Although it has perhaps not received the attention that it deserves, the issue of Agitation is a common symptom in people living with dementia, and it can be one of the most complex and stressful challenges to manage for caregivers. It is estimated that more than half of people living with dementia may experience some degree of agitation at some point during the course of their illness and it is considered to be one of the core features of behavioral and psychological symptoms of dementia.
Agitation can manifest in various ways, including verbal or physical aggression, restlessness, wandering, pacing, gesturing, profanity, and refusal to cooperate with carers, and the effects can have a far-reaching impact on caregivers. It has been linked to accelerated disease progression, functional decline, and decreased quality of life and is also a significant cause of caregiver distress. In severe cases, medication may be required, including antidepressants and anxiolytic drugs, but wherever possible priority should be given to non-pharmacological treatments or interventions, subject of course to professional healthcare advice. No two individuals are identical and clearly what works for one may not work for another but perhaps there are simpler and easier areas that a caregiver can examine first, hopefully without needing recourse to medication. Here are a few suggestions:
Perhaps at the top of the list is physical discomfort, caused by, for example, pain, hunger, or thirst; each of these may trigger agitation and consequently caregivers should always be aware of the individual’s basic needs, and try to ensure that they are met promptly. In fact, pain management is particularly important, as people with dementia may not be able to effectively communicate the level of pain that they are experiencing.
The side effects of medication can also sometimes cause agitation; some medications, such as antipsychotics, can have serious side effects. It probably goes without saying that caregivers should always work closely with relevant
healthcare professionals to manage medications effectively to ensure that they are necessary and appropriate.
Agitation may also be triggered or exacerbated by environmental conditions, for example loud noise, very bright lights, “loud,” or very bold colors in rooms, or even unfamiliar surroundings. To minimize this, caregivers should try where possible to create a calm and familiar environment that minimizes noise and other distractions.(See our blog post on Colors and Dementia:https://amindtocare.com/caregiver-tips/are-different-colors-relevant-to-dementia/ )
It is also true that the use of structured routines, coupled with familiar activities can work to reduce agitation as well as improving the individual’s overall sense of well-being. Allied with this, unmet needs, such as boredom, social isolation, or a lack of any meaningful activities, can also potentially contribute to agitation for someone living with dementia. To try and avoid this, caregivers should identify any particular interests and preferences that the individual they are caring for has, or had prior to contracting the condition, and come up with activities that speak to or resonate with those interests. One example is a gentleman who had been a CPA in his professional life; his son found that activities that involved sorting coins seemed to particularly hold his attention and provide enjoyment for him. It is clear that social engagement can definitely improve the individual’s quality of life and reduce agitation. This was the inspiration behind the development of the A Mind to Care Game & Activity Kit ( https://amindtocare.com/benefits/)
Although people do behave and react in different ways, it is true that Touch can also be an effective way to reduce agitation in certain individuals living with dementia. A gentle touch, such as hand-holding can have a calming effect and also provide a sense of comfort, security and reassurance, and can alleviate feelings of anxiety, restlessness or agitation. Touch can also provide gentle sensory input and promote a calming effect; activities that involve touch such as providing a soft blanket, or tactile objects, such as fidget boards, can help to engage the senses and help to reduce agitation. It is important of course to approach touch with respect and sensitivity, always obtaining consent and considering individual preferences and comfort levels.
There have been numerous studies that have confirmed the benefits of musical intervention in reducing agitation in people living with dementia. This can be either active, where the individual participates in singing, dancing, or playing a musical instrument, or it can be passive, where they listen to music. There is plenty of evidence that music seems to have a unique ability to evoke emotions and trigger memories; even for people living with advanced dementia, music is able sometimes to tap into deep-rooted emotional responses and stimulate positive feelings, and these emotional connections can help to reduce agitation and anxiety. For a moving example of the power of music take a look at this
YouTube video showing Lady Gaga and Tony Bennett Lady Gaga & Tony Bennett – The Lady Is A Tramp (One Last Time: Live At Radio City Music Hall, NY) HD – YouTube