 Show I am here to let you know if you pay attention you may be able to diffuse the situation or even prevent it. Things to try to decrease agitation and aggression: First thing to do is remind yourself to stay calm, it can be very very difficult but by reassuring your resident you are offering them security and creating a safe environment. Our job is to figure out What they are trying to tell us?? remember all behaviors stem from something. So, we are going to listen to our resident as they verbally and maybe physically express their frustrations. They may not make much sense to you but sometimes a good detective can figure it out and ease the person agitation. Possible triggers: So, what are possible triggers: Pain, discomfort, like being too hot, too cold, hungry, needing to use the bathroom, etc.). Perhaps they may be frustrated or overstimulated. Environmental triggers: turn down the tv/radio, decrease noises that are loud and startling, move the resident to a smaller dimmer area, play soft music, hold their hand if they will let you and continue to reassure them you want to help. Do Not: scold them or tell them things like “you know better” “stop that” “ don’t touch that” that’s not yours” “ this is not acceptable. Because it is not going to help, in fact, it may make things worse. Get yourself into their reality they are only trying to meet their needs. Your Behaviors: It is also very important to reflect on your behavior in response to the person. If you are not already doing so, reassure the person that you are there to provide assistance and comfort. If it seems like the person needs something to do, try redirection to an enjoyable activity. Refer to a social history if there isn’t one accessible talk to your manager. Behavior charting: when charting on a behavioral incident or when filling out a behavior flow sheet, it is helpful to use specific, concrete words that clearly describe what a resident is doing so you can truly track whether the interventions/changes the environment work to decrease the behavior Remember: no person is the same so not every intervention will be successful and what works for one may not work for the other. When you do find something that works, share it with your coworkers and manager. Emmy Kaczmarksi, RN is a Master Trainer for AGE-u-cate® Training Institute, Dementia Educator, Behavioral Specialist and lives in Hudson, WI. http://www.AGEucate.com
You notice your loved one becoming more forgetful. She cannot recall her visit with her granddaughters yesterday. She claims she took her medications this morning, yet you find them untouched in her pill case. You wonder how this mild-mannered woman has become so angry, so quickly. She is often frightened now, disoriented, and unpredictable. Yet she still remembers every detail of your wedding day, the names of your four children, and how to play her favorite piano pieces. When you sing together, time temporarily stands still. Your loved one received a diagnosis of Alzheimer’s disease. Nights are the hardest time for her. You worry about her safety when she wanders through the house. She almost broke the door last week; you can tell her arm still hurts when you bathe her. She resists and yells at you when you take her to the bathroom. She has started to show behavioral symptoms of dementia. Aggression and agitation in dementiaBehavioral and psychological symptoms are very common in dementia, and affect up to 90% of people living with dementia. In addition to memory changes, people with dementia may experience agitation, psychosis, anxiety, depression, and apathy. These behavioral symptoms often lead to greater distress than memory changes. When people with dementia become agitated or aggressive, doctors often prescribe medications to control their behaviors in spite of the known risks of serious side effects. The most frequently prescribed medication classes for agitation in dementia carry serious risks of falls, heart problems, stroke, and even death. Caregivers, who often experience burnout in managing aggressive behaviors, welcome medications that can temporarily decrease agitation. Unfortunately, aggressive and agitated behavior often contributes to the decision to transition a loved one to an alternative living situation. New research shows that nondrug therapies are more effectiveAccording to a new study looking at more than 160 articles, nondrug interventions appeared to be more effective than medications in reducing agitation and aggression in people with dementia. Researchers found that three nonpharmacologic interventions were more effective than usual care: multidisciplinary care, massage and touch therapy, and music combined with massage and touch therapy. For physical aggression, outdoor activities were more efficacious than antipsychotic medications (a class of drugs often prescribed to manage aggression). For verbal aggression, massage and touch therapy were more effective than care as usual. As a result of this study, the authors recommend prioritization of nonpharmacologic interventions over medications, a treatment strategy also recommended by the practice guidelines of the American Psychiatric Association. Helpful tips for caregiversTo decrease agitation and aggression with dementia, caregivers can help their loved ones in the following ways:
The bottom lineTo decrease agitation and aggression in people with dementia, nondrug options are more effective than medications. Physical activity, touch and massage, and music can all be used as tools to manage agitation related to dementia.
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