Alternative Treatments for Agitation

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Agitation does not go away by itself. Research shows that it usually continues for 2 or more years, especially if it is associated with aggressive behavior. If treatment is begun early, there is a better chance to find the most effective and safest treatment before agitation causes safety or health risks for the person or the family.


How is agitation treated?

There are a number of non-drug therapies that you and the clinicians working with you can provide to an agitated person:

* Providing the right environment
* Supervising activities
* Learning to communicate with a person who has dementia
* Getting support and improving coping skills


PROVIDING THE RIGHT ENVIRONMENT

It is important to evaluate the person's environment—his or her bedroom, daytime areas, and schedule—to see if any of the following problems may be contributing to agitation:

* Some people with dementia become particularly agitated at certain times of the day. Would it help to change the person's routine to avoid these problems? It is helpful to try to do things in the same place at the same time each day.
* Agitation may result from thirst or hunger. If a person with dementia forgets to eat, offer frequent snacks and beverages.
* Agitation may result from physical discomfort. Has the person remembered to use the bathroom? Is he or she constipated? Could there be aches and pains from sitting in one place?
* Does the person have a regular, predictable routine? Unexpected changes or last minute rushing can cause people with dementia to become scared and disoriented.
* Getting dressed can be frustrating for someone with dementia. Try to simplify this task, for example, by using Velcro fasteners and not insisting on matching outfits.
* Is the person feeling stressed, hungry, tired, scared, cold, or hot? Does he or she need to use the bathroom? Fresh air or air conditioning can reduce agitation. It is also important not to rush individuals with dementia.
* Is there a chance for regular exercise? Walks and simple exercises are good ideas. If a person wants to pace and isn't disrupting anyone, that's OK, too.
* Is the room well lighted? Good lighting can help reduce disorientation and confusion. Provide night-lights.
* Is the environment too noisy or confusing? Are there too many people around? It may be helpful to use picture cues, to personalize the room, and to decorate and highlight important areas with bright contrasting colors.
* Is the environment safe? If not, take necessary steps to ensure the safety of the person and his or her caregivers (e.g., lock up knives and guns, take stove knobs off at night, put safety latches on doors, camouflage unprotected exits, install inconspicuous locks to restrict access to cleaning solutions and other hazardous substances or poisons). It is a good idea to register the person with the Alzheimer's Association SAFE RETURN program (p. 108) in case he or she wanders off and gets lost.


SUPERVISING ACTIVITIES

People with dementia often need help or supervision in dealing with activities of daily living, such as getting dressed and bathing. Giving the person something useful or interesting to do, especially when directions and structure are offered, can help prevent anxiety and agitation. Here are some suggestions:

* Structure and routine. Try to follow regular predictable routines that include pleasant, familiar activities. Remind the person that everything is going according to plan.
* Pleasant activities. Make time for simple pleasant activities the person knows and enjoys. Listening to music, watching a movie or sporting event, sorting coins, playing simple card games, walking the dog, or dancing can all make a big difference.
* Keep things simple. Break down complex tasks into many small, simple steps that the person can handle (e.g., stirring a pot while dinner is being prepared; folding towels while doing the laundry). Allow time for frequent rests.
* Redirect. Sometimes the simplest way to deal with agitation is to give the person something else to do as a substitute. Someone who is restless and fidgety can be asked to sweep, dust, rake, fold clothes, or take a walk with the caregiver. A person who is rummaging can be given a group of items to sort and arrange.
* Distract. Sometimes it is enough to offer a snack or put on a favorite videotape or some familiar music to interrupt behaviors that are becoming difficult.
* Be flexible. Your loved one may want to do something or behave in a way that at first troubles you, or may refuse to do something you planned, like taking a bath. Before trying to interfere with a particular behavior, ask yourself if it is important to do so. Even if the behavior is bizarre, it may not be a problem, especially in the privacy of your own home.
* Soothe. Simple, repetitive activities, such as massage, hairbrushing, or a manicure, may help reduce agitation.
* Compensate. It is important to let people with dementia do things they are able to do, so that they will feel empowered. At the same time, helping the person with tasks that are too demanding for them is comforting and prevents frustration.
* Reassure. Let the person know you are there and will keep him or her safe. Try to understand that fear and insecurity are the reasons the person may "shadow" you around and ask for constant reassurance.
* Getting to doctor appointments. Is the person upset about going to the doctor or dentist? Here are some helpful hints: Stress the importance of having regular check-ups rather than talking about a specific test. Try to figure out if your loved one does better with advance notice in order to prepare or if he or she responds better without being told ahead of time. Present the trip in a matter-of-fact way as part of the day's plans. Allow plenty of time to avoid having to rush. If possible, have the relative or caregiver who works best with the patient come along to the appointment. If the person resists, don't argue; instead, try distractions like "We will go out to lunch afterward."


