What Do Dementia Patients Take to Calm Down? Exploring Safe Options

According to the Alzheimer's Association, behavioral and psychological symptoms of dementia, including agitation, affect up to 90% of those living with the condition. When faced with this distress, caregivers often ask: what do dementia patients take to calm down? The answer involves prioritizing non-drug interventions first, with medication used cautiously and under strict medical supervision.

Quick Summary

Managing agitation in dementia involves prioritizing non-drug interventions like creating a calm environment and using sensory therapies. For severe cases, physicians may prescribe antipsychotics, antidepressants, or other medications, weighing benefits against significant risks. Behavioral and environmental strategies are recommended as the first line of approach.

Key Points

• Prioritize Non-Drug Interventions: Non-pharmacological strategies, such as music and touch therapy, are often safer and more effective for managing dementia agitation than medications.

• Address Underlying Triggers: Calming a patient requires identifying and addressing the root cause of agitation, which can be unmet needs like pain, hunger, or confusion.

• Create a Calming Environment: Minimizing noise, clutter, and distractions, while maintaining a consistent routine, can significantly reduce anxiety and restlessness.

• Use Medication Cautiously: Antipsychotics, antidepressants, and anxiolytics may be used for severe agitation, but carry risks of serious side effects and must be prescribed and monitored by a specialist.

• Brexpiprazole is FDA-Approved for Agitation: As of recent guidance, brexpiprazole (Rexulti) is the only FDA-approved atypical antipsychotic for agitation related to Alzheimer's dementia, but still carries a 'black box' warning for use in elderly patients.

• Tailor Care to the Individual: Effective care involves creating a personalized approach based on the patient's history, preferences, and triggers, rather than a one-size-fits-all solution.

Understanding the Root Causes of Agitation

Before considering any treatment, it is crucial to investigate the underlying triggers of agitation. Dementia-related behaviors are often a form of communication when a patient can no longer express their needs effectively. Identifying and addressing these issues is the first and most effective step toward calming a person with dementia.

Common causes of agitation

• Physical Discomfort: Unrecognized pain, hunger, thirst, constipation, or a full bladder can cause distress. Caregivers should look for non-verbal cues like grimacing or restlessness.
• Environmental Triggers: Excessive noise, glare, confusing clutter, or an unfamiliar environment can overwhelm a person with dementia. Changes to routine can also be highly unsettling.
• Overstimulation or Understimulation: Too much activity, noise, or people can be overwhelming, while boredom can lead to restlessness and agitation.
• Fear and Confusion: Delusions, paranoia, or difficulty with reasoning can cause fear. Symptoms like sundowning, where confusion worsens in the late afternoon, are a common source of agitation.
• Poor Sleep: Sleep disturbances and fatigue are known to increase late-day restlessness and irritability.

Non-Pharmacological Strategies to Calm Patients

Many dementia specialists and recent studies emphasize that non-drug interventions are safer and often more effective than medication for managing agitation. These strategies focus on person-centered care, tailoring the approach to the individual’s preferences, history, and needs.

Practical non-drug approaches

• Create a Consistent Routine: Predictable daily schedules for meals, bathing, and bedtime provide a sense of security and reduce confusion.
• Modify the Environment: Reduce noise and clutter to create a peaceful atmosphere. Use nightlights to prevent nighttime confusion and close blinds at dusk to minimize disorienting shadows.
• Use Sensory Therapies: Engaging the senses can be highly calming.
  • Music Therapy: Playing familiar, gentle music can reduce agitation. Personalized playlists based on the person's past can be especially effective.
  • Therapeutic Touch: A gentle hand massage or holding the person's hand can provide reassurance and comfort.
  • Aromatherapy: Using calming scents like lavender has shown some benefit, though studies are mixed.
• Provide Engaging Activities: Meaningful activities can occupy and distract from agitated thoughts. Simple tasks like folding laundry, sorting objects, or gardening can be helpful.
• Validate and Reassure: When a patient expresses fear or distress, respond to the emotion rather than correcting the facts. Phrases like, “I can see you’re upset. I am here for you,” can be more effective than arguing.

Medications Used for Agitation

When non-pharmacological methods are insufficient, a physician may consider medication. It is critical to note that many of these drugs carry significant risks, and treatment should be closely monitored by a specialist, such as a geriatrician or psychiatrist.

