How to Deal with Agitation and Agression From A Loved One With Alzheimer's Disease

Agitation means that a person is restless and worried. He or she doesn't seem to be able to settle down. Agitated people may pace a lot, not be able to sleep, or act aggressively toward others. They may verbally lash out or try to hit or hurt someone. Most of the time, these behaviors happen for a reason. When they happen, try to find the cause.
For example, the person may have:

• Pain, depression, or stress and not know how to explain it
• Too little rest or sleep
• Constipation
• Soiled underwear or diaper

Other causes of agitation and aggression:

• Sudden change in a well-known place, routine, or person
• • A feeling of loss. For example, the person with Alzheimer's Disease may miss the freedom to drive or the chance to care for children
• Too much noise or confusion or too many people in the room
• Being pushed by others to do something. For example, to bathe, or remember events or people, when Alzheimer's Disease has made the activity very hard or impossible
• Feeling lonely and not having enough contact with other people
• Interaction of medicines

Tips to help you cope with agitation and aggression:

• Look for the early signs of agitation or aggression. If you see the signs, you can deal with the cause before the problem behaviors start.
• Try not to ignore the problem. Doing nothing can make things worse. Try to find the causes of the behavior. If you deal with the causes, the behavior may stop.
• Slow down and try to relax if you think your own worries may be affecting the person with Alzheimer's Disease. Try to find a way to take a break from caregiving.
• Allow the person to keep as much control in his or her life as possible.
• Try to distract the person with a favorite snack, object, or activity.

You also can:

• Reassure him or her. Speak calmly. Listen to the person's concerns and frustrations. Try to show that you understand if the person is angry or fearful.
• Keep well-loved objects and photographs around the house. This can make the person feel more secure.
• Reduce noise, clutter, or the number of people in the room.
• Try gentle touching, soothing music, reading, or walks.
• Build quiet times into the day, along with activities.
• Limit the amount of caffeine, sugar, and "junk food" the person drinks and eats.

Things the doctor can do:

• Give the person a medical exam to find any problems that may cause the behavior. These problems might include pain, depression, or the effects of certain medicines.
• Check the person's vision and hearing each year.

Important things to do when the person is aggressive:

• Protect yourself and your family members from aggressive behavior. If you have to, stay at a safe distance from the person until the behavior stops.
• As much as possible, protect the person from hurting himself or herself.
• Ask the doctor or Alzheimer's Disease specialist if medicine may be needed to prevent or reduce agitation or aggression.

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What Nurses Wish Caregivers Knew

When an elder is hospitalized, the primary objective of the medical staff is to tend to that person's immediate medical needs, hopefully making them well enough to return home. Each member of an aging adult's healthcare team is integral to the overall success of this mission.

However, there is one type of professional care provider that stands perfectly poised to provide much-needed information and support to both family caregivers and their elderly loved ones: the nurse.

Why nurses are so important

Nursing personnel perform a range of tasks, from monitoring vital signs and managing medications, to coordinating care and executing a treatment plan.
A good portion of the hands-on care that an elder receives in a hospital will likely be provided by a nurse, or nurse practitioner.

All of this one-on-one time spent with patients and their family members means that nurses quickly become well-versed in the nuances of their charges' care. This gives them the ability to not only act as a liaison between an elder, their caregiver and their doctor, but also to serve as a knowledgeable touchstone of support and information.

Nurses' guidance for family caregivers

We asked a team of veteran nurses from Hospice of the Ozarks and Carlow University to tell us what they wish all family caregivers knew.

They responded with a variety of suggestions, most of which centered on how to approach caregiving with patience and understanding—not only for your loved one, but yourself as well.
Ultimately, their guidance boiled down to six key insights:

1. Aging adults are not children: It can sometimes be challenging not to view an elderly loved one in a childish light. This is especially true for those who suffer from a disease, such as Alzheimer's, that can cause them to act out in infantile ways. But, as a caregiver, you should always, "Try to remember that you loved one has had a full life and deserves respect," says Carri Butcher, R.N., who works for Hospice of the Ozarks and has more than two decades of nursing experience. "Be patient, make sure they are safe—but allow them as much independence as possible.
2. Look out for depression: Depression is a common affliction among the elderly. But Butcher cautions caregivers not to view this mental ailment as a "normal" side effect of aging. "Depression in the elderly can, and should, be treated," she says.
3. Recognize what your loved one has lost: "The things that keep us going as adults are often lost as we age," according to Butcher, who says that the most profound loss experienced by elders is the loss of independence. This loss can be so upsetting, that it may cause your loved one to lash out and refuse your help. Butcher says it's vital for family members not to take these outbursts to heart. "Caregivers frequently don't understand and don't know how to deal with these behaviors," she says. "But it's important to try not to view them as personal attacks."
4. It's important to keep moving: Your loved one may be resistant to physical activity due to stiff joints, sore muscles, or other mobility issues, but it's vital that they get their blood pumping in some way on a consistent basis. Regular physical activity is one of the easiest ways to stave off a host of undesirable ailments, including: osteoporosis, arthritis, diabetes and heart disease, to name a few. Research has also linked exercise with better brain health and a reduction in risk for developing depression.
5. Assume that they can hear/understand you: As their loved one's life draws to a close, families sometimes believe that their elder loses the ability to hear and understand them. But, Butcher points out that this is usually not the case. "At the end of life, hearing is one of the last things to go. We never know what they do and do not understand, so it's better to just assume that your loved one can hear you."
6. Everyone needs a break—even you: Caregivers hear it all the time, but Mary Lou Bost, R.N., a professor at the Carlow University School of Nursing, feels that it bears repeating: "You'll be a better caregiver if you take a break," she says. Butcher echoes these sentiments, mentioning that—as difficult as it may be—it's important that even close family caregivers take time to "disconnect" from their loved one. "Everyone needs someone to come along side them and share the burden of care," she says.

It is this final directive—take care of yourself first—that many caregivers fail to honor; generally out of guilt or lack of awareness of the resources available to them.

Caregiving needs to be a team effort in order to avoid burnout.



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