LEARNING TO COMMUNICATE WITH A PERSON WHO HAS DEMENTIA

People with dementia often find it hard to remember the meaning of words or to think of the words they want to say. During the late phases of the illness, people with dementia may communicate mainly by gestures and expressions. The following suggestions may help you communicate with a person who has dementia:

* It is understandable that you may sometimes feel angry; but showing your anger can make the person's agitation worse. If you are about to lose your temper, try "counting to ten," remembering that the person has a disease and is not deliberately trying to make things difficult for you.
* Try and talk about feelings rather than arguing over facts. For example, if the person with dementia is mistakenly convinced you didn't see him yesterday, focus on his feelings of insecurity today: "I won't forget you."
* Identify yourself by name and call the person by name. The person may not always remember who you are; don't ask "Don't you remember me?"
* Approach the person slowly from the front and give him or her time to get used to your presence. Maintain eye contact. A gentle touch may help.
* Try to talk in a quiet place without too much background noise such as a television or other people in conversation.
* Speak slowly and distinctly. Use familiar words and short sentences.
* Keep things positive. Offer positive choices like "Let's go out now," or "Would you like to wear your red or blue cap?"
* If the person seems frustrated and you don't know what he or she wants, try to ask simple questions that can be answered with yes or no or one-word answers.
* Use gestures, visual cues, and verbal prompts to help. For example, if suggesting a walk, get out the coats, open the door, and say "Time for a walk." Set up supplies in advance for tasks such as bathing and dressing; have a special signal for needing to go to the bathroom. Try to break up complicated tasks into simple segments; physically start doing what you want to happen.
* If a subject of conversation makes a person agitated or frustrated, it is better to drop the issue rather than keep trying to correct a specific misunderstanding. He or she will probably forget the issue and be able to relax in a short while.


GETTING SUPPORT AND IMPROVING COPING SKILLS

Some of your loved one's behaviors may be difficult, exhausting, and even frightening for you. When you feel frustrated, try to remember that these behaviors are part of the disease that is affecting the person's brain. Many caregivers struggle with feelings of guilt and anger and need support and reassurance to remember that the disease is creating the behavior, not the person they once knew.

Social support is important for caregivers, whose own mental health can be affected by the stress and sadness of caring for someone with dementia. Help is available from support organizations, newsletters, books, and sites on the Internet—many of these are listed at the end of this guide. Joining a support group allows caregivers to meet and share ideas with others who are coping with similar problems. Group members who have "been there" can often share good ideas for dealing with day-to-day problems. You can locate the nearest support group by contacting the Alzheimer's Association or sometimes through a community organization (e.g., senior center) or a local hospital.

Therapists can help caregivers deal with stress, anxiety, or depression and sort out conflicts about priorities in time or living arrangements. Religious organizations can also help through support groups, and some individuals may find solace in counseling from a member of the clergy.

Caregivers sometimes find it hard to arrange time to attend meetings or groups outside the home. In this case, you might want to try calling one of the telephone help lines, most of which are toll-free, where clinicians and counselors as well as trained peer counselors are available to answer questions or just talk about problems you may be having. There are also a number of Web sites, Internet chat groups, e-mail listserves, and bulletin boards that can provide support and information for caregivers. In addition, there are many good educational publications and videotapes. Some have been written or produced by experts for families and caregivers; others have been written by family members or even people with dementia.


A FINAL WORD ABOUT AGITATION IN DEMENTIA

It is painful to see a family member change and decline because of dementia, and especially difficult if agitation is also present. It is helpful to remember the following points in caring for an agitated family member with dementia:

* The agitation is caused by a medical illness; it is not the fault of the person with dementia.
* It is important to provide a calm, structured, safe, and caring environment.
* Carefully chosen medications can relieve distress and help the person function.

Research in treating agitation is only in the very early stages. We have presented the best of current opinion, but much remains to be learned. Learn as much as you can about dementia and the agitation that can occur with dementia—your knowledge will make a difference in the quality of life for you and your family member.