Tuesday, June 7

9 Tips for Coping with Agitation and Aggression

MOODINESS: As Alzheimer's progresses, people may become more agitated or aggressive. Check out 9 tips for handling it.

Agitation means that a person is restless or worried. He or she doesn't seem to be able to settle down. Agitation may cause pacing, sleeplessness, or aggression, which is when a person lashes out verbally or tries to hit or hurt someone.

Causes of Agitation and Aggression

Most of the time, agitation and aggression happen for a reason. When they happen, try to find the cause. If you deal with the causes, the behavior may stop. For example, the person may have:
  • Pain, depression, or stress
  • Too little rest or sleep
  • Constipation
  • Soiled underwear or diaper
  • Sudden change in a well-known place, routine, or person
  • A feeling of loss—for example, the person may miss the freedom to drive
  • Too much noise or confusion or too many people in the room
  • Being pushed by others to do something—for example, to bathe or to remember
  • events or people—when Alzheimer's has made the activity very hard or impossible
  • Feeling lonely and not having enough contact with other people
  • Interaction of medicines
Look for early signs of agitation or aggression. If you see the signs, you can deal with the cause before problem behaviors start. Try not to ignore the problem. Doing nothing can make things worse.

A doctor may be able to help. He or she can give the person a medical exam to find any problems that may cause agitation and aggression. Also, ask the doctor if medicine is needed to prevent or reduce agitation or aggression.

Tips for Coping

Here are some ways you can cope with agitation or aggression:
  1. Reassure the person. Speak calmly. Listen to his or her concerns and frustrations. Try to show that you understand if the person is angry or fearful.
  2. Allow the person to keep as much control in his or her life as possible.
  3. Coping with changes is hard for someone with Alzheimer's. Try to keep a routine, such as bathing, dressing, and eating at the same time each day.
  4. Build quiet times into the day, along with activities.
  5. Keep well-loved objects and photographs around the house to help the person feel more secure.
  6. Try gentle touching, soothing music, reading, or walks.
  7. Reduce noise, clutter, or the number of people in the room.
  8. Try to distract the person with a favorite snack, object, or activity.
  9. Limit the amount of caffeine, sugar, and "junk food" the person drinks and eats.

Here are some things you can do:

  • Slow down and try to relax if you think your own worries may be affecting the person with Alzheimer's.
  • Try to find a way to take a break from caregiving.

Safety Concerns

When the person is aggessive, protect yourself and others. If you have to, stay at a safe distance from the person until the behavior stops. Also try to protect the person from hurting himself or herself.

    The Alzheimer's Disease Education and Referral (ADEAR) Center is a service of the National Institute on Aging, part of the National Institutes of Health. The Center offers information and publications for families, caregivers, and professionals about Alzheimer's disease and age-related cognitive changes.

Comment or Share:

  1. Giving showers is one of the hardest jobs in the memory care unit I work in. (You can only let them skip so many days!) Also, changing adult disposable briefs is hard. Many residents just don't want it done. I've seen the Teepa Snow video about giving showers, but nothing seems to work for me. If anyone has any ideas to make it less stressful for the resident let me in on the secret.

    1. try putting it in the schedule for the same days each week so your loved one/patient gets to know it's part of a routine. They may learn to expect it that way even if they forget. If it is written on a calendar where they can see it often it may help.

    2. Talk softly, but be authentic, tell them what your are doing each step as u get ready for shower, tell them they can stop if it doesn't feel good, make sure they are as warm as they can be, let them decide on temperature, talking softly all the time about the process and reassuring them, if it's practical let them hold the sprayer on themselves. At home with my mother we sometimes get wet, from fun or by just giving the shower. Make sue they are immediately warm after water is turn off. Keep talking about what you are doing. Go slow and gentle and talk to them. Remind them how good it will feel. If all that doesn't work tell them they are smelling bad (this has worked too). Good luck.

    3. Try to take your time, a lot of patients will shut down if you try to rush them. I worked in an Alzheimer unit for 14 years and liked to take care of the harder to take care of patients. Try to make it their idea and make sure the room is warm. For me though just taking my time and going at their pace seemed to work best.

    4. I think the key is to take your time, try doing it from behind the person so they can't see you. Don't forget about oral hygiene either. I've noticed since becoming a student Nurse, oral hygiene seems to be put to the side when it comes to dementia patients, simply due to time constraints and staff shortages. I don't know when my dad's teeth were last brushed as he doesn't know how. It's still important to do as it can lead to pneumonia and other infections which could result in death simple because it's been ignored or not considered that important. All personal care, where possible should be done from behind to help ease aggression, while explaining what your going to do before you do it and calmly, with a soft voice. It won't always work for everyone but it should help. Same with teeth brushing, it their right handed stand behind them and brush their teeth with your right hand, or use hand over hand technique.

    5. i have same problem at home with wife,do not know what to do apart from hand wash.

