What actions would you take first with a resident who is anxious, agitated, or has a change in behavior?

Over 90% of individuals with dementia experience behavioral and psychological symptoms at some point, making it critical for caregivers to know what actions would you take first with a resident who is anxious, agitated, or has a change in behavior? This authoritative guide outlines the immediate, person-centered approaches that prioritize resident safety and emotional well-being.

Quick Summary

The priority is to first ensure safety, then approach calmly while identifying potential causes like pain or discomfort. Use a low, calm voice and simple phrases to provide reassurance, validate their feelings, and gently redirect their attention using non-confrontational techniques.

Key Points

• Prioritize Safety First: Always ensure the immediate safety of the resident and others before any other intervention.

• Remain Calm and Reassuring: Your calm demeanor and gentle voice can de-escalate the situation and prevent further agitation.

• Identify Potential Triggers: Assess for underlying causes such as pain, hunger, fatigue, or an overstimulating environment.

• Validate Feelings, Don't Argue Reality: Acknowledge the resident's emotions rather than trying to correct their perceptions, which can increase frustration.

• Gently Redirect with Distraction: Instead of confrontation, use a preferred activity or a new topic to shift their focus.

• Consider Medical Causes: Report any significant behavioral changes to a nurse or doctor to rule out underlying medical issues.

• Focus on Prevention: Maintain consistent routines, personalize the environment, and provide engaging activities to minimize future episodes.

Prioritizing Safety: The Immediate First Steps

When a resident exhibits signs of anxiety, agitation, or a significant change in behavior, the first priority is to ensure the immediate safety of both the resident and those around them. The initial moments are crucial and set the tone for the entire interaction. Remaining calm yourself is paramount, as your own anxiety can escalate the resident's distress.

The 5 'R' Approach for De-escalation

1. Remain Calm: Approach the resident with a relaxed demeanor, using a soft, low tone of voice and non-threatening body language. Avoid sudden movements that could startle them.
2. Respond to Feelings: Instead of focusing on the behavior itself, address the emotion behind it. Acknowledge and validate their feelings, saying something like, "You seem upset" or "I can see you're frustrated."
3. Reassure: Use simple, calming phrases to let the resident know they are safe and you are there to help. Reassurance, rather than arguing, helps to build trust.
4. Remove: If the environment is overstimulating or triggering, gently suggest moving to a quieter, more private space. This can help reduce external stressors.
5. Return: Give the resident time to de-escalate. If the situation permits, you can return to the initial task later, once the resident is calmer. If not, pivot to a different, less stressful activity.

Investigating Potential Triggers and Root Causes

Behavior is a form of communication, and an abrupt change is a signal that something is wrong. A thorough, yet discreet, investigation into potential triggers is the next step after ensuring immediate safety. Common causes can be medical, environmental, or psychological.

Potential Triggers to Assess

• Physical Discomfort: Is the resident in pain? Are they too hot or cold? Do they need to use the bathroom? Are they hungry or thirsty? Unmet basic needs are a frequent driver of agitation.
• Medical Issues: An infection (like a UTI), medication side effects, dehydration, or an underlying illness can cause confusion and distress. It is vital to report any behavioral changes to a nurse or doctor to rule out medical causes.
• Environmental Factors: Excessive noise, bright or dim lighting, a cluttered space, or a change in routine can be disorienting and frightening for residents with cognitive impairments.
• Psychological Factors: Feelings of loneliness, boredom, fear, or loss of control can lead to agitation. Changes in routine, unfamiliar faces, or a perceived threat can trigger anxiety.

Communicating with Compassion: Verbal and Non-Verbal Techniques

Effective communication is the cornerstone of managing challenging behaviors. It's not just what you say, but how you say it.

Effective Communication Strategies

• Use Simple, Direct Language: Avoid complex instructions or overwhelming questions. Use short sentences and one-step requests.
• Maintain Eye Contact: Approach the resident from the front at eye level to show respect and avoid startling them.
• Listen Actively: Pay attention to their non-verbal cues and listen for the feelings behind their words. Don't interrupt.
• Practice Validation: Validate their feelings, even if their perception is inaccurate due to cognitive impairment. For example, if they insist on going "home," acknowledge their feeling of wanting to be there before gently redirecting.
• Avoid Arguing or Correcting: Trying to reason with someone whose reality is distorted is counterproductive and will likely increase frustration.

Effective vs. Ineffective Responses: A Comparison

Understanding the difference between an effective, person-centered response and an ineffective, traditional one is critical for de-escalation.

