How to deescalate a situation with someone with dementia?

Dementia can alter an individual's behavior, leading to moments of agitation, confusion, or aggression. Understanding these changes is the first step toward learning how to deescalate a situation with someone with dementia effectively and with compassion.

Quick Summary

Use a calm demeanor, validate their feelings, and simplify your communication to address the unmet needs driving the behavior, while maintaining a safe and quiet environment and redirecting their attention to a comforting activity.

Key Points

• Stay Calm: Your calm demeanor is the most important tool for de-escalation; the person with dementia will mirror your mood.

• Validate Feelings: Acknowledge their emotions without correcting their perception of reality to build trust and reduce distress.

• Simplify Communication: Use short, simple sentences and speak slowly to avoid overwhelming the individual with dementia.

• Modify the Environment: Reduce noise, clutter, and harsh lighting to prevent sensory overload and anxiety.

• Use Redirection: Gently change the subject or offer a comforting activity to shift focus away from the source of agitation.

• Ensure Safety First: Prioritize safety by removing potential hazards and maintaining a safe distance during an episode.

• Know When to Get Help: If behaviors are persistent, worsening, or dangerous, consult a healthcare professional to rule out underlying medical issues.

Understanding the Root Causes of Behavior

Aggressive or agitated behavior in a person with dementia is rarely intentional. It is often a signal of distress, fear, or an unmet need that they are no longer able to express verbally. Potential triggers can include physical discomfort, environmental overstimulation, or confusion. By learning to be a detective, you can begin to identify patterns and preemptively address triggers.

Common Triggers for Agitation

• Physical discomfort: Pain, hunger, thirst, or the need to use the restroom.
• Environmental stress: Loud noises, glare from windows or reflective surfaces, clutter, or unfamiliar surroundings.
• Routine disruption: Unpredictable schedules can cause confusion and anxiety.
• Communication breakdown: Misunderstanding what you are saying or feeling unable to express their own needs.
• Sensory overload: Too many people, conversations, or activities happening at once.

Immediate De-escalation Techniques

When a situation begins to escalate, your immediate response is critical. The goal is to reduce the person's stress and regain a sense of calm and safety for everyone involved. The 5 “R”s method offers a helpful framework: Remain calm, Respond to feelings, Reassure the person, Remove yourself if necessary, and Return later.

Step-by-Step De-escalation Protocol

1. Assess the immediate risk: First, ensure your safety and the safety of the person with dementia. Remove any potential hazards from the immediate area, such as sharp objects or furniture that could be knocked over.
2. Create a safe distance: Stand at a non-threatening angle, slightly to the side rather than face-to-face. Maintain at least two arm's lengths away to give them personal space.
3. Use a calm, soothing voice: Lower your tone and volume. Speak slowly and use simple, direct sentences. Avoid an emotional or confrontational tone, as they will mirror your energy.
4. Validate their emotions: Acknowledge their feelings, even if the reason for their distress seems illogical. Phrases like, "I can see that you're upset," can validate their emotions and help them feel heard.
5. Do not argue or correct: Do not challenge their reality. Arguing will only increase agitation. It is more important to ease their distress than to prove a point.
6. Redirect their attention: Gently shift their focus to something else, preferably a pleasant memory or a calming activity. "Would you like to listen to your favorite music?" or "Let's go look at the flowers in the garden" can be effective distractions.
7. Offer a simple choice: Providing a limited number of simple choices can help restore a sense of control. For example, instead of "Do you want to get dressed?" ask, "Would you like to wear the blue shirt or the green one?".

Long-Term Strategies for Prevention

Consistent, proactive care is the best way to prevent escalating behaviors. Implementing a predictable routine and maintaining a calm environment can significantly reduce anxiety for someone with dementia.

Creating a Soothing Environment

• Minimize noise and clutter: Reduce auditory and visual overstimulation. Keep televisions and radios off or at a low volume.
• Use soft lighting: Bright, harsh lights can cause confusion and disorientation.
• Incorporate personal items: Familiar photos, blankets, or keepsakes can provide a sense of security and comfort.

