If you are caring for someone with dementia, you may have noticed that your loved one has a tendency to get agitated. If so, you are far from alone. Research has found that 60% of people with mild cognitive decline experience agitation, and this increases to 76% for people with Alzheimer’s disease, the most common type of dementia.
“Agitation has been part of every [dementia care] journey I’ve been on, and on the journeys of other caregivers I’ve met throughout the years,” says Sue Ryan, co-founder of The Caregiver’s Journey and a former dementia caregiver for her grandmother, father and husband.
Agitation can be extremely challenging for both dementia patients and their caregivers. As such, many caregivers need support in learning how to calm a dementia patient. The good news is that there are many options. It’s often a matter of understanding what triggers the person with dementia, and then employing techniques to calm them. Ahead, Ryan and other experts share their tips and advice for helping dementia patients deal with agitation.
What does agitation in dementia look like?
First, it can be helpful to understand what agitation in dementia looks like — because it can look different for each person, according to Christopher Norman, a board certified geriatric nurse practitioner with the National Council on Aging. Agitation can present as any of the following behaviors:
- Restlessness.
- Pacing.
- Rocking.
- Doing the same thing over and over.
- Verbal aggression (yelling, screaming, shouting or using profanity).
- Physical aggression (hitting, slapping, kicking or biting).
Ryan shares that for the family members she cared for, repetitive behaviors were often a sign that agitation was at play. “My grandmother began polishing her silver spoon collection over and over, and my dad began walking around the house checking the window latches,” Ryan says. “My husband made piles on his desk and kept moving them around.”
In each of these cases, the defining characteristic was that these behaviors were out of the ordinary from her loved one’s normal routine, Ryan notes.
“The parts of our brain that allow us to control our emotions tend to work less and less as many dementing illnesses progress, so a person with dementia is often left with feelings they cannot always manage ‘appropriately.'”
—Christopher Norman, geriatric nurse practitioner with the National Council on Aging
Why do dementia patients get agitated?
Often, people with dementia get agitated because their disease makes it difficult for them to process or understand the world around them, Norman says. This frustrates them, triggering feelings of agitation and agitated behaviors. This is compounded by the fact that people with dementia often can’t fully articulate how they feel or what they need.
Emotional dysregulation is also an issue. “The parts of our brain that allow us to control our emotions tend to work less and less as many dementing illnesses progress, so a person with dementia is often left with feelings they cannot always manage ‘appropriately,’” Norman describes. “The person could also be uncomfortable, in pain or upset by changes in their routine.”
Specific causes or triggers for agitation
There are often specific triggers or causes for dementia-related agitation, says Dr. Gary Small, a memory and aging expert and chair of psychiatry at Hackensack University Medical Center. These include:
- Pain.
- Depression.
- Constipation.
- Sleep deprivation.
- Excessive fatigue.
- Medication side effects.
- Untreated infections.
- Excessive noise.
- Too many people in the room.
- Unfamiliar visitors.
- New caregivers.
- Disrupted routines.
- Any move, such as to a new home, a nursing home or assisted living.
“Agitation is common in long-term care facilities, especially when the patient is unfamiliar with the surroundings,” Small adds. Additionally, for many people with dementia, there are certain times of day when they may be more likely to experience agitation. “When daylight fades in the evening, patients may become agitated, a condition known as sundowning,” says Small.
How to calm a dementia patient
Thankfully, there’s hope when it comes to agitation. There are specific things you can do as a caregiver to help calm your patient or loved one. Norman shares the following tips for how to calm someone with dementia down:
1. Stay calm and speak softly
Try to avoid raising your voice or arguing. Instead, take a deep breath, remain calm and listen to what the agitated person is saying. Check that their immediate needs are met and offer assistance if possible.
2. Use simple touch
Hold their hand or give a gentle pat on the shoulder, arm or upper back. When approaching an agitated person, approach from the side or at a diagonal; coming directly at someone may be perceived as confrontational.
3. Provide redirection
If possible, try to redirect the person’s focus to something calming, such as a familiar object, photograph. You may also encourage them to move to a quieter area to relax.
4. Avoid sudden movements and loud noises
Keep the environment quiet and familiar, dimming lights slightly or lowering shades. Loud sounds, bright lights and large groups of people can be stressful. Avoid having too many people help at once, as this can be overwhelming.
5. Offer reassurance
Validate the person’s concerns, and let them know you understand how they feel. Try not to use complex sentences; instead use simple phrases, like “you’re safe” or “I’m here with you.”
“Sometimes it’s being in the messy middle with them, helping them feel safe and supporting them until they can get through it.”
—Sue Ryan, co-founder of The Caregiver’s Journey
How to prevent agitation for people with dementia
In addition to calming agitation when it’s happening, there are things you can do to prevent agitation from happening in the first place — or at least lessen the intensity of the agitation.
Here are Norman’s suggestions:
- Stick to a regular daily routine to help them feel safe.
- Ensure that basic needs are met, including enough food, water, physical comfort and regular bathroom use.
- Provide activities they enjoy and can handle easily.
- Avoid things that might upset them, including loud noises or sudden changes.
- Limit or avoid “surprise” visits from friends or loved ones, as this can be stressful.
- Provide ongoing reassurance and support to help them feel more secure.
- Avoid asking the person with dementia if they remember something, as this can trigger frustration.
As for how to calm dementia patients at night, when sundowning behaviors and agitation are most common? “Including opportunities for exercise will promote restful sleep at night and reduce excessive fatigue during the day,” Small offers.
The bottom line
Some amount of agitation is common with dementia, and can often be well managed by caregivers. If a person with dementia is severely agitated or is harming themselves, their homes, their belongings or others, you should reach out to their medical provider. Their provider may be able to adjust their medications, check for medical conditions that may be contributing or offer other suggestions for agitation management.
It’s important to remember, too, that to some extent, agitation is normal. “Depending on the cause, unfortunately, sometimes there isn’t a solution or an absolute go-to,” says Ryan.
But it’s possible to make peace with this aspect of their condition and still care for them as best you can. “Sometimes it’s being in the messy middle with them, helping them feel safe and supporting them until they can get through it,” Ryan concludes.
