Laura Perry

Caregiver Tips: How to Calm Agitated Adults

Older adults with dementia (a disease that causes problems thinking and remembering) are frequently confused. Sometimes, this confusion becomes more problematic than usual, and the person with dementia can become agitated. This can be a frightening and stressful experience for both you and the elder! Today, we’ll go over some of the causes, and caregiver tips to help.

What do we mean by “agitation”?

Doctors often refer to agitation as “behavioral disturbance” – a change in the way the person is behaving into something that wouldn’t be considered part of normal emotions and reactions. “Agitation” can take a lot of different forms, including:
  • Crying uncontrollably
  • Cursing or yelling at people in everyday situations
  • Screaming the same words over and over again, such as “help me!”
  • Hitting, punching, slapping or scratching
  • Using a cane or walker as a weapon
Why does agitation happen? Agitation happens when the elder with dementia is in some kind of distress, but isn’t able to express themselves and fix their problems. In many ways, an agitated older adult is similar to a crying baby – there could be many reasons why, and it’s up to caregivers to figure out what’s wrong this time. In order to help stop the problem, it takes a little bit of detective work.  Physical problems. Agitation can be a result of:
  • Pain
  • Hunger
  • Thirst or dehydration
  • Tiredness
  • Constipation
  • Needing to urinate
Emotional problems. Agitation can also be an expression of:
  • Fear
  • Grief
  • Feeling overwhelmed
Psychological problems. In some cases, older adults with dementia can experience problems with how their brains process what is happening in the world. This can include
  • Hallucinations – seeing or hearing things that aren’t really there
  • Delusions – believing things that aren’t true. Some examples include that their belongings have been stolen when they are still in the house, or that their family members are impostors.
If you think that the elder is having delusions or hallucinations, it’s important to discuss it with the person’s doctor.

Caregiver Tips: 4 Steps to Relieving Agitation

Step 1. Determine the pattern.

Tease out when, where, and under what circumstances the older adult becomes agitated. Some common examples include:
  • During bath time or with clothing changes
  • In noisy surroundings
  • Evening hours
  • When startled
It often helps to keep a log or journal of agitation, including what time it happened, what had been going on right beforehand, what the person was doing, what other nearby people were doing, and what kind of agitated behavior resulted. You might also include anything you tried to calm them down, and whether or not it worked.

Step 2. Think about what you already know.

Racking your brain for what you already know about the elder will help you put the agitation into context. Ask yourself:
  • What health problems does the elder have? Do they have had knee arthritis that might be causing them pain? Did they complain about constipation when they were younger? Is their eyesight very poor, and might they not be able to see someone who is standing to their side?
  • What were their habits? Was this person a night owl who always stayed up late, but now has to go to bed early because of the family’s schedule? Was this person a loner who never liked to be in large groups?
  • What did they like to do for fun? What would calm them down when they were upset as a younger and healthier person? Did they like to listen to music, spend time outdoors, or cuddle with a beloved pet?

Step 3. Ask more questions.

When the older person is agitated, try asking them what’s wrong. If you don’t get an answer, ask more specific questions, like:
  • Does anything hurt? If the answer is yes, but they can’t show you where, try gently pointing to different body parts that might hurt. Common spots include knees, back and belly.
  • Do you have to go to the bathroom?
  • Are you scared? You might follow this up with What are you scared of?
  • Do you want a glass of water?
  • Do you want your ______? Some favorite objects might include glasses, particular blanket, remote control, or book.

Step 4. Put 2 + 2 together.

The best caregiver tips I have to help stop agitation are for you to figure out what’s causing it, and to change that situation. Here are two examples. Example 1:  Donna always got upset and started crying whenever her daughter brought her to church, even though she had loved going every Sunday when she was younger. It was particularly bad when the organist started playing. Her daughter then tried having her watch church services on TV, and found that she really enjoyed these. She realized that Donna was overwhelmed by the crowds of people and loud noises. Her daughter started bringing her to the mid-week services on Wednesdays, which did not have any organ music and only a few attendees. Donna brightened up during these services every week. Example 2:  Walter would start howling and swinging every time his home health aide would try to give him a bath, particularly when she was getting him into the bathtub. His son looked through Walter’s medical records and noticed that his doctor had recommended getting a hip replacement for bad arthritis, but Walter never had it done. The home health aide and son realized that Walter’s hip probably hurt when he had to lift his leg to get into the tub. His son started giving him Tylenol an hour before scheduled baths, and Walter was much calmer.

Still stuck?

If you try these caregiver tips without any luck, it’s a good idea to get help from an expert. Some resources include:
  • The elder’s doctor. The doctor might make suggestions, change medications, or refer you to a specialist, such as a geriatrician, psychiatrist, or neurologist.
  • A geriatric care manager. These are usually nurses or social workers who specialize in caring for older adults.
  • Support groups of other caregivers. The Alzheimer’s Association runs many of these all over the United States.

