While a person living with dementia may be still very much themselves, there are times when an always-gentle parent or a kind and loving spouse will suddenly become angry and lash out. What can you do to help?
The answer is to meet them where they are: stay calm, offer respect and validation, and gently assist them in re-focusing.
Here are ten well-tested tips for calming agitation in a loved one living with dementia.
1. Stay Calm
Agitation and aggression are contagious. When you are talking to someone who is upset, it is natural to feel upset yourself—psychologists call this phenomenon “mirroring,” and you can use it to your benefit.
When you stop and take a deep breath to calm yourself, you are demonstrating calmness. This helps to make your loved one feel safe and reassured. Take a step back and see if you can identify a cause for the agitation, for example, a tense mood in the room. Remember that your loved one is not trying to give you a hard time—he or she is struggling as much as you are.
2. Slow Down
Stop whatever you are doing and slow down. Listen to what your loved one is saying, even if it doesn’t make sense. Don’t correct, as that just adds conflict. Take a deep breath and remember a good memory you share with your loved one. Allow that warmth to enter your eyes and look directly at him or her. Smile gently and try to ask for permission for what you need to do or offer help. For example: “May I help you wash the dishes?” You can then make a positive request like: “Will you walk with me to the store?”
A person with dementia might be overwhelmed by overstimulation or frustration. Instead of rushing in with more ideas or words, just take a pause. Silence gives your loved one time to think and figure out what they are trying to say.
3. Focus on Feelings, Not Facts
Dementia can impact a person’s ability to reason and speak, but feelings still remain strong. You need to respond to your loved one’s feelings instead of their words. Trying to reason and argue with a person with dementia will only frustrate both of you!
Listen to the expression of frustration even if the actual words don’t make sense. Your loved one might be saying, “I need the car to drive to the ball!” You could respond by saying, “you really are wanting the car today?” Then try to provide clear reassurance. For example, “I will take you out in the car today and we can get what you need.”
4. Offer Respect and Validation
Always treat your loved one with respect. These feelings can help foster effective communication with someone with dementia. Even more importantly, continue to interact with your loved one with dignity. Although you may see behaviors that remind you of a child, your loved one is not a child. Guarding his or her dignity will prevent hurt feelings that lead to agitation.
The reality of your loved one with dementia may not agree with the reality that you see. But the feelings that he or she is experiencing are something you can both understand. Using what’s called the Validation Method can improve your communication. You can agree with your loved one’s perception of reality without lying. The easiest way to do this is to ask gentle questions about what they are telling you. When your loved one tells you that there is a “strange man” in her kitchen, you can validate the feeling behind it and ask questions—even if that strange man is actually her husband.
Try saying, “That must be frightening! Would you like me to go check why he is there?”
Other bridging phrases are:
- What is that like?
- Tell me more about….
- It would be so lovely to do that….
5. Limit Distractions
Set your loved one up for success. Dementia causes damage to the brain which makes it difficult to express thoughts and perform tasks. The brain can be overstimulated by background noises, clutter, crowds, or lights. This overstimulation can bring on feelings of restlessness.
Develop an environment of calm in your loved one’s home. Choose smaller gatherings over crowds as much as possible. One or two visitors will be easier to handle than a room full of talking guests. Turn off the TV when talking to your loved one—its noise can be difficult for your loved one to block out.
Limiting distractions for yourself will also help you as a caregiver. Research has shown that smartphone use can make you less aware of those around you. When you are distracted, you may be missing early cues of frustration. Try leaving your phone in another room during care activities—see if your undivided attention helps calm your loved one.
Always aim to simplify your surroundings when you notice signs of agitation. Move into a quieter space. A calm environment will often calm your loved one. Reducing the amount of non-essential items is a great way to increase feelings of calm in a home. Bright, distracting patterns and moving objects can be too much—one or two meaningful, personal pictures will offer a more calming environment than 20 frames.
Clutter causes your loved one’s senses to live in overdrive. If they are constantly filtering out what is important and necessary, then their brain can’t relax. Your loved one will not know what to focus on. Help to calm them by limiting the things that surround them. Clutter also makes it easier to lose important objects or not see something that is “out in the open”.
Lights are another stimulating presence. Particularly in the evenings and late afternoon. It is important to switch from bright overhead lights to smaller, dimmer lights as the sun goes down. The glare and reflections from lights off windows, mirrors, or picture frames can be startling or even frightening for your loved one.
7. Check for Discomfort
Your loved one may have trouble telling you that they are uncomfortable. Fidgeting, restlessness, having trouble sitting in one place, or just being irritable can all be signs of physical discomfort.
Making sure that your loved one is physically comfortable will drastically reduce aggression and agitation. Here’s a handy checklist to help you figure out what might be wrong:
- Are they hungry? When did they last eat? Try offering a small, nutritious snack. Better yet, sit down with them and have a snack yourself. Keep yourself at your best!
- Is there an infection? Urinary tract infections (UTIs) in older adults can often develop or worsen symptoms of confusion and agitation.
- Are they thirsty? What has your loved one had to drink in the last 24 hours? Dehydration is common in elderly people because of a decreased sense of thirst. Dry eyes, mouth, and skin are symptoms to watch for along with confusion and forgetfulness. Make your loved one a hot or cold cup of non-caffeinated tea, offer a slice of juicy watermelon, and make sure to add water-dense foods into their daily meals. Or gently remind your loved one to sip water throughout the day.
- When did they last have a bowel movement? If it was more than 24 hours ago, that’s an important discomfort to address!
- What is your loved one wearing? Check for a waistband that itches, socks bunched at the toe, a collar that is too tight, or a fabric that scratches. All of these minor irritations can cause agitation.
Pay attention to the immediate situation or activity. Notice if the activity seems to be triggering your loved one. If so, make a change, redirecting to more peaceful and relaxing activity. If a conversation is upsetting either of you, change the direction. Acknowledge what your loved one said and then move to a different topic.
9. Say Yes
Aim to say yes as much as possible. If your loved one mentions that she saw someone who passed away years ago agree with how lovely it would be to talk to them again. You can even build on that and ask what they talked about. This gives you both a sense of connection and comfort with each other.
Saying "yes" lets your loved one know that you understand what is important to him or her. That you hear them. That you are listening.
Even though the reality your loved one is experiencing is different from yours, you can still find common ground.
Being on the receiving end of a sudden outburst of anger from a loved one is heartbreaking and scary. But remember that dementia affects the whole brain, not just short-term memory. Your loved one living with dementia cannot control the intensity of their feelings, whether they are scared, confused, or suddenly furious.
As Alzheimer’s and other dementias progress, the world is largely experienced through the senses. You can listen to music together, go for a walk, play an instrument, offer a massage, or brush your loved one’s hair.
Dementia may cause personality changes in your loved one, but that doesn’t mean you can’t still connect.
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