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Research-based tips for reducing agitation and aggression due to dementia in a mindful way

Caring for a loved one with dementia can feel like a daily battle. You are dealing with the loss of the person you once knew, yet you still love them despite this change. You may be seeing new episodes of agitation and aggression and find it difficult to predict when these behaviors will arise.

There are strategies that can help you respond to the challenges of dementia in an effective and mindful way. One of the best things to learn is effective communication strategies for helping your loved one.

Why are Some People with Dementia Combative?

It can be hard to understand why your loved one is behaving the way he or she does. Dementia changes the brain of the person you love. Through no fault of their own, you might experience unexpected aggression and anger from your loved one.

Often aggression will appear in the later stages of dementia. The first time your loved one is aggressive may surprise you. Your loved one may become angry without warning and yell at you, curse and scream, or even throw something at you.

Being on the receiving end of aggression is heartbreaking and frightening. But remember that your loved one is not in control of these feelings. Aggression and agitation stem from symptoms of the disease and the way his or her brain is changing. Your loved one may be combative as a reaction to feeling confused, frustrated or frightened.

You can learn how to handle the difficult behaviors seen in dementia. This gives you the ability to enjoy your days with your loved one. One of the things that dementia cannot steal from you is love. Research has shown that people with dementia remember feelings and emotions. They can feel love and happiness long after they have forgotten an actual visit or experience.

10 Strategies to Calm Agitation from Dementia

Love in your relationship remains and can be your secret defense against agitation and aggression. Keeping these 10 strategies in mind can help strengthen your relationship. You can focus on the love you feel and continually build the bond you share.

  1. Stay Calm

Agitation and aggression are contagious. When you are talking to someone who is agitated and upset, it is natural to feel upset yourself. This phenomenon is called mirroring and you can use it to your benefit.

When you stop and take a deep breath to calm yourself, you are demonstrating calmness. This helps to make your loved one feel safe and reassured. Take a step back and see if you can identify a cause for the agitation, for example, a tense mood in the room. Remember that your loved one is not trying to give you a hard time – he or she is struggling as much as you are.

  1. Slow Down

Stop whatever you are doing and slow down. Listen to what your loved one is saying, even if it doesn’t make sense! Don’t correct, as that just increases the agitation. Take a deep breath and remember a positive memory you share with your loved one. Allow that warmth to enter your eyes and look directly at him or her. Smile gently and try to ask for permission for what you need to do or offer help. For example, “can I help you wash the dishes?” Calmness often reassures those with dementia. You can make a positive request like “will you walk with me to the store?”

A person with dementia might be overwhelmed by the conversation or situation. Instead of rushing in with more ideas or words, just pause. Silence gives your loved one time to think and figure out what they are trying to say.

Read: Communication in Early Stage Dementia

  1. Focus on Feelings, Not Facts

Dementia can impact a person’s ability to reason and speak but feelings still remain strong. You need to respond to your loved one’s feelings instead of their words. Trying to reason and argue with a person with dementia will only frustrate both of you!

Listen to the expression of frustration even if the actual words don’t make sense. Your loved one might be saying, “I need the car to take to the ball!” You could respond to that expression by saying, “you really are wanting the car today?” Then try to provide clear reassurance. For example, “I will take you out in the car today and we can get what you need.”

Read: Communication in the Middle Stages of the Dementia Journey

  1. Bridge Communication Problems

Always treat your loved one with respect. These feelings can help foster effective communication with someone with dementia. Even more importantly, continue to interact with your loved one with dignity. Although you may see behaviors that remind you of a child, your loved one is not a child. Guarding his or her dignity will prevent hurt feelings that lead to agitation.

The reality of your loved one with dementia may not agree with the reality that you see. But the feelings that he or she is experiencing is something you can both understand. Using Validation Theory in dementia care can improve your communication. You can agree with your loved one’s perception of reality without lying. The easiest way to do this is to ask gentle questions about what they are telling you. When your loved one tells you that there is a “strange man” in her kitchen, you can validate the feeling behind it and ask questions. Even if that strange man is actually her husband.

Try saying, “That must be frightening! Would you like me to go check why he is there?”

Other bridging phrases are:

  • What is that like?
  • Tell me more about….
  • It would be so lovely to do that….
older husband and wife walking
  1. Limit Distractions

Set your loved one up for success. Dementia causes damage to the brain which makes it difficult to express thoughts and perform tasks. The brain can be overstimulated by background noises, clutter, crowds, or lights. This overstimulation can bring on feelings of restlessness.

Develop an environment of calm in your home. Choose smaller gatherings over crowds as much as possible. One or two visitors will be easier to handle than a room full of talking guests. Turn off the TV when talking to your loved one. The noise of the TV can be difficult for your loved one to block out.