Learn more caregiver tips from professionals. Online classes for caregivers of any experience level: CareAcademy

Laura PerryCaregiver Tips: How to Calm Agitated Adults
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Providing Help to Elders with Urinary Incontinence

Providing care to elders with urinary incontinence can be one of the greatest challenges that caregivers can face. You might feel frustrated, overwhelmed, or uncomfortable helping your parent go to the bathroom. Your parent might feel helpless, embarrassed, and might even try to hide the fact that they are having accidents. The good news is, there are many remedies that can help make it easier for your parent to stay dry – and they don’t all involve extra pills! The strategies to use depend on what type of incontinence your parent has.
  • Stress incontinence is when someone has leaks that occur when they sneeze, cough, laugh, or otherwise squeeze their belly muscles. People with stress incontinence often only leak small amounts of urine.

People with stress incontinence can help control leaks by doing exercises to strengthen the muscles that keep their bladder closed. These exercises are called “Kegels.” To practice, tell your parent the next time they pee, to squeeze the muscles to try and stop the flow of urine. This helps them know which muscles to squeeze. Then, practice squeezing these muscles several times throughout the day. If this is too hard, tell your parent to imagine that they are trying to stop themselves from passing gas. Do the same thing – practice squeezing these muscles a few times a day.

In the meantime while these muscles are getting stronger, most people end up wearing a pad in their underwear. If one type of pad doesn’t work, try a different brand – it can take a few tries to find one that feels comfortable and protects clothing.

  • Urge incontinence is that “gotta go gotta go” feeling – when the person feels a very sudden and powerful urge to pee that they cannot hold back for very long, and they lose control before they make it to the bathroom.

People with urge incontinence should try to go to the bathroom “early and often” – before the urge comes. Many people find that having a bathroom schedule helps. Start by bringing your parent to the toilet once every hour while they are awake, whether they think they have to go or not. If that keeps your parent dry, then you know you have found a successful strategy. Then, start spreading the toilet visits out farther – every hour and a half, then every two hours, then every three hours – until you figure out how long they can go without needing to “go”. Some people find that they only need to visit the toilet after meals and before bedtime to stay dry.

Certain foods and drinks can make urge incontinence worse. Avoid these, or at least cut down on them:

  1. Caffeine such as coffee, tea, and sodas
  2. Alcohol including beer, wine and liquor
  3. Chocolate
  4. High-acid foods such as citrus fruits and tomatoes
  5. Carbonated drinks

Some medications can also make urge incontinence worse. Common culprits include diuretics (water pills) and certain blood pressure medications. If your parent is constipated, that can also make urge incontinence worse. Talk to your parent’s doctor about whether any of their medicines might be worsening the problem.

If none of these strategies help, there may medication to help control bladder urges, and you can ask your parent’s doctor about these. These should be used with caution, as they have many side effects. In people with memory or thinking problems, they can cause worsening confusion. They also frequently cause constipation – and that can make incontinence worse! Many people find that these medicines are not worth the trouble.

  • Functional incontinence happens when a person would be able to keep control of their urine, but they can’t make it to the bathroom in time for other reasons. Some examples include bad arthritis that makes it hard to walk, lung problems that make them too out of breath before they get to the bathroom, or memory problems so they don’t remember to go to the bathroom.

The same strategies that work for urge incontinence will work here. Additionally, you might find that a commode placed closer to the chair or bed where your parent spends their time will make it easier than going back and forth to the bathroom.

  • Overflow incontinence happens in patients with nerve or spinal cord damage who can’t feel when their bladder is full, and the urine just pours out of them. People with overflow incontinence usually leak very large amounts of urine without any warning.

If your parent can control when they pee, but just don’t feel the need to, try using the toilet schedule strategy. If your parent can’t pee on their own, their doctor might suggest using a catheter to help drain the bladder of urine before it drains itself.

If you think your parent has overflow incontinence and you don’t know that they have nerve or spinal cord damage, call their doctor right away. This could be a sign of a serious problem.

  • Nighttime-only incontinence might be a sign of an untreated medical problem or a medication side effect. If your parent has this, it’s time for a visit to the doctor.
Many elders with urinary incontinence have mixed incontinence – with features of more than one type of incontinence. In these cases, a blend of different strategies often works best. Even with the best strategies, not all elders with urinary incontinence will stay dry. It’s normal to feel upset or frustrated. It’s also normal to feel that you don’t want to be the one changing your parent’s diaper. If this is how you feel, remember that it’s okay to reach out and ask for help.
Laura PerryProviding Help to Elders with Urinary Incontinence
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