How to help dementia restlessness? Effective strategies for caregivers

According to the Alzheimer's Association, up to 90% of people with dementia experience behavioral and psychological symptoms, including agitation and restlessness. Navigating the distress and discomfort of these symptoms requires a calm, patient, and person-centered approach. By understanding the root causes and implementing effective coping strategies, caregivers can learn how to help dementia restlessness and improve the overall quality of life for their loved one.

Quick Summary

Restlessness in dementia is often caused by unmet needs, changes in routine, and environmental overstimulation. Caregivers can manage this behavior by identifying triggers, creating a calming environment, using redirection techniques, and incorporating physical and sensory activities.

Key Points

• Identify the Root Cause: Restlessness is often a form of communication signaling pain, confusion, or emotional distress; look for triggers like discomfort or environmental changes.

• Create a Calming Environment: Reduce noise, clutter, and harsh lighting to prevent sensory overload and confusion, which are common triggers for agitation.

• Stick to a Daily Routine: Maintain a consistent schedule for meals, activities, and sleep to provide a sense of predictability and security.

• Use Gentle Redirection and Distraction: Avoid arguing or correcting. Instead, shift the person's focus to a calming activity or conversation to de-escalate frustration.

• Engage in Therapeutic Activities: Incorporate physical activity like walking or sensory activities such as listening to music or holding a fidget toy to provide a positive outlet for energy.

• Validate Feelings Calmly: Acknowledge the person's emotions with a calm, soft voice to provide reassurance, rather than focusing on correcting factual inaccuracies.

• Consult a Doctor for Medical Issues: If restlessness is sudden or severe, arrange a medical assessment to rule out underlying issues like pain, infection, or medication side effects.

Restlessness and agitation are common behavioral symptoms of dementia, manifesting as repetitive pacing, fidgeting, or wandering. While these behaviors can be challenging for caregivers, they are often a form of communication signaling an unmet need, discomfort, or confusion. Effective management begins with identifying the underlying cause and implementing non-pharmacological strategies before considering medication.

Identify the Triggers and Underlying Causes

Before you can effectively address the behavior, you must become a detective and look for what might be causing it. Keeping a journal of when restlessness occurs can help identify patterns and triggers.

Common Triggers for Restlessness:

• Physical discomfort: Pain, hunger, thirst, needing to use the bathroom, or an infection like a UTI can all cause distress.
• Environmental stress: Noise, glare, clutter, or an unfamiliar environment can cause confusion and overstimulation.
• Routine changes: Changes in daily schedules, caregivers, or surroundings can be unsettling for someone with dementia.
• Fatigue and sleep deprivation: Being overtired can increase anxiety and worsen restlessness, especially during the late afternoon or evening, a phenomenon known as “sundowning”.
• Emotional needs: Feelings of fear, anxiety, boredom, loneliness, or a perceived sense of loss can drive agitated behavior.
• Medication side effects: Certain medications can increase restlessness or cause other adverse reactions.

Create a Calming and Secure Environment

Creating a serene and predictable atmosphere can significantly reduce anxiety and restlessness.

Practical Environmental Adjustments:

• Reduce sensory overload: Lower the volume of the television and radio. Use soft, warm lighting and avoid harsh glares.
• Introduce natural light: Ensure plenty of natural light during the day to help regulate the sleep-wake cycle.
• Maintain familiar surroundings: Arrange furniture to allow for safe, clear pathways for pacing and wandering. Keep familiar objects and family photos visible to provide comfort and orientation.
• Minimize hazards: Lock up car keys, knives, and other potentially dangerous items to prevent accidental harm, particularly if wandering is an issue.
• Ensure comfort: Check that the person is wearing comfortable clothing and that the room temperature is agreeable.

Use Redirection and Therapeutic Activities

Instead of arguing or confronting, use gentle redirection to shift focus away from the source of distress. Engaging activities can provide a positive outlet for energy and anxiety.

