If You’re Looking After Someone With Dementia
Your needs as a carer are as important as the person you’re caring for.
To help care for yourself:
- join a local carers’ support group or a specialist dementia organisation â for more details, call the Carers Direct helpline on 0300 123 1053 lines are open 8am to 9pm Monday to Friday, and 11am to 4pm at weekends
- call Dementia UK’s Admiral Nurse Dementia Helpline free on 0800 888 6678 to talk to a registered specialist dementia nurse lines are open 9am to 9pm Monday to Friday, 9am to 5pm at weekends
Confusion About Time Or Place
Your loved one may keepon saying, I want to go back home,or This isnt my home. Dementia patients are always confused, and they maywant to leave their own homes and go to their homes.
Remember that dementiacauses adverse and negative impacts on the patients cognitive functioning.This is what causes memory loss and confusion.
Besides, theres a psychological component that drivesdementia patients towards wanting to go home. Often, your loved one is tryingto go back to a place where he has more control over his life.
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Agitation in dementia describes the excessive verbal and physical activity that sufferers sometimes experience. It often shows up in the middle stages of various dementia types, including Alzheimers, Parkinsons, and Dementia with Lewy bodies. Caregivers taking care of loved ones are most likely familiar with the signs restlessness, worry, pacing, verbal or physical aggression, crying, and calling out.
These reactions are common because as many as 80 percent of those suffering from dementia experience behavioral problems. Thankfully, theres much you can do to help. Continue reading below to find out how you can prevent and respond to agitation in dementia patients.
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Helpful Tips For Caregivers
To decrease agitation and aggression with dementia, caregivers can help their loved ones in the following ways:
- Find a multidisciplinary team of specialists. This may include a psychiatrist to carefully consider the risks and benefits of medications for managing behavior, a geriatrician to optimize your loved ones medical situations, and an occupational therapist to consider modifications of a persons living environment and daily routine.
- Go for a walk or on an outing for a change of scenery. Physical activity has additional benefits on , and .
- Add massage and touch therapy, or just provide a calming hand massage.
- Incorporate music into your loved ones daily routine.
- Notice the first signs of agitation. Nondrug options work best the earlier they are used.
- Get creative: discover what works and try using different senses. Aromatherapy, an activity such as folding laundry, brushing hair, or dancing can all be calming.
- Consult with your physicians. Medications are often prescribed as first-line interventions despite what we know about the effectiveness of nondrug options.
- Educate all the people caring for your loved one on the interventions that work best, and check in with them about how these approaches are working.
Why Would Seniors With Dementia Want To Go Home
Often, the mid and latestages of dementia exhibit challenging behaviors in our elderly loved ones. Thefear, anger, sadness, confusion, and paranoia that dementia patients experiencecan result in violent and aggressive actions.
Learn more about thereasons that may make the elderly with dementia express their desire to gohome.
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Dementia Medications To Avoid
It is important to note that there are medications that can actually make dementia worse than it is. When dementia drugs are developed, they are meant to increase Choline levels, which is a chemical that is needed by brain cells to communicate with one another.
However, some drugs can decrease the levels of this chemical and end up worsening dementia and can result in agitation and confusion. They may also cause issues with urination, constipation and a dry mouth.
There are many ailments that can affect dementia patients and they need to be treated. The drugs may have a negative effect on the patient and so alternatives should be sought out.
Prevention Strategies For Home
Person-centered care is an operating system in healthcare, which considers the health practitioner and the patients as partners in achieving tailored care that meets patients’ needs in a unique way . In the PCC framework, the social and historical background, the personality, and the lifestyle of the patients are considered to promote a positive social environment, good compliance, and best outcomes for patients with dementia . The PCC approach is considered a successful option to prevent agitation in home-living and care home patients with dementia and reduce antipsychotic use . Nonetheless, not every PCC-based strategy is effective. For instance, the Dementia Care Mapping , which is based on patients’ systematic observations, has generated conflicting results. In contrast, the Managing Agitation and Raising Quality of Life intervention has failed to improve agitation prevention in care home settings.
Previous studies have indicated a role for boredom in the onset of physical agitation . Thus, activity-based strategies have been developed to prevent this condition. The application of combined stimuli has shown to be more effective than a single activity . However, the most effective activity was live socialization .
Data that emerged from other non-pharmacological approaches, such as acupuncture and electroconvulsive therapy, are mostly conflicting. Some ongoing trials could possibly clarify a potential role for these therapies .
