This blog is a continuation of our series on Behaviors as Communication. To read other entries in the series, please click through to one of the following links below:
What is it?
Those affected by Alzheimer’s disease and related dementia often struggle to clearly articulate their wants and needs. Their disease stage and loss of cognitive function limit their ability to communicate with others and even identify their own feelings. This lack of communication along with other factors can contribute to agitation, frustration, and even aggression in the individual.
When the ability to speak or communicate clearly is negatively impacted, one may feel isolated, alone, and even misunderstood. What was once a straightforward operation – with everything working efficiently from stimuli to thought/feeling and response – is now a disjointed process, as though a wrench has been thrown in the works. Although not always clear, it is important to trace back, from the response to the stimuli, in order to address the cause of the agitation.
Identifying the Cause
It is helpful to think of causes of agitation as both internal and external. Internal stimuli can include, physical factors, and emotional distress. External stimuli include the current environment and how this is affecting the individual. Below are a few helpful questions for evaluating the cause of the agitation. This is not a comprehensive list but should offer some good suggestions on where to start.
Internal: Physical Factors
When evaluating agitation, start with physical factors by looking at unmet needs.
- What Activities of Daily Living does the individual need assistance with, and have all of these needs been met recently? Consider if they might be hungry, thirsty, or need to use the restroom.
- Is the individual in pain or physical discomfort? They could be experiencing a Urinary Tract Infection, Joint Pain, or soreness.
- Have they been getting enough quality sleep and rest? This agitation could be a result of a lack of sleep.
Internal: Emotional Distress
- Is the individual feeling isolated and disconnected from others? Consider how to get them involved in an activity with others they would enjoy.
- Are they confused about what to do, and seeking purposeful engagement? Consider how you can reassure them and provide engagement through cooking, gardening, or other familiar tasks.
- Are they looking for family members or loved ones who have since passed away? Reminisce with them for a moment, and then find an opportunity to redirect the conversation to their favorite memory or activity with their family/loved one.
External: Current Environment
With the current environment, evaluate your perceptions and then imagine how the individual is processing the information around them.
- What is the noise level of your location? If the noise level is excessively loud for the individual, chances are that this is overwhelming and stressful. Move to another location that is quieter and more calming.
- Are there many people in your general area? Sometimes large crowds can cause anxiety, overstimulation, and lead to agitation.
- Is the location unfamiliar or confusing? Is the individual struggling with orientation in their current space? Consider changing the location to somewhere more familiar and consistent.
Approach Resolutions with Safety in Mind
When interacting with an individual who is agitated and/or aggressive, the first concern should be the protection and safety of yourself and those around you. If possible, it is also important to protect the agitated individual from themselves.
A great resource for interacting with those affected by memory loss, and even approaching those who are agitated or distressed is The Positive Physical Approach, from Teepa Snow.
The best resolution is to avoid agitation by proactively planning. While this may seem difficult, all it takes is a consistent schedule and dedication. Provide a set schedule and routine for the individual, with mealtimes, activities, and time to relax and decompress. Avoid stressful situations with large groups, loud noises, and other overwhelming factors. Focus on building opportunities for daily meaningful engagement and activities.
Even with all of these helpful tips, it can be overwhelming for the family caregivers and loved ones who are giving of their time, patience, and compassion each day. If you or someone you know need a break or additional resources, please contact your local JEA Senior Living community for information on our Respite Stay programs or on how to approach Behaviors as Communication.