Caregiver Tips for Reducing Agitation in Dementia
Agitation can be one of the most difficult behaviors for caregivers to cope with. In this Sharepost I want to briefly look at possible causes of agitation and provide some links to more information, as well as the steps you might take to help prevent, reduce and treat agitation.
Agitation can result from one of these four main causes or a combination of them, so you may need to consider a number of overlapping reasons for your loved one’s distress.
Physical Causes of Agitation
Alzheimer's is a degenerative brain disease. The damage caused to the brain’s structures can be the primary cause of agitation or may significantly contribute to it, especially in the mid and later stages of the disease. Other physiological causes include:
- Illnesses such as heart, liver and kidney disease, breathing difficulties, malignancy. Delirium - examples of which include post-operative states, diabetes or infections. Medical treatment of disease can cure or improve levels of agitation.
- Pain and physical discomfort- People who are unable to express their feelings and who are confused have to be carefully assessed for discomfort and possible pain. Research into the prevalence of pain in elders in nursing homes is estimated at between 40 and 80 percent. There is evidence that people with cognitive disabilities may have an even higher risk of being under-medicated for pain.
- Medications- Drugs can be very effective in treating agitation but require frequent evaluation by the patient’s medical team. A lot of information is available to show that elders are more sensitive to toxic side-effects and to drug interactions that can cause agitation. Treating agitation in the mostly elderly group of people who suffer from Alzheimer's or other types of dementia is very difficult. Tranquilizers and antipsychotic medications have very powerful sedative effects that can overwhelm the patient even if given in very small amounts. More information on monitoring drugs for anxiety and agitation
- Dehydration, poor nutrition.
Psychological Causes of Agitation
Identifying psychological illness, stressful situations or events known to cause arousal that leads to agitation can significantly help people with dementias like Alzheimer’s. Social and environmental causes of agitation can often contribute to psychological distress and this has to be thought of when trying to identify causation:
- Confusion is a significant cause of agitation. The term confusion although a primary descriptor and cause can and should be investigated to identify issues that can be improved such as establishing a good routine, improved communication, good healthcare.
- Sleep problems- for example sleep deprivation. Here is a link for caregiver tips on coping with sleep problems and Alzheimer’s
- Psychiatric illnesses. Agitation is associated with paranoid psychosis in about 35 to 50 percent of cases.
- Stress can be a cause of agitation in people with dementia. Stress can be induced by such things as visits to friends, doctor’s appointments as well as caregiving procedures like washing and escorting the person to the bathroom. Reducing stress can significantly improve agitation.
- Frustration and Disempowerment- People with dementia are often assumed to be unable to communicate their needs. Institutions and medical care facilities are frequently guilty of this assumption.
Social Causes of Agitation
Social situations such as visits, appointments and family celebrations
Environmental Causes of Agitation
Causes of agitation may be being influenced by poverty and deprivation, crowded and chaotic living environments, extremes in temperature or prolonged, disruptive noise and light levels
Cantley C. (2001) The Handbook of Dementia. Open University Press. Philadelphia