Understanding and Managing Agitation in Aging Loved Ones

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[Harrison] This morning, I wanted to talk about a theme that pops up a lot, a recurring issue, especially when we’re talking about cognitive decline. It seems like sometimes it’s a roll of the dice as to whether or not your mother or your father will end up having some agitation or maybe not a pleasant demeanor, let’s say, at least at varying times in the aging process. But specifically, when we’re talking about our senior loved ones having agitation problems or really being, let’s say, aggressive verbally or even physically, what are some of the things that maybe families should watch out for and maybe what are some tools that they can use to think about and even process those kinds of, let’s say, outbursts or different situations that pop up?

[Ms. Joan] I guess I’m going to separate a little bit just from someone that has dementia versus someone else. There are some underlying things that are the same. One thing is to just find out what’s really going on. Are they feeling bad physically? Are the medications working effectively for them? Have they always been very anxious and the changes can kind of pile up? One thing that I always teach when I talk about dementia, but it’s true even if you don’t, is that the loss and suffering of sometimes just your health decline or particularly the scariness if someone has dementia, they get very sad. The interesting thing is that sadness and anger are basically the same thing. Sadness is anger you put inside, where anger is the sadness that you project. So sometimes when someone’s really acting angry, you can really stop them in their tracks and you say, “What’s making you sad?” Because sometimes that’s what really happens. They’re scared, they’ve had a lot of losses, so they lash out at people around them.

Identifying Underlying Issues and Providing Comfort

So if you can, if the family members can realize that that’s what’s really going on, you can often deal with it more effectively. Because if somebody’s really angry, most human beings back off, you know, get away, let me get out of here. But if they’re crying and they’re sad, we put our arms around them, and we console them, and we give them some comfort. So if we realize that sometimes that anger is really that they really need to be held and then they need to have somebody work with them. But checking out and particularly with dementia, many times people can’t really tell you what’s happening. If they have a UTI, they don’t know that that’s going on, they just know they don’t, something’s wrong, and they act angry. If they’re really hurting, they can’t express pain.

Finding Meaning

So you have to be like a little detective and figure out if that behavior is not their norm, then what’s really happening? And look at something beyond what looks like the obvious. They’re not just having a temper tantrum, there’s something hurting them or something’s bothering them. Sometimes people can get very agitated when they see other people seeming normal and they know that they’re not. They can’t remember their daughter’s name or, and some of those that makes them mad. So it’s really trying to figure out what would they normally like, making sure that they are physically okay. If someone is not normally very agitated and suddenly gets agitated, something’s causing that and you got to figure out what is it, what’s causing it? Is it an emotional thing? Is it a physical thing?

Also, boredom sometimes, you know, people can if they’re used to being very busy, very involved, people rely on them for things and now suddenly they’re sitting in a chair and staff are taking care of them and they don’t have any useful purpose in life or that they feel. So that can make them again sad but it’s angry because I used to be the pillar of my home or I was the where everybody turned to and now nobody’s asking me questions, nobody’s telling me anything, I’m just sitting here.

Fact-Finding and Dealing with Physical Manifestations of Anger

So in the case where let’s say there are physical manifestations of the anger perhaps playing themselves out to the adult daughter, I mean even a swing or trying to grab them, how should the family caregiver respond in those situations and how should they mentally process it themselves? What are some tools that they can use to frame the situation? First, try not to take it personally. It’s that they’re not, they’re the anger or the agitation is not unless you’ve done something, you know, you inadvertently did something that bothers them. But if it’s just out of the blue, try not to take it personally.

Now in a family situation, if Mama or daddy or whoever it is has always been a little bit of an edgy person, then they’re not going to change. Nobody, that’s who they are and if they have dementia, it’s going to get exacerbated. But otherwise, it’s don’t take it personally, try to find out what’s really happening, what really triggered it.

Understanding the Bigger Picture

[Harrison] Part of what I’m also hearing you say too is there’s perhaps an opportunity to do some fact-finding especially if let’s say your mother or father is not consistently angry or upset, they’re not that kind of person, but yet there’s let’s say a season of agitation that they’re going through. Like perhaps especially in the case of cognitive decline, there may be some underlying issue that they’re not able to communicate. What are some ways that people can do some intelligent fact-finding if let’s say the senior is unable to communicate what they’re really frustrated about?

[Ms. Joan] It’s almost there’s no easy answer to that. It’s like how well do you know this person? Can you see if they, if you touch their arm or their leg, really grimace, would you like mean it hurts? Trying to find out, have they had normal bowel movements? Constipation can be very uncomfortable and since I can’t say I’m uncomfortable, trying to make sure you know as the caregivers that has my mom had a normal bowel movement or some diarrhea, you know, what might be really happening. Sometimes if they haven’t seen a doctor in a long time, having a checkup to see is there something really going on in their physical health.

But so it’s a combination, it’s really being like a detective, you know, trying to sort through all the possibilities of what might be going on especially if they can’t tell you. And even people who don’t have dementia, if they get to the place where they can’t, they need your memory care services, they know they’re no longer quite in charge of themselves and that makes them mad and that makes them sad and so they have to kind of work through that and come to terms with okay, this is what’s happened. I broke my hip, it’s healed, but it’s not, I can’t move like I used to. I had to give up driving, I’m now stuck in my house, you know, just what are the things that are going on and how can we support them to find a new meaning in their situation?

Persisting Through Difficulty and Recognizing the Bigger Picture

[Harrison] I think that’s really helpful. It’s difficult to keep in mind and I can imagine, I don’t like to imagine the people and I don’t think anybody does. In the heat of the moment, it feels almost impossible sometimes to let those things slide off your back. But you just have to consider the bigger picture. So thank you so much.

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