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Drugs Included For Prn Use Evidence And Rationale
While the above sections describes steps the panel endorsed for sequential treatment of agitation and aggression in Alzheimers and mixed Alzheimers/vascular dementia, it was recognized that at times the regular treatments cannot offer adequate protection from the impact of these symptoms. Accordingly, the algorithm allows for the possibility of supplementing medication given in the main sequence with drugs to be given on a PRN basis. The main drug selected for this purpose was trazodone, with use of lorazepam considered acceptable in certain circumstances.
PRN drug 1: trazodone
PRN drug 2: lorazepam
Benzodiazepines -A receptor, benzodiazepine site) have been widely used as anxiolytic and sedative/hypnotic agents since their introduction 50 years ago . However, they have been associated with falls and fractures , and acute cognitive deficits, especially in the elderly . Benzodiazepines are also associated with tolerance and addiction. For these reasons the panel chose not to recommend benzodiazepines in the sequence of regular treatments. Nevertheless, it concluded that occasional use of the benzodiazepine lorazepam as a PRN drug was acceptable in cases of extreme agitation or aggression where behavioural interventions and trazodone are ineffective, or when brief stressful circumstances might exacerbate or induce agitation and aggression, for example, medical tests or dental procedures.
How To Calm A Dementia Patient
If the measures youve taken to prevent agitation fail and you need to calm a dementia patient, here are some tips to help:
Start by saying one of the following phrases: May I help you? Do you have time to help me? Youre safe here. Everything is under control. I apologize. Im sorry that you are upset. I know its hard. I will stay with you until you feel better.
And then:
- Involve the Person in Activities
- Change the Environment thats Causing Agitation
- Find Outlets for the Persons Energy
- Consult a Doctor or Specialist
If you regularly have difficulting caring for a patient who is suffering from dementia, you may want to consider hiring a home caregiver who specializes in dementia care. They would be able to help reduce stress, agitation, and anxiety in the patient, reducing the chances of outbursts or other problems.
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Dementia And Agitation: 11 Ways Of Dealing With Agitated Behaviors
Agitation is a catch-all term used to describe excessive movement and speech. Agitation is sometimes but not always aggressive. It is not intended to harm other people. However, agitation is disruptive to care routines and burdensome to patients and caregivers alike.
Agitation is more common in “major” neurocognitive disorders than it is in “minor” neurocognitive disorders. It usualy occurs in the middle stages of dementia, when it is clear that the person who has the disorder is no longer capable of self-care. Agitation may manifest as pacing, masturbation, twirling hair, doodling, wandering, aggressive speech, out-of-character use of profanities or racial slurs, and sometimes physical combativeness.
Aggression And Agitation In Dementia
Behavioral 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.
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Prevalence Of Agitation In Dementia
Statistics vary, butsome research estimates that as high as 80% of people with dementia experience agitation. One study determined that approximately 68% of people with dementia who were living in the community experienced excessive agitation. Another study found that among people with dementia who were in nursing home care, approximately 75% of them experienced agitation.
What Should I Do When Dementia Leads To Agitation
Dementia Leads To Agitation, Dementia is a serious health concern that affects approximately 50 million people worldwide. Symptoms of this condition include impaired thinking, changes in behaviour, and problems with memory. Agitation can be a symptom of dementia that challenges caregivers and family members.
Patience seems to be the key when dealing with agitation, says Paul Frisch, MD, FACP. Its important not to take it personally. Patience is very important when dealing with agitated patients, as you need to allow them time to process the information they may not be able to understand right away.
Dementia can cause agitation or madness, which are both difficult for carers to manage. Symptoms of dementia and the agitation it causes can vary depending on the patients age and stage of the condition.
What medication is used for agitation in dementia?
Its common for dementia to cause frustration as patients can become easily confused and forgetful. Patients also tend to repeat questions and actions, such as pacing back and forth or repeating the same phrase. These behaviors are normal for dementia, but can be difficult to deal with when youre at the end of your rope. The important thing is to remain calm in order to avoid agitating the patient even more. If patients are getting physically aggressive, then chemical restraints may need to be used in order to keep everyone safe.
What should I do when dementia leads to agitation?
How to cope with Agitation?
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What You Can Do About Medications And Difficult Dementia Behaviors
If your relative with dementia is not yet taking medications for behaviors, consider these tips:
- Start keeping a journal and learn to identify triggers of difficult behaviors. You will need to observe the person carefully. Your journaling will come in handy later if you start medications, as this will help you monitor for benefit and side-effects.
- Learn to redirect and de-escalate difficult dementia behaviors. Contact your local Alzheimers Association chapter or local Area Agency on Aging to find support near you. You can also learn a good approach in this article: 7 Steps to Managing Difficult Dementia Behaviors
- Ask your doctor to help assess for pain and/or constipation. Consider a trial of scheduled acetaminophen, and see if this helps.