Effective Response	Ineffective Response
Focuses on underlying emotion. (e.g., "You seem frustrated.")	Focuses on correcting the behavior. (e.g., "Stop pacing.")
Validates feelings. (e.g., "I understand you want to go home.")	Argues reality. (e.g., "This is your home.")
Offers reassurance. (e.g., "I'm here to help you.")	Uses condescending language. (e.g., "Sweetie, just relax.")
Distracts or redirects gently. (e.g., "Let's go look at these photos.")	Physically restrains or forces compliance.
Uses a calm, low tone of voice.	Speaks loudly or demands compliance.

Proactive and Long-Term Strategies for Prevention

While on-the-spot interventions are essential, preventing future episodes is key. A person-centered care plan incorporates individual preferences and routines to minimize triggers.

Proactive Prevention Techniques

• Maintain a Consistent Routine: Predictability can significantly reduce anxiety. Keep meal times, activities, and rest periods consistent.
• Personalize the Environment: Decorating a resident's room with familiar items, photos, and a favorite blanket can create a sense of security and belonging.
• Provide Meaningful Activities: Engagement in personalized, purposeful activities reduces boredom and frustration. For a former baker, folding towels might be a meaningful task.
• Correct Sensory Deficits: Ensure eyeglasses, hearing aids, and dentures are working correctly. Uncorrected sensory issues can lead to confusion and agitation.
• Encourage Exercise: Gentle physical activity, such as a supervised walk, can help reduce restlessness and anxiety.

When to Seek Medical Help

While many behavioral changes can be managed with non-pharmacological methods, knowing when to escalate to a medical professional is vital. A change in behavior, especially if sudden or severe, warrants immediate attention from a nurse or physician to rule out an acute medical issue. If agitation is severe and puts the resident or others at risk of harm, emergency protocols should be followed. Medication may be a consideration only as a last resort, after all other non-pharmacological strategies have been exhausted.

For additional resources and training on person-centered care, visit the National Council of Certified Dementia Practitioners.

Conclusion: The Person-Centered Approach

Approaching an anxious, agitated, or behaviorally changed resident requires a compassionate, systematic, and person-centered approach. By first prioritizing safety and then calmly assessing and responding to the potential triggers, caregivers can de-escalate situations effectively. Understanding that behavior is a form of communication allows for empathetic responses that validate feelings rather than challenging them. Implementing proactive strategies like consistent routines and meaningful activities can prevent future episodes and improve the resident's overall quality of life. This holistic perspective ensures dignity and respect remain at the forefront of care, even in challenging situations.

Frequently Asked Questions

What is the very first step to take with an agitated resident?

The very first step is to prioritize safety. Ensure the resident is not in danger and that you and others are at a safe distance. Then, approach calmly with a gentle, non-threatening posture and tone of voice.

How do you identify the cause of a resident's sudden agitation?

To identify the cause, observe the resident and their environment. Look for signs of pain, hunger, fatigue, or a full bladder. Consider environmental factors like noise or clutter. Also, assess if a change in routine or a specific event may have triggered the behavior.

What if the anxious resident is non-verbal?

With a non-verbal resident, observation becomes even more critical. Look for non-verbal cues of pain (grimacing, guarding) or discomfort (restlessness, agitation). Use a calm, reassuring tone and gentle touch, if appropriate. Offer simple choices non-verbally, like a water cup or a comfortable chair.

What is the 'validation therapy' approach when a resident is confused?

Validation therapy involves acknowledging and validating a resident's feelings, rather than correcting their facts. For example, if a resident wants to see their mother who passed away, you can respond, "It sounds like you miss your mother very much," instead of stating that she is deceased. This validates the emotion behind the statement.

How can staff training improve responses to agitated residents?

Staff training provides caregivers with the skills and knowledge to understand the root causes of behavioral changes and apply person-centered, de-escalation techniques. It helps foster empathy, improves communication, and empowers staff to respond proactively and compassionately, reducing resident and staff stress.

When is it appropriate to use medication for anxiety or agitation?

Medication should be considered a last resort, only after all non-pharmacological interventions have been exhausted and the behavior continues to present a significant risk. A physician or qualified medical professional should be consulted to determine if medication is necessary, safe, and appropriate for the resident's condition.

How can the environment be modified to reduce anxiety in residents?

The environment can be modified by reducing noise and clutter, ensuring comfortable lighting and temperature, and creating a personalized, familiar space. Providing access to familiar objects, pictures, and calming music can also reduce anxiety.