When dealing with an agitated individual who has dementia, the best action to take is to remain calm and validate their feelings, rather than arguing.

According to the National Institute on Aging, agitation is a common and challenging symptom of Alzheimer's and related dementias, with many caregivers reporting its presence. When dealing with an agitated individual who has dementia, the most effective approach is to focus on understanding the underlying cause of their distress while maintaining a calm, reassuring presence. This is more productive than trying to reason or argue, which can worsen the situation.

Quick Summary

The most effective actions to take involve staying calm, using validation therapy to address feelings, and identifying potential unmet needs or environmental triggers. Gentle communication, distraction with familiar activities, and a consistent routine are key strategies. It's crucial to ensure safety and know when to seek professional medical help if agitation escalates or underlying health issues are suspected.

Key Points

• Prioritize safety: Ensure the agitated individual and others are not in danger by securing potential hazards and providing a safe space.

• Practice validation therapy: Acknowledge and empathize with their feelings instead of arguing with their reality to build trust and reduce anxiety.

• Identify triggers: Look for the root cause of agitation, such as unmet needs (pain, hunger) or environmental stressors (noise, clutter).

• Use calming communication: Speak in a calm, low tone of voice, use simple sentences, and maintain reassuring body language.

• Redirect and distract: Gently shift the person's attention to a different activity, a cherished object, or soothing music.

• Create a predictable routine: Maintaining a consistent daily schedule can provide a sense of security and reduce confusion and fear.

• Modify the environment: Reduce noise, clutter, and harsh lighting to prevent sensory overload and create a more peaceful setting.

• Call for help when needed: If de-escalation is unsuccessful and behavior becomes unsafe, seek immediate professional assistance.

Understand the Root Causes of Agitation

Agitation in dementia is rarely a random occurrence; it's often a form of communication signaling an unmet need, discomfort, or distress that the individual can no longer verbalize. Acting as a detective to uncover the trigger is a critical first step. The cause could be physical, emotional, or environmental.

Common triggers for agitation

• Physical discomfort: This includes pain, hunger, thirst, fatigue, constipation, or the need to use the bathroom. Many individuals with dementia cannot communicate these basic needs effectively.
• Environmental stress: Loud noises, glare, clutter, or overstimulation from too many people or activities can be overwhelming. For some, this stress is heightened during late afternoon or evening, a phenomenon known as 'sundowning'.
• Emotional distress: Feelings of loss, anxiety, fear, loneliness, or boredom can trigger agitated behavior. A sudden change in routine or a feeling of being rushed can also cause significant anxiety.
• Medication side effects: Agitation can be a side effect or interaction of certain medications. If a person's behavior changes abruptly, it's wise to consult with a doctor.

Respond with Calmness and Validation

When an agitated individual with dementia becomes upset, your response is paramount. It is essential to manage your own reactions to prevent further escalation.

De-escalation techniques

• Remain calm and composed. Speak in a soothing, low tone of voice and use gentle body language. Your calm demeanor can help regulate their emotions.
• Validate their feelings. Don't argue with their version of reality or try to correct them. Instead, acknowledge and empathize with their feelings. Phrases like, "I can see you are upset," or "You seem worried about something," can be very effective.
• Provide reassurance. Let them know they are safe and that you are there to help. Holding their hand or a comforting touch can provide immense reassurance when words fail.
• Create a sense of space. Approach the person from the front and give them room. Standing too close or blocking their path can feel threatening and increase agitation.
• Shift attention. Redirect their focus to a different, pleasant activity, a cherished object, or a snack. Engaging the senses through familiar music or a favorite TV show can also be a powerful distractor.
• Simplify requests. Keep your language simple, using short sentences and straightforward questions. For example, instead of asking, "What would you like to drink?" offer a choice, like, "Would you like water or juice?".

Modify the Environment to Prevent Agitation

A supportive, predictable environment is a cornerstone of dementia care. Small adjustments can make a large difference in reducing a person's stress and confusion.

Environmental adjustments to reduce agitation

• Keep a routine. Stick to a consistent daily schedule for meals, bathing, and activities. Predictability can reduce confusion and anxiety.
• Reduce clutter and noise. A simplified, clutter-free space with minimal background noise (like turning off the TV) can prevent sensory overload. Soft lighting is also preferable to harsh fluorescent lights.
• Ensure safety. Remove potential hazards like sharp objects, cleaning chemicals, or medications from easy access. Install locks or alarms if wandering is an issue.
• Provide meaningful activities. Keep the individual engaged with simple tasks they once enjoyed, like folding laundry, watering plants, or looking at photo albums. A memory box with familiar objects can also be soothing.

