Managing Agitation & Aggression - DementiaHub.SG

Managing Agitation & Aggression

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At some point, persons living with dementia may behave aggressively, display an outburst of emotions, or act angrily towards individuals around them.

Defining Agitation & Aggression

Agitation

A set of behaviours that involve a person living with dementia experiencing verbal or motor anxiety.1

Aggression

A further level of agitation in which the behaviours can be expressed through verbal abuse, threats, damaging property, physical violence towards another person or over-reacting to minor setback or criticism.1

Possible Causes of Agitation & Aggression

Sometimes, a person living with dementia may display agitation or behave aggressively as a result of an unmet need, which is causing them discomfort. Managing their agitation and aggressive behaviour is not easy. However, it is always useful to identify the cause/unmet need that triggers the agitation and/or aggressive behaviour, and find effective ways to manage them.1

The table below lists down some possible unmet needs that persons living with dementia may experience:

Biological

Progression of dementia causing loss of control over behaviours

Physical discomfort, such as pain, fever, illness, or constipation

Adverse reaction to medications

Fatigue/ sleep deprivation

Misunderstandings due to poor eyesight/ hearing

Hallucinations and delusions

Social

Lack of social contact and loneliness

Boredom, inactivity and sensory absence

Changing of established routine

Psychological

Frustrations at not being able to complete tasks

Possibility of depression

Perception that personal space is invaded

Perception that independence and freedom are threatened

Feeling ignored

Fear of surroundings or people as he/she can no longer recognise them

Some Ways to Manage Agitation & Aggression

Communication and Interaction Style

• Try to stay calm and take a deep breath. Avoid potential confrontations. Any expression of fear, alarm, anxiety or anger may make the situation worse.

• Be patient and listen to what they are saying.

• Approach the person living with dementia slowly, maintain eye contact and try to encourage communication.

• Validate the person’s feelings – reassure them and acknowledge how they are feeling.

• If the person living with dementia gets agitated/aggressive when you are caring for him/her, explain your actions in short, simple sentences such as “I am going to help you remove your shirt” or “We are here to help you”.

• Ask yourself if what you are doing for the person really needs to be done at that moment.

• Give them some time and space, and return in a while to try again gently.

• If the person living with dementia gets physically abusive

• Make some space between you and the person (at least one arm-length) to prevent yourself from getting physically injured.

• Do not try to restrain or restrict the outburst of anger unless they are causing harm to themselves or others.

• Call for help if needed.

• Ensure the environment is safe by keeping away dangerous items, such as scissors, knives, or any sharp objects.

• Identify and be aware of signs or behaviour indicating agitation or aggression. Redirect the person’s attention to focus elsewhere early with appropriate activities, before their outburst.

• Ensure the person’s basic needs are met, such as hunger, thirst, and sufficient sleep.

• Try to maintain consistency in the person’s daily routines, environment and carers.

• Ensure the person’s medical conditions and medications are reviewed regularly by the doctor.

Adapted from: Changi General Hospital

Galen's Mother: A Journey Into Dementia Documented Over The Years

Galen Yeo documents the drastic changes in his mother over the years, since she was diagnosed with dementia.

She was the sociable hostess whom friends loved to be around. And then one day, she started losing her memories. Frustrated at losing who she was, she’d have moments of violent temper. Being around her became a draining ordeal. These are the challenges of facing dementia.

Source: CNA Insider

References

  1. Changi General Hospital. (2020, October 5). Managing agitation and aggression in dementia. https://www.healthhub.sg/live-healthy/843/managing-agitaton-and-aggression-in-dementia
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