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Having heard a lot about agitation, I’d like any extra advice I can get

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February 22, 2012

- Alzheimer's Care, Blog, Elder Law Articles

“Love cures people. Both the ones who give it and the ones who receive it.” 

— Karl Menninger

The above is a good quote to keep in mind. Dealing with agitation and/or dementia can be a marathon struggle. Choose your battles wisely and know that just because a person’s behavior might be bothersome to you, that does not mean it is an issue for a person with dementia. If you’re stressed about a loved one’s behavior, first ask yourself: Is this person in danger? Is anything detrimental to his or her health? Do I really have to do anything? Or might I be making a mountain out of a molehill? Here’s a good example: Your loved one is getting dressed — with multiple layers of clothing. This is a change from pre-dementia days. Before worrying, getting angry or trying to change anything, ask yourself: “Is it really hurting anyone?” If the answer is “no,” then let it go. Confronting someone with dementia about this and making him or her change clothes, could produce agitation, and possibly an angry outburst. Remember: Your goal in this type of situation is to prevent or divert any stimulus that could bring on agitation. As typical adults, we don’t like being told what to do. A person with dementia is no different in this regard. Being able to “go with the flow” on your part will go a long way; concentrate more on the issues that are truly serious enough to address. If you can do this, you and your loved one’s lives will be much less stressful. We must constantly remember an underlying premise: People with dementia always need to feel loved, useful and needed. We must help create an environment that shows them love. We also must allow them to help as much as they want, and in so doing set them up for success. A big tenet of this is coming to grips with “behavior acceptance.” As caregivers and loved ones, we have to realize unwanted behavior is part of the disease process and that there is a reason for it. When we think this way, we can respond more effectively to situations where agitation is present, as well as others that need attention. What are some strategies for doing this? For example, instead of putting someone on the defensive with something like: “Your clothes are dirty. Would you please change into something clean?” You could phrase it this way: “Let’s go change our clothes so we an go to the store.” This directs action but it is less demanding of the person with dementia. By involving yourself, it comes off as less threatening. Use this line of thought, if it will help: “We cannot control what comes our way, but we can control how we respond.” If our thought preparation is, “How can I best respond to this situation or behavior?” it averts putting the onus on your loved one as “the problem.” The person with dementia is not able to change, so we have to.
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What are the effects of pain on agitation?

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February 17, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Confusion and/or agitation almost always increase when pain is present. Furthermore, if there’s a sudden increase in confusion or agitation, it should be a tip-off that something wrong is going on physically. Dementia does not typically progress that rapidly. There is a cycle of pain that gives us a picture of how pain can affect the entire body. It goes something like this: Pain, anxiety, fatigue, depression, pain, anxiety, fatigue, depression, pain … and so on. If a person who has dementia is in this cycle and unable to let anyone know, we have to intercede and determine what’s really happening. The sources of pain can be numerous. Most people forget at least a few when listing them. A partial list includes: arthritis (the No. 1 affliction of older Americans), joint and muscle problems, infection, inflammation and headaches. If your loved one has chronic problems or even just a history with any of these conditions, ongoing visits with the physician (who presumably will prescribe some form of treatment) are critical. Ongoing assessments by a doctor or other clinician are very important. By examining overall health frequently, a clinician can learn whether something like a headache, urinary tract infection or other condition is a sign of something bigger. Be sure to keep the physician informed, even when you’re not going to see him or her in person. Watch your loved one’s facial expressions and body language since they are common indicators. Something as simple as a flare-up of arthritis or a foot wore can cause a change in behavior. Also be aware that some medications can cause agitation. Always call a physician if you have any questions or concerns about medication issues or effects. Caregiving involves ever moving targets so constant assessments and questions should be a part of it. Talking with others in your position can help. Discussions with other caregivers, whether they’re in a support group you’ve joined or are on their own, can be a good source of support. Family members and friends who sincerely care and try to understand are other good resources. There is no need to think you have to go through these challenges alone. Reach out for, and accept, help often. There are many good sources out there, including this free booklet: “The Indispensable Alzheimer’s Resource Kit.” Click here to get it sent to you for free.  
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Besides medication, how can one deal with agitation?

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February 10, 2012

- Alzheimer's Care, Blog, Elder Law Articles

First, it’s important to be on common terms when discussing any word, concept or issue. This holds true for agitation. Many of us have experienced agitation at some point in our lives. When we get so emotionally overwhelmed, it leads to unrest. Let’s look at the meaning of agitation, as cited in several authoritative resources:

* “Extreme emotional disturbance.” (The American Heritage Dictionary of the English Language)

* “A mental state of extreme emotional disturbance, the feeling of being agitated; not calm.” (WorldNet 1.6)

* A stirring up or arousing; disturbance of tranquility; disturbance of mind that shows itself by physical excitement.” (Webster’s Revised Unabridged Dictionary)

Most people can identify such a feeling in themselves and use appropriate coping mechanisms. But this can be impossible for people with Alzheimer’s disease. Often, they are unable to get in touch with, or express, their feelings. When they experience agitation, therefore, it is hard for those around them — caregivers, family members and others — to understand or offer help. We won’t go in-depth into it here, but the issue of medication should be mentioned. Medication could be responsible for sudden changes in mood or behavior, and that includes agitation. A new medication or a changed dose might be the source of new levels of agitation. Keep notes and discuss them with your physician. Do not think you have to wait for your next appointment, which could be weeks or months away. Call right away for assistance. Realize that both prescription and over-the-counter medications can be responsible for heightened levels of agitation. Always consult a doctor before starting, stopping or changing any medication.
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