Comparative Overview of Dementia Medications

Medication Class	Primary Purpose in Dementia	Key Risks/Side Effects	Use Considerations
Atypical Antipsychotics (e.g., brexpiprazole, risperidone, quetiapine)	Addresses severe agitation, aggression, hallucinations, and delusions. Brexpiprazole (Rexulti) is the only FDA-approved atypical antipsychotic specifically for agitation associated with Alzheimer's.	Increased risk of stroke, death, sedation, falls, and extrapyramidal symptoms.	Should only be used for severe symptoms that pose a danger to the patient or others, and for the shortest possible duration. Use with extreme caution in patients with Lewy body dementia.
Antidepressants (SSRIs) (e.g., citalopram, sertraline, trazodone)	Manages agitation associated with anxiety, depression, or sleep problems.	Variable effectiveness for agitation alone. Some are associated with increased fall risk or heart problems, particularly at higher doses.	Often used for patients with co-existing depression or anxiety. Side effects are generally less severe than antipsychotics.
Anxiolytics (e.g., lorazepam, oxazepam)	Short-term management of acute anxiety or severe restlessness.	Can worsen confusion and increase risk of falls. There is a high risk of dependence and sedation.	Use is generally discouraged due to significant risks, but may be used at the lowest possible dose for very short periods.
Cholinesterase Inhibitors (e.g., donepezil, rivastigmine)	Primarily for cognitive symptoms, but may also slightly reduce agitation in some cases, particularly in specific dementias like Lewy body dementia.	Nausea, vomiting, diarrhea, and fatigue are common.	Not prescribed specifically for agitation, but can have a calming effect as a secondary benefit in some patients.

Combining Approaches for Comprehensive Care

Effective dementia care almost always requires a multifaceted approach that combines non-drug strategies with careful medical management. A team of specialists, including neurologists, geriatricians, and occupational therapists, can help create a personalized care plan. Caregiver education is also vital to understanding and implementing these strategies effectively. By treating the person, not just the dementia, caregivers can enhance quality of life and reduce the need for powerful, high-risk medications. Finding what works best is a process of observation, flexibility, and patience.

Conclusion

While various medications are available for dementia-related agitation, such as atypical antipsychotics and antidepressants, the safest and most effective first-line approach involves prioritizing non-pharmacological interventions. Behavioral strategies—like creating a calm environment, maintaining routine, and using sensory therapies—address the root causes of distress without the serious risks associated with drugs. When medication is necessary, it must be used cautiously and under expert supervision to manage severe symptoms, always weighing the benefits against potential side effects. A comprehensive, person-centered approach provides the best chance for keeping a dementia patient calm and comfortable.

Authoritative Outbound Link

For more information on understanding dementia behaviors, visit the official resource page from the Alzheimer's Association.

Frequently Asked Questions

What is the best way to calm a dementia patient without medication?

The best non-medication strategies include maintaining a consistent daily routine, creating a calm and distraction-free environment, and using sensory therapies like listening to familiar music or gentle touch. Validating their feelings and redirecting their attention to a pleasant activity can also be very effective.

What medications are specifically approved for dementia-related agitation?

While many drugs are used 'off-label,' brexpiprazole (Rexulti) is currently the only atypical antipsychotic specifically FDA-approved for agitation associated with dementia due to Alzheimer's. Other medications like antidepressants and anxiolytics are often prescribed off-label but with more caution.

Are there natural supplements to help calm dementia patients?

Some alternative approaches like melatonin for sleep disturbances and certain herbal combinations have been explored, but research is limited and results are mixed. For example, some studies found melatonin helpful for sleep-related agitation, while aromatherapy showed mixed results. Always consult a doctor before starting any supplement due to potential interactions.

Why are some anti-anxiety medications not recommended for dementia patients?

Many anti-anxiety medications, particularly benzodiazepines like Ativan or Xanax, are often not recommended because they can worsen confusion, cause sedation, increase the risk of falls, and potentially lead to dependency in older adults with dementia.

What is 'sundowning' and how can it be managed?

Sundowning is a state of increased confusion, agitation, and anxiety that occurs in the late afternoon and evening in some people with dementia. Management strategies include maintaining a structured routine, ensuring daily exposure to bright light, reducing evening stimulation, and using nightlights to prevent disorientation.

How can caregivers communicate effectively during an agitated episode?

Caregivers should approach the person calmly and patiently, using simple language and a soothing tone. Listen to their feelings without arguing or correcting them. Gently reassuring them that they are safe and redirecting their focus can de-escalate the situation.

When should medication be considered for an agitated dementia patient?

Medication should be considered only after exhausting non-drug interventions and consulting with a healthcare professional. It is typically reserved for severe symptoms, such as aggression, psychosis, or distress that poses a risk of harm to the patient or others.