Thursday, July 18, 2013

How to Respond to Agitation in Someone with Dementia

We all become agitated at some point in our lives, even our days, and that frustration and anxiety manifests in myriad ways, from sudden withdrawal to verbal physical aggression. People with dementia may not be able to articulate pain or annoyance the same way able-minded people can, and so they express themselves with behaviors that can be disconcerting and even harmful.

This week Dr. Glenn Panzer, M.D., who is the chief medical director at Elizabeth Hospice, outlined the triggers and treatments when caring for someone with dementia who appears agitated. His presentation was part of the monthly meeting of the San Diego Dementia Consortium in Escondido. Dr. Panzer also is president of the consortium.

The first step is to try and treat the underlying cause, which requires you attempt to determine what might be causing the behavior. Consider the following internal triggers, some of which are obvious and some not so much:

• Pain
• Infection (such as urinary tract infection, which is more common in the elderly)
• Sleep Deprivation
• Withdrawal from drugs, such as opiods or barbituates; alcohol; or cigarettes
• Depression
• Medication or anesthesia
• “Metabolic encephalopathy,” which is a typically temporary brain disorder caused by abnormal body metabolism
• Hypoxia (reduced oxygen)
• Toileting needs
• Hunger
• Constipation
• Tiredness

There are also environmental stimuli that can cause verbal or physical aggression, such as:
  •  Misinterpreting an approach (you need to explain what you’re doing before you start doing it)
 • Delusions
 • Confinement to a chair (which causes discomfort)
 • Loud noises
 • Too dark or too light in a room or outdoors

In all of these instances, a person with dementia may not be able to tell you what is wrong. They may be confused by what is happening and what you are doing and lash out instinctively. If the behavior is persistent or potentially harmful, drug and non-drug treatments may be appropriate.

Non-drug Treatments
Treating agitation without the use of medication is always preferable. Some non-pharmacologic treatments include:

 • Redirection (where you try to take their mind off something by introducing them to something else)
 • Removing the annoying stimuli, such as lowing the lighting or music or raising the volume on the television
 • Checking to see if they need to use a restroom or are incontinent
 • Repositioning them, especially if they are using a wheelchair without a gel seat
 • Playing music known to calm them (though this doesn’t necessarily mean it’s “calm” music)

There’s a movement away from using antipsychotic drugs and more toward complementary and alternative medicines. Such therapies include:

• Music therapy
• Aromatherapy
• Touch
• Massage Therapy

If medication appears to be an option or recommended solution, there are numerous types known to help with agitation and/or anxiety in patients with dementia. They include painkillers, antidepressants, mood stabilizers (such as lithium and Depokote/Tegretol), anxiolytics (such as Prozac, Ativan and Buspar), and cholinesterase inhibitors (Cognex, Aricept, Exellon and Reminyl).

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