- Consider the possibility of depression. Consider a trial of escitalopram or a related antidepressant, but realize any effect will take weeks to appear.
- For all medications for dementia behaviors:
- Monitor carefully for evidence of improvement and for signs of side-effects.
- Doses should be increased a little bit at a time.
- Especially for antipsychotics, the goal is to find the minimum necessary dose to keep behavior manageable.
If your relative with dementia is currently taking medications for behaviors, then you will have to consider at least the following two issues.
The other issue is to make sure you are aware of any risks or side-effects that the current medications may be causing.
What Causes Restlessness In People Living With Dementia
They may be a symptom of the physical changes in the brain caused by dementia. A person may become agitated suddenly because of a change or specific cause, such as increased noise or not being able to do something they previously could. Or they may feel a general sense of agitation but not know why.
A person may feel restless as a side-effect of certain medication . If you think this is the case, ask the persons GP to check whether their prescription could be causing them to feel restless.
There is also a medical condition called restless leg syndrome that gives people an overwhelming, irresistible urge to move their legs to stop unpleasant sensations mostly at night. This condition causes people to get up and walk about during the night. If you think the person you are supporting might have restless leg syndrome, talk to their GP.
Some people may be restless because they feel anxious. A number of things can cause anxiety. For example a person with dementia might be more aware of the changes they are experiencing or because they are unable to continue with hobbies and tasks they enjoy.
A less common reason is that they may be responding to issues with their visual perception or hallucinations and how they interpret what they see. This is a more common symptom of certain types of dementia, such as dementia with Lewy bodies.
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Do Dementia Patients Feel Bored
Yes, just like everyone else, dementia patients may feel bored from time to time. Unfortunately, when they are no longer able to plan their own activities, the boredom may easily turn to frustration. The person may become agitated and start wandering the house, simply because his/her mind has been idle for too long. Activities that will keep dementia patients busy and engaged can help get rid of boredom.
Safe And Effective Physical Restraints In The Emergency Management Of Agitated Patients
There is ongoing debate as to whether or not physical restraints should be used at all in the management of the agitated patient in the ED. If you are going to use physical restraints the goal should be to use them as a last resort, only as a bridge to adequate chemical sedation, which should take no longer than 5-15 minutes with appropriate dosages of calming medications. Prolonged use of physical restraints may result in active resistance of restraint by the patient which may lead to electrolyte abnormalities, arrhythmias, and put the patient at further risk for rhabdomyolysis.
One option is not to use physical restraints, and rather have the patient held down by security for the few minutes it takes for the claiming medications to take effect. The other option is to first place the physical restraints on the patient, immediately followed by IM calming medications and releasing the restraints as soon as the patient is calm. Physical restraint should always be followed by immediate chemical sedation.
When used properly, physical restraints can be quite safe as was demonstrated in this 2003 study by Zun. However, improper use can be lethal as shown in this 2012 study of 26 deaths presumed to be the direct result of improper physical restraints.
Restraints are not benign. Dont restrain and walk away. Ensure the following:
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How To Deal With Manipulation
Your loved one may have lost the ability to distinguish between truth and falsehoods, and they may no longer have a sense of morality around lying. These symptoms can be especially difficult for a caregiver to handle, as it may feel like a complete change in personality. In fact, a person with dementia may not realize theyre lying.
Manipulation is often the root behavior for trust, control, and security. Sometimes, it can even be a cry for help.
- Set limits when possible.
- Remain aware of your personal responses. Do you feel angry, hurt, or frustrated? Acting on these emotions can bring more distress to an already stressful situation.
DONT:
- Hold dementia behaviors against your loved one.
- Bring up events to prove or disprove statements.
- Use accusatory language such as youre lying or youre being manipulative.
- Engage in heated arguments.
Dealing with dementia behaviors can quickly wear out a caregiver or family member. If you care for a person with dementia and are feeling resentment, anxiety, or depression, dont hesitate to seek help. A caregiver support group, counselor, friend, or family member can offer camaraderie and advice.
Although there are no treatments to stop dementia behaviors in the elderly, there are medications, dementia therapies, and memory care communities that may help.
C Data Abstraction And Data Management
We will explore the possibility of including relevant systematic reviews determined to have fair or good quality to replace de novo extraction for specific population/treatment/outcome comparisons. Only systematic reviews that assessed and reported individual study risk of bias will be assessed for quality. We will reassess risk of bias of included studies for comparison purposes. We will extract author, year of publication, eligibility criteria, relevant synthesis results and strength of evidence assessment. We will use data provided by the systematic review to assess strength of evidence for results without strength of evidence assessments. Studies in included systematic reviews will be tracked for contribution to unique population/treatment/outcome comparisons to avoid double-counting study results.
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