There are several general rules that will be repeated here for caregivers of someone with dementia that has to deal with behaviors that may be a problem. The approach for any problematic behavior should be to:
- Check your own motivation for wanting to change the behavior. Is the person just simply annoying you? Do you need a break from them? Are you beginning to become resentful?
- Consult with medical personnel to help to determine the cause of the behavior. Many times, a sudden change in behavior in a person with dementia is a result of a medical issue.
- Very often, a simple adjustment to the person's environment can make a big difference.
People with dementia become agitated for many reasons that can often easily be adjusted. However, agitation may also be a feature of the progressive nature of the disorder or some new medical issue and may require medical assistance. Some of the situations that may increase agitation are:
- Any change of environment or routine that becomes confusing for the person. This can include any change such as moving to a new room/dwelling, simply leaving one's environment to go to the doctor's office, getting a new caregiver, a new schedule, a new medication, etc.
- Fatigue or anxiety that can occur because of confusion, physical needs not being met, or other cognitive issues.
- Misperceived threats.
- Brain damage due to the course of the disorder.
To reduce agitation (and anxiety):
- Try and create a calm environment by removing the person to a quieter place, adding more familiar features to the environment, or the use of some security object that the individual recognizes.
- Simplify tasks for the person.
- Eliminate distractions such as turning off TVs and radios, vacuum cleaners, etc.
- Check to see if the person needs to use the bathroom, if they are too hot or too cold, if they are hungry, or if they have some type of other irritation.
- Provide distractions such as removing the person from the environment, taking them on a walk, playing cards with them, putting on dance music with them and dancing, etc.
- If anxiety and agitation persist consult with medical personnel.
For some people with dementia increasing signs of aggression may be associated with the worsening of their disease. Always check your own motivation when dealing with perceived aggressive behaviors (either verbal or physical). Remember that people with dementia who act aggressively are not purposely doing so to annoy you. A sudden change in behavior that represents aggressive actions may be caused by some acute factor such as a urinary tract infection or the side effects of new medications. Check all options such as:
- Is the person uncomfortable? There are many reasons that can produce discomfort in people with cognitive impairment. Remember that people with dementia often cannot control their own situation. Is the person confused? Is the person in pain? Is the person hungry? Does the person need to use the bathroom, or have they soiled themselves? Is the environment distracting? Is there a chance that a new medication or multiple medications are leading to side effects that contribute to the problem? Etc.
- Is the environment leading to aggression? Environmental factors that can lead to aggressive behaviors include overstimulation, feeling that one is in an unfamiliar environment, a new routine, etc.
- Consider the time of day when aggressive behaviors occur: Aggressive behaviors happening in the evening may suggest issues with delirium.
- Does the person understand what is expected of them? Poor communication, being overwhelmed with questions or demands, etc. can lead to aggression.
- Diet: Caffeine and other stimulants may increase aggressive behaviors. Check for the over use of coffee, tea, sugar, etc.
- Are you the cause? Is the person reacting to your resentment or behavior? Check and see if your behavior or attitude is making the person defensive, confused, or resulting in some other reaction.
Often simply slowing things down, changing the environment, removing distractions, and communicating properly can eliminate many aggressive behaviors. However, aggression from people with dementia is often handled with medical interventions such as medications.