When caring for a resident who is agitated, you should use calming de-escalation techniques

According to the Alzheimer's Association, up to 90% of individuals with dementia will experience behavioral symptoms, including agitation, at some point. Therefore, knowing how to respond effectively when caring for a resident who is agitated is a crucial skill for all caregivers.

Quick Summary

When a resident becomes agitated, the correct response is to remain calm, avoid confrontation, and validate their feelings while identifying potential triggers and safely redirecting their focus. Creating a quiet, reassuring environment is paramount to de-escalation and promoting resident dignity and safety.

Key Points

• Stay Calm: Your demeanor is the most important tool for de-escalation; remain calm, composed, and patient.

• Identify Triggers: Agitation is often a form of communication; assess if the cause is physical discomfort, environmental, or emotional.

• Validate Feelings: Acknowledge the resident's distress to build trust and show empathy, even if the reason for their agitation is unclear.

• Redirect Gently: Shift the resident's focus to a new activity or topic to interrupt the cycle of agitation.

• Optimize the Environment: Reduce noise, clutter, and harsh lighting to create a more soothing, predictable space.

• Communicate Respectfully: Use a calm voice and simple language, and avoid arguing or contradicting the resident's reality.

Understanding the Triggers of Agitation

Agitation in residents, particularly those with dementia or other cognitive impairments, is a common and complex challenge. Understanding the root cause of the behavior is often the first and most critical step toward de-escalation. Agitation is not typically a deliberate attempt to be difficult; it is a form of communication, often signaling an unmet need, discomfort, or confusion.

Common Underlying Causes

• Physical discomfort: This can include pain, hunger, thirst, or the need to use the bathroom. A resident may be unable to articulate their physical needs clearly.
• Environmental factors: Overstimulation from loud noises, bright lights, a cluttered space, or a change in routine can be overwhelming. Conversely, a lack of stimulation can also lead to restlessness and agitation.
• Cognitive changes: Confusion, memory loss, and the inability to understand or express themselves can be frustrating and frightening, leading to agitated behaviors.
• Emotional distress: Feelings of loss, fear, loneliness, or boredom can manifest as agitation. The resident may feel a loss of control over their life and environment.
• Medication side effects: Some medications, or an adverse interaction between different drugs, can contribute to or cause agitation. A medication review by a healthcare provider may be necessary.

Immediate De-escalation Techniques

When an agitated episode occurs, your response is key. The goal is to safely and calmly guide the resident toward a calmer state without escalating the situation.

The CALM Approach

1. C - Clear the Space: If possible, move the resident to a quieter area or, if they are mobile, guide them away from the source of the agitation. This also means asking onlookers to leave to reduce embarrassment or further stimulation.
2. A - Approach Calmly: Use a slow, non-threatening approach. Never rush or stand over a resident. Get to their eye level and maintain a respectful personal distance.
3. L - Listen and Validate: Focus on active listening. Listen to their words, body language, and tone. Validate their feelings by acknowledging their distress, even if you don't fully understand the reason. Say things like, “I can see you are upset,” or “This seems frustrating”.
4. M - Move to Redirect: After validating their feelings, gently try to redirect their attention to another activity or topic. This distraction can break the cycle of agitation. A simple suggestion like, “Let’s go for a walk,” or offering a favorite snack can be effective.

Communication Strategies

Your communication, both verbal and non-verbal, is a powerful tool in managing agitation. It is essential to communicate with clarity, patience, and compassion.

• Speak Slowly and Clearly: Use short, simple sentences. A fast pace and complex language can increase confusion and frustration.
• Use a Calm, Low Tone: Your tone of voice is more important than your words. A soothing tone can be reassuring, while a raised voice will often trigger a defensive reaction.
• Avoid Arguing or Correcting: Do not argue with the resident or attempt to reason with a hallucination or delusion. This will only increase their distress. Instead, acknowledge their reality and pivot to a new topic.
• Use Positive Body Language: Maintain an open, relaxed posture. Avoid crossing your arms, pointing, or clenching your fists. A calm and reassuring demeanor can help put the resident at ease.

