How to Decrease Dementia Agitation without Increasing Drug Doses

It’s painful.

You have a close family member with dementia.

You had to help her into an Assisted Care facility.

She is having some problems with adjusting to her new home. Chances are that she’s showing signs of agitation. A lot of it. And it doesn’t make sense. At least not to you.

The food is good, the place is clean, the staff is friendly but everything seems to bother her.

At first, it just seemed like she just wanted to go back home. That’s normal. Lots of people feel that way.

It’s hard to explain that she just can’t. There are too many traps at home. Burners that don’t turn themselves off. Knives that cut when held the wrong way. Showers that burn when she forgets to turn on cold water as well as hot. Necessary medication that she forgets to take.

Explanations don’t work for her.

Standard care doesn’t help.

The facility helps the way they have been trained to. But the longer she is there, the more agitated she gets. She is developing unusual behaviors.

Medication isn’t helping. There are too many side effects.

You ask what’s wrong and she can’t tell you why.

It’s frustrating. And aggravating. She’s sad. She’s crying. Agitation leads to anxiety. Or anger. It seems like there are no reasons for her to be that way.

But there are. And they’re not what you think.

How to react in different situations to keep her feeling calm

She’s transported back in time

Wandering is common in an Assisted Care facility. Trying to prevent it often leads to agitation.

People who wander often do it at a particular time every day. Staff at her Assisted Care facility may use her timetable to plan the times they will physically stop her. They might station someone at a door to prevent her “escape” to the outside. Or block her way inside, to try to make her sit down. Or even yell “Sit down!”

This just causes increasing frustration and agitation. In her mind, there is something she needs to do at that time. Something she used to do daily — at least during the week. If she can’t keep her appointment, something bad could happen.

Mothers who used to pick up their children at school often get restless around 3 in the afternoon. Women who had an office job need to get out of the house every morning, in time for work. Women who had a night job are most likely to become restless in the evening. Former caretakers are more likely to wander in the facility (and bother people).

Attempts to reason with her will not solve anything. Her world is firmly anchored in the past. In her mind, those caretakers are strangers who are trying to interfere with important things she has to do. She knows this is part of her daily routine.

Instead of trying to bring her into your world, join her in her world. Make her feel comfortable there.

You can use something connected with the reason for her wandering. If she thinks she needs to pick up her kids, talk about her kids just before the behavior starts. If she needs to go to work, give her a briefcase with a few colorful magazines inside and look at the magazines with her. If she used to be a caretaker, give her some towels to fold.

Sometimes pleasant distractions work without the wandering connection. When you know the time she wants to start wandering, try distracting her 10 or 15 minutes before that time. Give her a special treat to eat. If she likes flowers, give her a flower and join her in a conversation about it. Look at a book with pictures that she likes. A pleasurable distraction can direct her to happy thoughts, instead of worry about being late.

By using redirection or distraction, she will have a nice activity connected to the time of day that started her agitation. There will be no need to wander any more.

She becomes agitated when you want her to walk down a certain hallway

Take a look at that hallway. Does it really look like all the other hallways? Or is there something in it that is scary? Or could it seem to be blocking her way?

Her vision isn’t working as well as it used to. Her brain often shows her something different than what you see.

One of the common problems in hallways is a light rug color in sharp contrast to the darker color of the floor. To her, it can look like the edge of a cliff. Too dangerous to walk close to. Especially if she is unsteady on her feet.

There may be too much clutter in the hallway. Wheelchairs left here and there. Walkers abandoned outside rooms. Meal carts standing outside a room while the meal is delivered. To you, they are easy to go around. To her, a dangerous obstacle course. Too dangerous to try to navigate.

Chairs, wheelchairs, and walkers parked along the sides will not be so threatening. Open hallways with low-contrast rugs and light colored flooring will make the pathway through it obvious and inviting. With an obvious pathway she will travel down that hallway as readily as anywhere else.

She is agitated when you try to carry on a normal conversation like you used to have

If she is fixed in the past, she remembers things as they were, not as they are now. This includes people. This includes you.

So she may not remember you as you are now. She will be looking for a much younger person — maybe even still in middle school. She will probably not remember things you did together just last week. She will remember her friends and relatives who have passed on years ago.

She knows that is the world she is living in. The present day is a foreign country. She doesn’t speak the language of “now” any more. So talk to her in the language of “then,” instead.

The best conversations are “remember when” ones, and old TV shows and old songs. Those are the ones where you can share good times together.

She’s stacking boxes, continually rearranging her silverware, or behaving in another odd way

Funny behavior is often related to her old life. People with severe memory problems still want to feel busy and useful. She will want to keep doing what she used to do, even if she can’t remember all the steps.

Did she have to rotate stock and make displays in a store? Stacking boxes is part of that behavior. Did part of her job involve setting tables? Rearranging and straightening tableware keeps the customers happy. Did she work at a library? She might start rearranging books at the book collection in the facility.

If it doesn’t hurt anything, doesn’t bother other residents, and keeps her busy, there is no reason to restrain her. It will keep her busy, keep her happy with her “job,” and make her feel useful.

And her agitation will go away.

She is bewildered by your questions

Questions like “what do you want to do today” or “what do you want to eat?” are too complex. There are too many possible answers.

She gets trapped thinking about:

• one thing
• then another
• still another possibility

It reminds her about something else, a different activity, why isn’t her sister here, and what was the question again?

Coming from you, talking to your friends, that is a funny question.

Coming from her, talking to you, that is an unhappy statement.

The best questions for her now are ones with two choices: Walk or go for a drive? Fish or chicken? Do you remember when we did this (yes or no)?

She can answer those. And you can share something together again.

Getting back to the person you used to know

Now you can stop asking “What’s wrong?” and start asking the questions she can answer. You can remember the good times that are still familiar to her. You can distract her, and that can help the agitation.

As you learn this new way of talking together, you both will feel calmer. You will learn what she really needs.

Meeting those needs will calm her agitation and melt away any anxiety she may be feeling.

And your visits will be joyful again.