Jun 23, 2016

7 Ways to Cope with Dementia Patient Agitation, Aggression, and Meanness

Studies indicate that agitation or aggression is seen in up to 80 percent of Alzheimer's patients.


How to deal with and help a dementia patient | Alzheimer's Reading Room

By Bob DeMarco
Alzheimer's Reading Room

I think about Alzheimer's, dementia, agitation, and meanness all the time. Why?

Agitation or aggression can lead to an Alzheimer's patient being placed in a nursing home, or a memory care facility.

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Here are 7 ways to decrease, manage, and cope with difficult behaviors on the part of Alzheimer's and dementia patients.

#1 Frequent Urinary Tract Infections make dementia patients mean, disoriented, dull and hard to manage.

It took me years to discover that my mom, Dotty, was suffering from frequent urinary tract infections. The failure to understand and realize this caused an enormous amount of stress and anxiety for both of us. Undetected UTIs in dementia are common, and most caregivers will tell you they lived a "miserble" life until they learned how to control them.

My mom's core temperature was 97.6. So when we went to the doctor and the nurse got a reading of 98.4, the perception was that Dotty was fine and dandy. It was only by accident that we discovered the problem. I asked our doctor to check my mother's hydration level. The results showed that she was hydrated; the result also showed that Dotty had a urinary tract infection. An undetected UTI even after she had been examined by both a physicians assistant and our doctor.

I finally realized that Dotty was suffering from frequent "silent urinary tract infections"; and, this was having a negative effect on her behavior.

As it turned out, I learned to take Dotty's temperature frequently. Subsequently, we caught 7-8 urinary tract infections that would not have been otherwisedetected. It is now clear to me that one of two things happened when Dotty had a urinary tract infections.

She got agitated. Or, sometimes very dull like "not there".

By checking her temperature daily we caught these infections quickly, long before they worsened, and before Dotty became meaner than a junkyard dog.

However, it is not unusual for Alzheimer's patients to end up in an emergency room more or less, "out of it" as a result of UTI that goes undetected. The "out of it" and a big spike in temperature leads to the emergency room visit. At that point the infection might get diagnosed.


The problem.

Frequent, or strong infections can lead to memory loss.

Memory loss that might never be regained. Infections in dementia patients can lead to hallucinations, agitation, and aggression.

The single best way to prevent urinary tract infections is with frequent toileting, and changing of undergarments (or briefs).

In other words, don't ever go longer than 90 minutes without "prompting a pee".

Problem behaviors with dementia patients are more prevalent than most of us realize, this certainly included me.

Most people assume that Dotty was a model Alzheimer's patient. Happy and sweet all the time. Well she was a model Alzheimer's patient for sure, but not all the time. She often became mean, confused, angry, agitated, and you might have called her Doctor NO at times.

Once I learned the harsh lessons of the urinary tract infection and learned to cut them off immediately, the episodes of meanness and anger did diminish and they became easy to manage.

I strongly recommend that you read through this topic, especially the first 5 articles. They will help you immensely.


#2 One of the best decision I ever made was the introduction of exercise into our daily routine. This clearly improved my mother's behavior.

Please note, I took my mother into the gym for the first time when she was 87 years old.

So let me ask you, if you have an agitated or aggressive patient are they getting "real" exercise everyday? Are they engaging in activities? Are they living life?


#3 Is your agitated or aggressive patient living in a very fertile environment?

Is your loved one receiving constant stimulation via conversation and socialization?

When they are mean, do you leave them all alone while you "stew" about it.

Well I stewed about so many things I can't remember them all. Thank goodness.



#4 Have you tried introducing music into the environment?

The power of music in Alzheimer's care can not be underestimated. In fact, music is an essential part of memory care.

My mother would start singing songs from the 1930s - songs I had never heard in my life. Songs that were made popular by Billy Holiday in 1932. Music could change her mood in an instant. We used the music channels on cable television quite effectively. My mother loved all the music from Shrek - loved him also.


#5 Are you making sure that the agitated or aggressive patient is getting heavy doses of bright light daily?

Never underestimate the importance of bright light. Bright light is mood changing. Do you let your loved on sit around even during the day in dim light. This is a mistake and you will pay for it as a caregiver.

Do you have bright light in the kitchen? A nice big window? Use it.

You can also get bright light in places like Walmart and Target. Plus exercise and social stimulation.

Nothing beats the sun. Plus the sun is the best source of Vitamin D.

If you have an agitated or aggressive patient, are there patterns to the behavior? Does the bad behavior come near the same time of day? In near darkness or darkness?

After they have been ignored for a long period of time? Bright light could be the answer.


#6 You can't leave a person living with dementia home alone

This ranks as one of the biggest mistakes that is made in dementia care.

When an Alzheimer's patient is diagnosed they can't remember 3 words. As the disease progresses they completely lose their sense of time. So if you step away or out for even 5 minutes they have no understanding of how long you have been gone.

Ever gone out to the store and when you return your loved one is angry. Do they start yelling at you or worse?

Here is why. They don't know how long you have been gone, and even if you told them where you are going - they can't remember that either.

Imagine if your teenager didn't come home on time. As time goes by you begin to worry. After a while you start getting all kinds of negative thoughts - like maybe something bad has happened.

Alzheimer's patients are easily confused. They don't know where you are. They don't know how long you have been gone. They don't know if you are ever coming back. They can't figure it out. They might even think you have "abandoned them".

When you return they are confused and filled with anxiety. How do you act when you are confused and filled with anxiety?

On one hand you might feel exasperated by the fact that you can't get a minute to yourself. On the other hand, this is just a sign of how much your loved one needs you. Then cannot stand to be without you. They cannot operate without you.

Consider this. Maybe they love you so much they just can't stand to be without you? They need you. If you are the one accept the love, accept the need. It might not be easy being you, but if you ask me I would say, you are the best!

Topic - You can't leave a person living with dementia home alone.

#7 What would your life be like if no one ever touched you or gave you a hug?

The important of touch (tactile communication) is often overlooked in dementia care. Just like you and me dementia patients are made of flesh and blood. They need to be touched and hugged.

When I started putting my arm around my mom, putting my head on her head, and reasuring her she became a completely different person. She stopped telling me to "get out".

In January, 2102, and 5 months before she went to Heaven, my mom gave the greatest hug I had ever received. Right after she woke up -she gave me a hug out of the clear blue sky. She also said, Bobby you are taking good care of me. I remember clearly, she felt very warm. Later that day I told my closest friend - my mom is getting ready to go to Heaven.

I have hundreds of great caregiver stories but nothing tops that moment in time. Nothing. I'll never forget. The role of touching, hugging, and reassurance can never be underestimated in dementia care. Don't be afraid or reluctant - go for it. You might be me some day.



Keep in mind, dementia patients can't remember, so they need more. More attention, more positive reinforcement, and more touch.


Agitated or not, I promise you, try the above and you might very well get a positive outcome that you could have never anticipated.

I did.

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Alzheimer's Reading Room

"I turn to the Alzheimer's Reading Room for advice, for suggestions, for news of developments in the field every single day. The job of giving care for a loved one with Alzheimer's is daunting. It's a little less so because of the reassurance and positive reinforcement ARR provides".

-- Pamela R. Kelley

Bob DeMarco
is the Founder of the Alzheimer's Reading Room (ARR).  Bob lives in Delray Beach, FL.

Original content the Alzheimer's Reading Room