy or irritate. How can caregivers (family members and staff at Aspen Senior Center) reduce agitated behaviors and better assist clients to feel safe and calm, to meet needs that cannot be spoken?
~Tamara Nixon, BS, CHES
Reference
King, C. (2012). Managing agitated behaviour in older people. Nursing Older People, 24(7), 33-36.