Establishing a regular bathroom routine can help to promote the individual’s dignity and independence
Anger and Agitation
Problems and Solutions: Anger and Agitation
Communications and Understanding
Are they anticipating an event, such as a visit from a relative or to doctor?
You may not be able to tell someone with dementia about an event days before it takes place, because the anticipation may create stress and anxiety. Informing the person about the event closer to when it will occur may reduce or eliminate stress.
Are they frightened or uncomfortable when you touch them?
While touch can be calming and reassuring, some people can misinterpret it. People with dementias like Alzheimer’s can also experience hypersensitivity to touch. If so, it may indicate an inability to correctly identify sensory input. These issues can also cause resistance to bathing, as person has trouble properly identifying the sensation of hot and cold or even water hitting the skin during a shower. It can also cause anger or agitation.
There are things you can do to help manage issues with touch. Always approach from the front and then get their attention by making eye contact before touching. Tell them in simple terms what you are going to do. For example, before combing or brushing their hair, show them the comb before using it and gently talk them through what’s happening. For bathing, you can try pouring a little water gently over the person’s hand to show that the water won’t hurt them.
Are they looking for reassurance?
Sometimes repetitive questions or actions may be a cry for reassurance. Try a gentle touch or hug if the individual is okay with being touched. Reassure them that everything is fine, and then try redirecting them with a conversation or activity.
Are they picking up on their caregiver‘s anger or impatience?
Caring for a person with dementia can be stressful. Be aware of your tone, facial expressions, finger pointing and head shaking. Your frustration is easy to sense and can lead to agitation, refusing help, and other negative behaviors. Caregiver burnout is very high when dementia is involved. Be aware of your stress level and get relief before the situation becomes overwhelming.
Are they reacting to being corrected, lectured, or told no?
Verbally correcting an inappropriate behavior can lead to agitation. Rather than scolding or yelling, speak in a calm voice. Often your tone alone can trigger unwanted behaviors. In some cases, distraction can work better than trying to correct the behavior. If it happens regularly, look for triggers. It is better to prevent the problem than to try to correct it.
For example, if someone with dementia always grabs toilet paper on the way into the shower, the normal tendency is to “correct” the person and take the toilet paper away. Instead, before the person attempts to grab the toilet paper, hand over a washcloth or a hand towel, something that can easily be used in the shower. Alternatively, move the toilet paper so it isn’t easily reached on the way to the shower.
Try to avoid saying “no” to unwanted behaviors. Remember they are still an adult and will not like being constantly told what to do. If you know this is an issue, try to be prepared with pre-planned responses that will help redirect them. Using redirection will help relieve this problem. Also, try to avoid situations that are known triggers for agitation, screaming, and other unwanted behavior.
Are you speaking too quickly or hard to understand?
If you speak too quickly or are hard to understand, wandering, repetitive behavior , or refusing assistance can be a coping mechanism. Make sure you speak in a calm, clear manner. Be aware that hearing loss is common in seniors. If you suspect that the individual may not hear well, contact a health care professional.
Could they be feeling rushed?
Due to changes in the brain, making decisions and performing tasks can take much longer. Waiting for them to complete a single step of a task may be frustrating to you, but it is important to allow them to do as much on their own as possible. For decisions, give them up to 90 seconds to think things through.
If you are impatient or feeling frustrated, they can easily sense it and become agitated. Be aware of your tone of voice and your body language Take a quiet, calm, matter-of-fact approach with your communication. It often takes much longer to eat or perform routine tasks, so allow plenty of time and stay as patient as you can.
Remember to give the person with dementia a chance to get involved. While it may take more time to assist someone rather than doing it yourself, the extra time is well worth it. Doing as much as they can themselves can make them feel less dependent and enhance feelings of pride and self-esteem.
Try to speak in a calm, friendly tone and avoid complicated phrases. Do not talk down to someone with dementia or treat them like children.
Are they bored or lonely?
If the person is living an isolated life, they may need more activity and human interaction. Try gradually increasing walks, visits by family or friends, and introducing additional activities to see if it helps reduce the problem.
Find activities they enjoy and find stimulating and try changing them up daily to avoid boredom. Consider past skills and interests when choosing activities and adapt them as necessary. Even doing part of an enjoyable activity can be beneficial.
Are they disoriented by the darkness or shadows?
Darkness and shadows in their bedroom at night can cause confusion, disorientation, and hallucinations. On the other hand, too much light in their bedroom can cause problems getting to sleep. Night lights can cut down on confusion should the person wake at night, and help prevent falls if they get up to go the bathroom. You’ll need to adjust the lighting to see what works best.