Limiting distractions for yourself will also help you as a caregiver. Research has shown that smartphone use can make you less aware of those around you. When you are distracted, you may be missing early cues of frustration. Try leaving your phone in another room during care activities. See if your undivided attention calms your loved one.

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  1. Declutter

Always aim to simplify your surroundings when you notice signs of agitation. Move into a quieter space. A calm environment will often calm your loved one. Reducing the amount of non-essential items is a great way to increase feelings of calm in a home. Bright, distracting patterns and moving objects can confuse your loved one. One or two meaningful, personal pictures will offer a more calming environment than 20 frames.

Clutter causes your loved one’s senses to live in overdrive. If they are constantly filtering out what is important and necessary, then their brain can’t relax. Your loved one will not know what to focus on. Help to calm them by limiting the things that surround them. Clutter also makes it easier to lose important objects or not see something that is “out in the open”.

Lights are another stimulating presence. Particularly in the evenings and late afternoon. It is important to switch from bright overhead lights to smaller, dimmer lights as the sun goes down. The glare and reflections from lights off windows, mirrors or picture frames can be startling or even frightening for your loved one.

Read: 24 Ways to Deal With Sundowners Syndrome

  1. Check for Discomfort

Your loved one may have difficulty communicating. They can have trouble telling you if they are uncomfortable. Signs of physical discomfort may be that your loved one is:

  • having trouble sitting in one place
  • constantly on the move
  • fidgeting
  • irritable

Making sure that your loved one is physically comfortable will drastically reduce aggression and agitation. Below is a thorough checklist to help you identify physical discomfort:

  • When did your loved one last eat? Could they be hungry? Try offering a small, nutritious snack. Better yet, sit down with them and have a snack yourself. Keep yourself at your best!
  • Could your loved one have an infection? Urinary tract infections and bladder infections can often develop or worsen symptoms of confusion and agitation.
  • What has your loved one had to drink in the last 24 hours? Dehydration is common in seniors due to a decreased sense of thirst. Dry eyes, mouth and skin are symptoms to watch for along with confusion and forgetfulness. Make your loved one a hot or cold cup of non-caffeinated tea, offer a slice of juicy watermelon and make sure to add water dense foods into their daily meals. Or gently remind your loved one to sip on water throughout the day.
  • Do you know when your loved one last had a bowel movement? That’s an important discomfort to address!
  • What is your loved one wearing? Check for a waistband that itches, the tongue of a shoe that is rubbing, socks bunched at the toe, a collar that is too tight, or a fabric that scratches. All of these minor irritations can be distracting and cause agitation.
  1. Refocus

Always look for ways that you can cherish your loved one. Choose not to focus on the more frustrating aspects of caring for him or her. Pay attention to the immediate situation or activity. Notice if the activity seems to be triggering your loved one. If so, try to be proactive in changing the situation or activity. Redirect to a more peaceful and relaxing activity. If a conversation is upsetting either of you, change the direction. Acknowledge what your loved one said and then move to a different topic.

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  1. Say Yes

Aim to say yes as much as possible. If your loved one mentions that she saw someone who passed away years ago, agree with how lovely that would be to talk to them again. Even build on it and ask what they talked about. This gives you both a sense of connection and comfort with one another.

"Yes" is a powerful and affirming word. Saying "yes" let’s your loved one know that you understand what is important to him or her. That you hear them. That you are listening.

Even though the reality your loved one is experiencing is different from yours, you can still find common ground. Think first of how you can say "yes" to open communication and create connection.

  1. Connect

Dementia may cause personality changes but keep your personal connection in mind while working through the aggression and agitation. Dementia CANNOT steal the love from your relationship. It only has the power to change that relationship.

Remember that you can only count on today. Enjoy the moments that you have. Listen to music together, dance, play an instrument, offer a massage, or brush your loved one’s hair. Go for a walk outside and listen to the bird’s songs or look at flowers. As Alzheimer’s and dementia progress, the world is largely experienced through senses. Express your love through touch, sounds, sight, tastes and smell.

You will never regret that you took the time to show your loved one you care about them when you had them with you.

Dementia, particularly dealing with the aggression and agitation, can be challenging for caregivers. Remember the importance of your connection with your loved one. Provide a soothing environment and aim to remain calm and loving. Empathize with your loved one’s feelings and always emphasize love.

Resources:

Understanding and supporting a person with dementia

Dementia & Verbal Communication

Anxiety and Agitation

Aggression and Anger

Urinary Tract Infections (UTIs) in Older Adults

Read about our dementia care services here: https://homecareassistance.com/alzheimers-dementia-care

About the Author(s)

Crystal Jo is a Registered Nurse who is passionate about helping older adults live happy, healthy lives at home. As a freelance writer, she enjoys educating and inspiring seniors, and those who love them, to choose a healthy life.

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