Comparison of Responsive Strategies for Agitation

Strategy	What it Involves	When to Use	Why it's Effective
Validation Therapy	Acknowledging and reflecting the person's expressed emotion, without challenging their reality.	When the individual is focused on a specific, illogical worry or is reliving a past event.	Builds trust, reduces frustration, and addresses the feeling behind the behavior.
Redirection	Gently shifting the individual's attention to a different topic, object, or activity.	When the person is fixated on a stressful thought or activity.	Interrupts the cycle of distress by moving their focus to something calming or positive.
Problem-Solving	Investigating the potential unmet need or trigger causing the behavior.	Always, as the first step in addressing agitation, especially when the cause is unclear.	Addresses the root cause rather than just the symptom, which is often a more sustainable solution.

Conclusion

Effectively responding to an agitated individual with dementia requires a compassionate, patient, and strategic approach. The best action is to first ensure safety, then to remain calm and use validation therapy to connect with their emotional state rather than arguing or confronting them. By identifying and mitigating the underlying triggers—whether physical, environmental, or emotional—and implementing non-confrontational strategies, caregivers can significantly reduce distress and improve the quality of life for both the person with dementia and themselves. Continued observation, environmental modification, and knowing when to seek professional help are crucial for long-term success.

Keypoints

• Prioritize safety above all else. Ensure the agitated individual and others are not in danger, and secure potential hazards in the environment.
• Stay calm and patient. Your own demeanor can either escalate or de-escalate the situation, so a calm presence is essential.
• Practice validation therapy. Acknowledge and empathize with their feelings rather than arguing with their reality to build trust and reduce anxiety.
• Identify potential triggers. Agitation often stems from unmet physical needs (pain, hunger) or emotional distress (fear, loneliness), and investigating the cause is key.
• Use redirection and distraction. Gently guide their attention toward a calming activity, familiar object, or pleasant memory to interrupt the cycle of distress.
• Simplify communication. Speak clearly and slowly using short, simple sentences. Offer choices instead of open-ended questions to prevent overwhelming them.
• Consider environmental factors. Reduce noise, clutter, and sensory overload while maintaining a consistent daily routine to foster a sense of security.
• Know when to call for help. If de-escalation strategies fail or behavior becomes unsafe, contact a healthcare professional or emergency services.

Frequently Asked Questions

What is validation therapy and how does it calm a person with dementia?

Validation therapy is a communication technique that acknowledges and respects a person's feelings and their perceived reality, rather than correcting them. It helps to calm an agitated person by making them feel heard, understood, and respected, which reduces frustration and distress.

Should I argue with a person with dementia who is agitated or confused?

No, you should not argue or reason with a person who has dementia. It is counterproductive and can increase their agitation and frustration. Focus instead on validating their feelings and redirecting their attention to something else.

What are some common triggers for agitation in dementia?

Common triggers include physical discomfort (pain, hunger), environmental stressors (noise, clutter), emotional issues (fear, loneliness), and changes in routine. Sometimes, a phenomenon called 'sundowning,' where agitation increases in the late afternoon, is the cause.

How can I use distraction to de-escalate an agitated individual?

Distraction involves gently shifting the person's attention away from the source of their agitation. You can use familiar activities, favorite music, a snack, or a cherished object to redirect their focus toward something calming or positive.

How important is my own emotional state when dealing with agitation?

Your emotional state is very important. Your tone of voice, facial expressions, and body language can influence the person's behavior. Remaining calm, patient, and reassuring is key to preventing the situation from escalating.

When is it necessary to seek professional help for an agitated individual with dementia?

You should seek professional medical help if the agitation is new or getting worse, if de-escalation strategies are not effective, or if the behavior becomes aggressive and poses a risk to the safety of the individual or others. In an emergency, call 911.

What kind of environmental changes can help reduce agitation?

To reduce agitation, create a calm and consistent environment. Minimize noise, clutter, and glare. Stick to a predictable daily routine and provide familiar, comforting items. Ensuring safety by removing hazards is also critical.