Are they in a new home or environment?
Changes or disruptions to the home environment can cause confusion or agitation, even hallucinations or paranoia. If they are in a new or unfamiliar environment, place familiar objects, furniture, and pictures around to make it feel more like home. Keep rooms easy to get around and uncluttered. Label rooms using door decorations and name plaques. For example, post a picture of a toilet on the bathroom door. Conversely, you may want to disguise or cover exit doors.
Could the temperature be too hot or cold?
Remember that what is comfortable to you may be either too hot or too cold for someone with dementia. In general, you’ll need to keep the house warmer than usual, especially the bathroom and bedroom while they undress.
As the disease progresses, they may also lose the ability to distinguish between hot and cold. When combined with the inability to verbalize, this can make it difficult for a caregiver to pinpoint the issue. Try playing with the room temperature or adding/removing layers of clothing to see if that helps.
Could they be afraid of poorly lit rooms and shadows?
Poor lighting can create rooms that are unfamiliar and frightening. In addition, shadows can be misinterpreted or scary. Make sure the living area is well lit and remember that older people usually require more light than younger folks.
Is a friend or family member out of sight?
Not being able to see or find a certain family member or friend may make the person with dementia feel lost, forgotten or insecure. It can also lead to agitation or angry outbursts. Speak in a reassuring voice and tell him/her that the person he/she is looking for is okay. Try to redirect the conversation with food, drink or an activity.
Is every room, including the bathroom, well and consistently lit?
People with dementia sometimes see things differently than those without dementia. Make sure there is adequate lighting, especially in the evening. The home may require brighter lighting than you feel is necessary.
Sometimes a room that is not well lit will create problems for someone with dementia as they may be unable to recognize the food on their plate, recognize people they would otherwise know, see their clothes in a drawer, or locate their toothpaste. In the extreme, shadows can feed paranoia and hallucinations.
It is also helpful to have the same level of intensity from room to room. That way they don’t have to adjust to different lighting levels when they enter a closet or bathroom, which can cause agitation.
Is sensory overload an issue?
Too many people, excessive activities, and noisy environments can lead to agitation, wandering, and other unwanted behavior. While keeping the person socially active is beneficial, it can also cause stress. Try limiting the number of people they interact with, as well as avoiding noisy situations to see if that helps.
Is their clothing making them physically uncomfortable?
Being uncomfortable can cause wandering, agitation, or repetitive actions. If the person is pulling or tugging on her clothes, change the person’s clothing and see if that stops the behavior.
Are they getting enough fluids?
Are they getting enough physical activity and exercise?
Are they hungry?
Are they overtired?
Could depression be an issue?
Could one of their prescription medications be causing or exacerbating the issue?
Could poor vision or hearing be part of the problem?
- Make sure they wear their glasses and hearing aides to help them function better in their environment and when traveling outside the home
- Explain any misinterpretations, such as, “That is just a shadow. See how it disappears when I turn the light on” or “that pounding noise is the men working outside.”
- Have vision and hearing checked regularly by a professional
Could they be suffering from a physical illness or ailment such as the flu, an infection, or arthritis?
Do they need to use the bathroom?
Have they soiled themselves?
Are activities too childlike?
Are they trying to avoid a difficult or unpleasant task?
As the disease progresses, tasks that were once simple may become more and more difficult. Don’t expect them to do everything they used to do. Simplify tasks by breaking them down into small, easy steps. Explain each step clearly using gestures and demonstrations. If they are unable to complete the entire task, have them do as much as they can.
Are they unable to complete tasks?
The inability to complete tasks that were once easily accomplished can lead to anger, frustration, and negative behavior. Try simplifying tasks by breaking them down into small, easy steps. Explain each step clearly using gestures and demonstrations. If they are unable to complete the entire task, have them do whatever they can. The goal may not be to complete the task, but rather to participate. For example, when doing a puzzle, the goal may be to talk about the picture on the puzzle, rather than completing the puzzle.
Does they feel useless, left out, or helpless while watching others work?
Have them perform tasks they are capable of doing. Involve them in household activities, such as folding towels and washing dishes. Thank them for their help and be reassuring.
Has there been a change in routine or schedule?
Consistency is extremely important with Alzheimer’s or a related dementia. Any changes to the schedule or routine can cause confusion and agitation. Families often think getting mom out or having a party for her will make her happy, when in fact, it may cause problems. When performing an activity that is not part of the normal routine, make sure the person is well rested and comfortable. Go to extremes to make sure the person is not agitated prior to the new activity.