All posts tagged: Dementia

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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Identity and Dementia: Where Do I Go?

Most of us spend a big part of our life searching for meaning, trying to find our identity, and although Thomas Szasz said in The Second Sin (1973):  “The self is not something one finds, it is something one creates.” We set ourselves for the pursuit of that elusive “identity,” and our meaning as human beings. What is life all about? And overall, what is our role in life? What do we really live for? Who are we? We pass many of our prime years looking for our identity, fighting for one, trying to assert one, if we are ever given a glimpse of it; we wrestle to have our needs met and to have our dreams come true. That search for identity comes sometimes in a puzzle of circumstances, challenges and exploits, and like the overprotected Nemo, we need to swim the oceans of uncertainty and grow until finding ourselves Through the journey in search of our identity, we attempt to unfold our potential, our desires, and to adjust to the best of our abilities to the challenges of daily life. We build our life upon joys, shadows, and sorrows and fill that life with the mementos and the facts we carve in our memory, those we gathered throughout our journey. But one day, zas! You are diagnosed with dementia. There you are, all of a sudden lost, confused, and soon to be stripped – if not of your identity, at least, officially, of your mind. I know, hopefully, we all have lost our minds out of excitement, passion, or love, yet, after the diagnosis of dementia, it is not the same. Of course, we could discuss what really the “mind” is, there is so much more to the mind than the cognitive aspect of it, yet for any purpose – the mind someone loses to dementia is THAT mind – the one holding memories, pains, and joys. It is ready to go with the wind. In reality, with the plaques and tangles created in your brain, after a certain time you will not even remember the diagnosis. Just as Clark Gable stated while playing Rhett Butler in Gone with the Wind, you may well say: “Frankly, my dear, I don’t give a damn.” But the clock is ticking. Professionals will offer all that they have. They talk and teach how to calm you down, how to deal with your mood swings and your challenging behaviors, but do they really know what a person with dementia is going through? What you or your loved one are going through? Do they know that you are going through the tunnel? In and out of the darkness. Do they know about the uncertainty and the challenge of living an existential tale of the here and now, for which, you did not sign up, and have never practiced for? Then come the drugs, the optimism, the clinical trials, the walking to fund more research. Hopefully, before it is too late for you. There is so much that is done, said, so much still to do, yet nobody really knows what you are going through. We try and theorize about the phenomenon of dementia – the neurological, psychological, emotional, and practical side of it. Even the spiritual side of it. Needless to say, we appreciate all the nice, legitimate attempts people make writing new books about breakthrough treatments and findings. They present lectures and write articles about you, but what if you could really explain how it is to know that your life is slipping away, fading away? What if you had a voice? What if they found a cure? I wish I could be more helpful, but I really do not know how it is. All this is my best efforts to explain a phenomenon, I can only observe and witness with powerlessness, compassion, and horror. I do not have dementia, and I wonder if I had it how I would feel. What would it be like? Again, I do not know, but if I could, if I were you, I would not like to go there. That said, I hope I would react calmly and with patience for myself, although I doubt it. But let the journey continue and keep on swimming. For now, I find some solace and motivation to keep on swimming in Thoreau’s wisdom: “I went to the woods because I wished to live deliberately… only the essential facts of life, and see if I could not learn what it had to teach, and not, when I came to die, discover that I had not lived. ~Henry David Thoreau, 1854  
Doris BersingIdentity and Dementia: Where Do I Go?
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