    6. My mom, in her 90's, had mild dementia and i cared for her at home. She loved the feeling after the shower, but the shower was not as enjoyable as before and i realized it was because she was cold when the water wasn't on her, and she was scared of falling. Sometimes it can be little things, each person is different, we wete able to resolve those issues once i figured it out. Shower chair, that slid from outside in/Out and turn the heat up.

    7. Perhaps bathing in a warm tub is a better idea. Most people need to control the temperature of a shower themselves. At least with bathing they can feel the temp of the water with their feet.

  2. Oops, my comment disappeared. Our residents do have a set schedule for showers, every other day either in the morning or evening, whichever they preferred when they lived at home. Some can no longer process reading, but I'll see if the calendar idea will work.

  3. instead of a calander which can a bit small to read how about a white board with a routine for the week on the board s they can see easily

  4. Mom's not going to the bathroom much and last nite I realized, when I put her in her bed clothes, that she had been wearing a soiled diaper for awhile. How do I check her diaper so she won't be sitting for hours in a wet or soiled one?

    1. Here at home we have a routine to check and change diapers early in the morning, early afternoon and check before putting my mom to bed. In my mom´s case she feels something is happening even though now she does not verbalize it but her body language let´s you know.

      Following Asian knowledge, the kidney works between 4 am and 6 am and around 5:30 pm. This also helps.

  5. My Mom is very resistant to bath. She gets agitated, angry and scared. The last shower was a nightmare. She fought, yelled for help and cried desperately. I tried to be calm and soft spoken. It tnow been months since that time. Sponge bathing just makes her angry. Any help would be a blessing.

    1. 1 in 4 of my moms showers are not terrorizing on me, lol I just don't know how to say it. She has super bad aphasia and at times does not know common words to speak or understand them. I have learned it's easier for me to dress her when we are uSing the restroom, so at least then guiding her into the shower is easier. I am going to go way back to basics (or at least my basics) I have a shower chair in case she feels she gets tired (some have suggested, toilet chair - you can reach under to wash their privates while they sit) I place a hand towel down for her feet, feels like carpet not something she will slip on, I guide her hands to the grab bars, also hand her a shower scrubbie (the netted poofy things) don't get me wrong she is repeating and often loudly saying "oh you, oh you, and no, no, no, stop it stop it," I sometimes don't even speak anymore due to my agitation rising and my tone will not be pleasant - when I do, I just keep repeating oh you will feel so good and clean and fresh. Doesn't this feel great, and also I am sorry, and I know, I know - I am so sorry. If she is super crazy about washing her hair, go to a beauty college for wash and style we do that also, mom doesn't flip out on them as much nor does she scream. I do warm them she can say inappropriate things and she has dementia.
      Don't get me wrong, shower time is my worst time. It's is like getting an octopus into the shower, I physically pick her leg up to step her in, keep the other arm on her waist guiding, and showers only happen on days I can conquer them. 1 a week mission accomplished, 2 or more bonus! Just remember the human body is an amazing thing and adapts to all sorts of stuff, and even tho health care officials may tell you this or that is preferred, have they lived it? Even if they have experienced it have they done so just as you are? I am sick and tired of them saying take time for yourself.... I am the only living child, her family is all out of state, I moved to her state to care for her. So when I say I am 24/7 I mean 24/7. I have found help on care.com (our funds are limited) and also investing in wireless cameras amazing, mom does have me following her everywhere in the house and out back now. Bestbuy has wonderful options and I have hung them up with 3M command adhesive strips - so simple.
      I hope maybe I have said something you can try or it has triggered a new thought, good luck.

    2. fabulous ideas and advice from the horses mouth. You are so right when you say that the health professions have no real idea what it`s like for the sole carer on a daily basis. Some of your ideas about shower taking has been noted down on paper this end, as I`m trying to be as prepared as possible when my partner gets to the stage where he`s unable to understand or comprehend the need for personal hygiene.

  6. Maybe give a "no-rinse" bath a try. Amazon.com has a variety of no-rinse body-washes. See a few at:
    Amazon.com -> Home -> Bathroom

  7. Using a dry erase board works great. Just do a day at a time. Too much written on the board just causes more confusion. Sometimes before bedtime, I put the next days activity and we talk about it. That seems to work well for me.

  8. Start with getting the feet wet first, then slowly move the water up the legs and trunk, wash the hair last. Make sure the room is warm. Fear is what causes the anxiety and agitation, give the person the hand held shower head if possible.

  9. @carolyn thrive. Thankyou will definitely try this technique

  10. From experience, asking a patient/loved one to help you works wonders. No matter what stage of alzheimer's or another dementia, they seem to keep the urge to help others. I've asked them to show me where I can bathe, then once in there ask them to show me how to do things (turn shower/bath on, how to wash etc.). Very few times was I met with any resistance.

  11. I find my most successful strategy is to NOT mention the work 'shower' - it can make the process fail before it has begun ! We are always 'going into the bathroom to freshen-up' !


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