Establishing a Predictable Routine

• Set a daily schedule: Maintain consistent times for meals, bathing, and sleep. This creates a sense of stability.
• Prepare for transitions: Announce upcoming changes in activity to give the person time to adjust.
• Schedule activities for the best time of day: If the person experiences "sundowning" (increased confusion and agitation in the late afternoon), plan more demanding activities for the morning.

Enhancing Communication

• Use non-verbal cues: Gentle touch, a reassuring smile, and relaxed body language can communicate care more effectively than words.
• Observe body language: Pay attention to their non-verbal signals. Pacing, fidgeting, or clenched fists can indicate building anxiety.
• Speak with respect: Always treat the individual with dignity. Avoid patronizing language, regardless of how advanced their dementia is.

Comparison of De-escalation Approaches

Technique	When to Use	Key Action	Benefit	Risks
Validation	When person is confused or distressed over a false reality.	Acknowledge their feelings without correcting the facts.	Builds trust, reduces combativeness.	May feel like you're lying if overused or insincere.
Redirection	When a person is fixated on a stressful topic.	Shift attention to a pleasant, calming activity.	Interrupts the cycle of agitation.	Can backfire if the person feels dismissed.
Environmental Modification	To prevent escalation and create a calm baseline.	Adjust lighting, noise levels, and clutter.	Reduces overall anxiety and sensory overload.	Needs careful observation to identify triggers.
Medical Assessment	When agitation is new, sudden, or persistent.	Consult a doctor to rule out pain, infection, or medication issues.	Addresses underlying physical causes.	Can be stressful for the person with dementia.

When to Seek Professional Help

Sometimes, even the most skillful de-escalation techniques are not enough. It is important to know when to seek help from a healthcare professional. Persistent or worsening aggression could indicate an underlying medical issue, a medication side effect, or an infection. A doctor can evaluate the situation and suggest a revised care plan or medication adjustments if necessary. For your safety and the safety of your loved one, know when to step back and call for assistance.

Conclusion: The Path Forward with Patience

Learning how to deescalate a situation with someone with dementia is an ongoing process that requires immense patience, empathy, and observation. By focusing on the unmet needs behind the behavior, maintaining your calm, and adapting the environment, you can create a safer and more peaceful experience for both of you. Remember that your compassionate presence is the most powerful tool you have. By remaining flexible and understanding, you can navigate these challenges while preserving the dignity and well-being of the person you care for. For more comprehensive resources and support, consider visiting the Alzheimer's Association website.

Frequently Asked Questions

What is the single most important thing to remember during a de-escalation?

The most important thing is to remain calm. Your calm energy will help soothe the person, while any visible frustration will likely increase their agitation.

Should I argue with a person with dementia about their version of reality?

No, you should never argue or correct their version of reality. Instead, validate their feelings and acknowledge their distress, as arguing will only increase their confusion and agitation.

What are some effective verbal techniques for de-escalation?

Use a soft, steady voice and simple language. Try phrases like, "I hear you," or "I can see you are upset." Offer simple choices to give them a sense of control, like, "Would you like a snack or a glass of water?"

What if physical contact is normally comforting but becomes agitating during an episode?

During an agitated episode, physical touch can be perceived as threatening. It's best to create space and maintain a safe distance. Observe their body language; if they relax, a gentle, reassuring touch on the shoulder might be appropriate later.

How can I prevent agitation before it starts?

Prevention is key. Maintain a consistent daily routine, reduce environmental stressors like loud noises, and pay attention to early warning signs of distress, such as pacing or fidgeting.

What is 'sundowning' and how does it relate to agitation?

Sundowning is a state of increased confusion, anxiety, and agitation that occurs in the late afternoon or evening. It can be managed by maintaining a consistent schedule, ensuring adequate sunlight exposure during the day, and avoiding caffeine or long naps late in the day.

When should I call for emergency help?

If the person becomes a danger to themselves or others, or if you feel unsafe, it is time to call for emergency help. Inform emergency responders that the person has dementia to ensure they approach the situation with the appropriate training and care.