The prevalence of agitated behavior in older people with dementia is substantial; the most common types of aggression are verbal and physical. The reasons behind negative behavior are complex and could include disorientation, fear, sadness, unmet needs (hunger, thirst, pain, feeling too hot/cold, exhaustion, needing to use the toilet, or inability to communicate.
REMEMBER: A person with dementia who can NO longer articulate his/her wants and needs will seek attention through behaviors in an attempt to feel calm, reassured, and connected.
The following examples illustrate common agitated behaviors:
- Joe has Alzheimer’s disease. He kicked at one of his caregivers during lunchtime and tried to scratch his wife while she was putting his seat belt on to go home after his first day at Aspen Senior 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; as is familiarity. In time, Joe will learn to love his days, complete with good friends and fun activities, at Aspen Senior Activity 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 could not 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 lives in an assisted living facility. He rudely accused his caregiver of taking his wallet and threatened to call the police. Bob used verbal aggression to express himself due to his 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 Aspen Senior Activity 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 consciously use negative behavior to hurt or annoy or irritate. Managing behaviors creates challenges for caregivers; it is important to identify strategies to keep the individual safe while providing appropriate care to relieve agitation.
- Hearing: Reduce noise pollution by replacing loud, confusing sounds with nature sounds or white noise. Music naturally calms agitation by lifting mood and increasing socialization skills. Caregivers at Aspen Senior Activity Center use music therapy (Frank Sinatra, Rosemary Clooney, Susan Boyle, Classical Piano, Tabernacle Choir, and Sing-Along-Songs).
- Touch: Redirection and rhythmic patterns relieve pacing and rummaging behaviors. Walking in familiar places or in a circular pattern may help reduce restlessness. People with dementia can be diverted when encouraged to feel various textures, such as scratchy sandpaper or a fury stuffed animal. A variety of textures, such as yarn, buttons, wood, stickers, and crepe paper can be enjoyed in Aspen’s daily art experiences.
- Taste: Improved sleep and decreased anxiety and agitated behaviors are the common results of comfort foods. Healthy snacks, such as cheese sticks, applesauce, or eggs provide not only important nutrition, but also a calming effect. Sufficient intake of water is also important. Aspen Senior Activity Center serves delicious snacks and a mid-day meal daily, including everyone’s favorite: Ice Cream!
- Smell: Aromatherapy massage oils help to reduce anxiety, stress, and agitation. Vanilla, lavender and chamomile provide best results. Battery-powered candles can stimulate a sense of calm and are safe to use around persons with dementia. Remember to consider any allergies or irritation to scents before use. Aspen Senior Activity Center does not use scents for these reasons, but encourages family to consider using this strategy at home.
- Sight: Decrease visual stimuli to decrease agitated behavior. Pleasant, soothing colors, such as pastel shades of greens and blues and soft lighting produce calming effects on mood. For those with visual impairment, bright light provides safety. Visual cues, such as photo of family or red scarf hung on doorknob can reduce disorientation; yellow signs over the restrooms and large-lettered cues are placed throughout the Activity Center, to help clients at Aspen feel more familiar with their surroundings and to promote safety and independence.
~Tamara Nixon, BS, CHES