Creating a Calming Environment

An ounce of prevention is worth a pound of cure. Many episodes of agitation can be prevented or minimized by carefully managing the resident's surroundings.

• Minimize Clutter: Keep the resident's space tidy and free of unnecessary objects. A clean, organized room is less visually overwhelming.
• Control Noise and Light: Reduce loud noises from TVs, radios, or other residents. Ensure lighting is soft and consistent, as sharp shadows can be frightening.
• Maintain Routine and Consistency: Stick to a regular schedule for meals, sleep, and activities. Predictability provides a sense of security and control.
• Incorporate Sensory Tools: Soothing music, aromatherapy (like lavender), or familiar objects can be calming. A stress ball or a soft blanket can also be used as a distraction.

Effective vs. Ineffective Responses

Effective Response	Ineffective Response
Stay calm and composed.	Raise your voice or appear flustered.
Approach slowly and at eye level.	Rush toward the resident or stand over them.
Validate their feelings and acknowledge their distress.	Argue with them or correct their perception of reality.
Use gentle redirection and distraction.	Confront the issue directly or demand compliance.
Respect their personal space and use non-threatening body language.	Invade their space or use aggressive gestures.
Provide simple choices to give them a sense of control.	Use restraints or force, which often worsens agitation.

Conclusion: Prioritizing Safety and Dignity

Ultimately, the priority when caring for a resident who is agitated, you should always ensure the safety and dignity of the individual and those around them. By practicing patience, empathy, and effective de-escalation techniques, caregivers can navigate these challenging moments successfully. Prevention through a predictable, calm environment is the best long-term strategy, but having a toolkit of responsive tactics is essential for managing immediate situations. Remember that each agitated episode offers an opportunity to learn more about the resident's triggers and unmet needs, allowing for better, more personalized care in the future. For additional resources and information on dementia-related behaviors, visit the Alzheimer's Association.

When to Seek Professional Help

While de-escalation techniques are powerful tools, some situations require professional intervention. Know when to contact a supervisor, doctor, or emergency services, such as if the resident becomes aggressive and poses a danger to themselves or others. A sudden, unexplained increase in agitation could signal a new medical problem, like an infection, and requires a medical evaluation. Team communication and documentation of agitated episodes are crucial for developing an effective, comprehensive care plan.

Frequently Asked Questions

What is the very first thing I should do when a resident becomes agitated?

The very first thing you should do is pause and remain calm yourself. This prevents you from inadvertently escalating the situation. Then, assess the immediate environment for safety and identify if there is an obvious trigger for the agitation.

How can I communicate with a resident who is agitated without making things worse?

Communicate by using a calm, low tone of voice and simple sentences. Avoid arguing or correcting them, as this often increases distress. Instead, validate their feelings by saying something like, 'I see you're feeling frustrated right now.'

What are some effective ways to redirect an agitated resident's attention?

Effective redirection can include offering a snack or a drink, suggesting a walk or another simple, familiar activity, or showing them a comforting object like a photo album. The key is to shift their focus away from the source of their agitation.

What if the resident becomes physically aggressive during an agitated episode?

If a resident becomes physically aggressive, your priority is safety. Create a safe distance and call for immediate assistance from other staff. Do not attempt to physically restrain the resident unless it is an emergency and you are trained to do so. In an extreme emergency, follow your facility's protocol, which may include calling 911.

Can environmental changes really help with a resident's agitation?

Yes, environmental changes are a crucial aspect of managing agitation. Reducing loud noises, harsh lighting, and clutter can create a more soothing atmosphere. Sticking to a consistent daily routine also provides predictability and comfort, which can prevent agitation.

Should I try to figure out why the resident is agitated during the episode?

During an agitated episode, it's more important to focus on de-escalation than to figure out the exact cause. You can assess for obvious needs (pain, hunger) and listen for clues, but avoid interrogating them, which can increase frustration. You can investigate triggers more deeply after the resident has calmed down.

How do I deal with an agitated resident who refuses all of my suggestions?

If a resident refuses all suggestions, give them some space and time to calm down on their own, while remaining nearby for support. Sometimes, a person just needs a break from interaction. Try offering your help again later, or have a different caregiver approach them if possible.