How to Use Redirection Effectively:

• Validate emotions, not facts: If they express a desire to go home, acknowledge their feeling rather than pointing out they are already there. Try saying, “It sounds like you want to go home. We can talk about that after we have some warm tea.”
• Use simple communication: Speak calmly and use short, clear sentences. Avoid complex instructions or overwhelming questions.
• Engage the senses: Sensory-based activities can be highly effective. This might include listening to familiar music, using aromatherapy, or offering a textured fidget blanket or soft toy.
• Offer simple, meaningful tasks: Engage them in tasks that provide a sense of purpose. Examples include folding laundry, sorting buttons, or watering plants.
• Suggest physical movement: A short, gentle walk outdoors can release tension and improve mood.

A Comparison of Intervention Strategies

Knowing when to use a particular strategy is key to calming restlessness. Here is a comparison of different approaches.

Intervention Strategy	How it Works	Best for Situations Involving...	What to Avoid
Redirection	Gently moves focus from distress to a new activity or topic.	Fixations on upsetting thoughts, repeated questions, or low-level agitation.	Arguing or correcting false realities.
Environmental Modification	Adjusts the surroundings to reduce triggers and sensory overload.	Sundowning, overstimulation from noise or clutter, or general anxiety.	Sudden or drastic changes that increase confusion.
Validation	Acknowledges the person's feelings and perspective without correcting them.	Emotional distress, fear, or frustration caused by confusion.	Dismissing or invalidating their feelings.
Sensory Activities	Uses familiar or soothing sensory input to calm anxiety and provide comfort.	Fidgeting, repetitive motions, or generalized restlessness.	Forcing an activity; let them participate at their own pace.

How to Respond During an Episode

When restlessness or agitation escalates, how you respond in the moment can de-escalate the situation and prevent further distress.

1. Stay calm and reassuring: Your demeanor sets the tone. Speak in a gentle, low voice and avoid rushing or making sudden movements.
2. Ensure safety: Move the person away from potential hazards and ensure your own safety if aggression is involved.
3. Offer a break: Sometimes, the best strategy is to step away for a moment if the environment is safe, giving both you and the person a chance to calm down.
4. Check for unmet needs: A quick check for pain, thirst, hunger, or needing the toilet can sometimes resolve the issue immediately.

Conclusion

Addressing dementia restlessness requires a comprehensive approach centered on understanding and addressing unmet needs. By identifying triggers, creating a calm environment, and using gentle redirection and therapeutic activities, caregivers can significantly reduce agitated behaviors and improve their loved one's well-being. Keeping a consistent routine and focusing on person-centered strategies are key to providing compassionate and effective care. Patience, empathy, and observation are the most valuable tools a caregiver can have in their toolkit. Always consult a healthcare provider to rule out medical issues that may be contributing to restlessness.

Authoritative Link: Alzheimer's Association on Anxiety & Agitation in Dementia

Frequently Asked Questions

Why does a person with dementia become restless?

A person with dementia becomes restless for many reasons, including unmet needs like pain, hunger, or thirst. Other common causes include feeling confused or frightened by changes in their routine or environment, boredom, and fatigue.

What is the best way to calm a person with dementia who is agitated?

The best approach is to remain calm, speak in a gentle and reassuring tone, and try to identify the underlying cause of their agitation. Using gentle redirection, sensory engagement, and ensuring their physical comfort are highly effective strategies.

How can I prevent sundowning-related restlessness?

To prevent sundowning, maintain a regular daily schedule with plenty of natural light exposure and physical activity. Limit caffeine and long naps late in the day, and create a calm, relaxing evening routine.

What are some examples of sensory activities to help restlessness?

Good examples include listening to calming music, engaging with a tactile fidget blanket, offering a comforting object like a favorite teddy bear, or a gentle hand massage. Gardening and art projects can also be helpful.

Should I argue with a restless person with dementia?

No, it is best to avoid arguing or correcting them, as this can increase their anxiety and agitation. Instead, validate their feelings and gently redirect their attention toward a positive activity or memory.

Is wandering a form of restlessness in dementia?

Yes, wandering is a common manifestation of restlessness in dementia. It is often triggered by confusion, an urge to fulfill a past duty, or a need for exercise. Ensuring a safe, secure environment and managing triggers are essential.

When should I seek professional medical help for dementia restlessness?

You should seek professional medical help if the restlessness is sudden, severe, or poses a danger to the person or others. A doctor can help rule out underlying medical issues or suggest medication if non-drug interventions are insufficient.