Caregivers to people with Alzheimer’s disease and other types of dementia often have the unsettling, frustrating challenge of trying to quiet an agitated and possibly aggressive elder who is unable to communicate the source of his or her distress. We know that the behavior is an expression of discomfort either of body or mind, yet we are left trying to comfort our loved ones with few clues as to the root problem. Even experienced clinicians are often baffled.
Pain is one common reason for aggression. When a person who can’t communicate or has lost the cognitive ability to pinpoint a source of pain and ask for help, what option is there? They will likely act out.
The National Institute on Aging suggests additional causes for the discomfort that can trigger agitation or aggression. Depression and stress lead the list, but too little rest, constipation, soiled underwear, a sudden change in routine or surroundings, too many people around, or being pushed by others to bathe or to remember things beyond their grasp can all cause this distressed behavior. Loneliness and interactions of medications are also possibilities.
Watch for patterns, get medical advice
Be mindful of any patterns of behaviors relative to specific physical environments, times of day, medications administered and other routine occurrences than may provide insight into the cause of the person’s distress.
Schedule and keep regular medical and dental health exams to proactively head off sources of physical discomfort, especially for those people who cannot articulate where pain may be coming from.
How to cope
Try to calm the person early on by listening carefully to the person’s frustration if he or she can explain what the problem is. Do your best to understand even if the reason seems senseless to you. The last thing you want to do is brush off the worry or say "that’s silly" or some related putdown. You can say, “I’m sorry that you are upset” and assure him or her that you will stay with them and try to help.
Provide reassurance by saying something like "we’re going to get to the bottom of this." If fear is the issue, you can say, "You’re safe now. We’ll take care of you."
Modify the environment if possible by decreasing noise and confusion. This may involve taking the person to another room.
Try to distract the person by changing the subject and then redirect him or her to another activity like art, music or some routine task that helps the person feel useful. If this doesn’t work, don’t push it. Maybe you’re trying too hard to fix the problem.
The person may be bored and need something to do so going for a walk or car ride could help.
Humor can also be helpful to both the caregiver and care receiver.
The National Alzheimer’s Association suggests that the caregiver check his or her own behavior. These experts say you should not ""raise your voice, show alarm or offense, or corner, crowd, restrain, criticize, ignore or argue with the person. Take care not to make sudden movements out of the person’s view."
I firmly believe that caregiver anxiety and stress can bleed over onto the care receiver causing that person for feel anxious. In other words, caregiver stress can be contagious. Therefore, caregivers do need to look at their own stress levels and find outside help if continuing stress is an issue. Even a brief respite can help the caregiver recover, and in turn the care receiver may feel more serene, thus breaking the stress cycle.
Keep the doctor in the loop. If agitation and aggression are common events, a new medication, a change in dosage of an older medication or a drug interaction may be causing the problem or at least exacerbating it. Also, the doctor may offer more suggestions or have a medication change in mind. Always keep in close contact with your loved one’s doctor when there are challenges.
No one is going to be able to completely smooth the way for their loved one with dementia. However, by keeping a clear head and asking for help when necessary, you may be able to limit their distressing episodes or at least cut down on the intensity.
National Institutes of Health National Institute on Aging. Alzheimer’s Caregiving Tips: Coping with Agitation and Aggression. Retrieved from http://www.nia.nih.gov/sites/default/files/Alzheimers_Caregiving_Tips_Coping_with_Agitation_and_Aggression.pdf
(2007, August 6 ) Johns Hopkins Health Alert: The Six "R’s". Retrieved from http://www.johnshopkinshealthalerts.com/alerts/memory/JohnsHopkinsHealthAlertsMemory_1433-1.html?CMP=OTC-RSS
Lazar, K. (2012, May 31) US aims to cut use of drugs on dementia patients. Boston Globe. Retrieved from http://www.bostonglobe.com/lifestyle/health-wellness/2012/05/30/aims-cut-use-drugs-dementia-patients/0YIPVAjhztUXyUHz5dROvL/story.html?camp=pm
Carol Bradley Bursack is a veteran family caregiver who spent more than two decades caring for a total of seven elders. She is a newspaper columnist and the author of Minding Our Elders: Caregivers Share Their Personal Stories. Bradley Bursack is also a contributor to several books on caregiving and dementia, and is passionate about preserving the dignity of elders. Her website is www.mindingourelders.com. Follow Carol on Twitter @mindingourelder and on Facebook at Minding Our Elders.