Agitation In Dementia
Dementia * is a disease like no other, in that the person with the disease has a change in awareness, behavior. It can take years before the behaviors of early brain damage are detected by the office screening of a MOCA or a MMSE (have the click to go to page for these tests) of 24/30 despite the elder losing capacity to make medical or financial decisions. Getting a diagnosis if an elder sounds sociable for 5 minutes can be difficult.
Bluntly, your loved one is not the person they were before. That in itself brings grief.
Yet, there is little time for grieving since now your loved one needs more care, financial, medical and personal. Dementia care is overwhelming…. then there are the behaviors that develop. Forty to sixty percent of people with dementia develop agitation
Agitation in Dementia
Agitation is treated often as a simple fever. There is a fever… so give a Tylenol to make it go away. However, like a fever may be just a cold virus or a deadly pneumonia, so too can agitation result simply from the disease of dementia or from a serious medical complication.
The first challenge is to recognize agitation as being part of the disease, as opposed to a loved one being “stubborn” or “difficult”. In dementia, an elder cannot reason, or be aware of the effect of their behaviors…. they just react.
Signs of Agitation in Dementia
Agitation can vary from repetitive questions, anxiety if a caregiver is not in sight, confusion when given a new routine, or asked an open ended question. Early these changes can be difficult to isolate and only in hindsight can many realize the pattern that may have been there several years. Other signs are that a loved one easily gets more angry, or they may be more socially or sexually inappropriate (again without awareness), or apathetic.
As the disease progresses, they may become more irrational, reactive; yelling, pinching, hitting, biting if encouraged to accept personal care or other needed care. They can become psychotic- delusions, hallucination, and paranoia. It can be confusing, frightening and made worse by over the counter or prescription medications.
That said, the first step is recongizing what is going on. It is important to find a dementia doctor, a geriatrician, a memory clinic if a loved one is acting bizarrely but the doctor says their testing in the office is OK (meaning that the score is over 24/30… not that there is no thinking problem, as these tests are not as detailed to catch all problems).
Dementia Agitation
The first approach is ALWAYS change the environment, and work on changing behavior. Is your loved one tired, overstimulated, hungry, in pain, irritated by an unwitting poor caregiver approach. Caring for needs, helping the elder enjoy their interests; walks, (simplified) cooking, scrapbooking, going to ballgames… AAA better than MLB. Keeping a senior physically active is a win-win-win. They are less likely to be agitated, will sleep better and have better digestion (less constipation).
Medication for Dementia Agitation
Common treatments agitation are Lorazepam/Ativan or Alprazolam/Xanax. This is a quick fix, often works…. at first, but does not fix the cause of agitation and is addictive, so the sedating effect wears off and the elder will be more agitated as the dose wears off, which leads to increasing the dose and the cycle begins again.
Much better to engage with enjoyable activities, keep physically active, treat pain, remove medications that can cause agitation.
We are here for you:
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Providing TeleHealth in California
Having a geriatrician on call in a time when getting an appointment with a nurse practitioner can take weeks is invaluable. Dr Liz provides expert TeleHealth medical care, scheduling to allow access, and available for urgent situations most every night and day. Instead of waiting 3 weeks for an appointment, or going to a clogged Emergency Room, have a seasoned geriatrician review the medical situation, work with the care givers and get in visiting RNs and physical therapy for most (non HMO insurance) situations. Get the medical help needed, when you need it.
Dementia Care Consulting
Care at home or in an assisted living community not going well? Not sure which steps are needed to make things work better? DLG provides seasoned social workers, nurses and care managers to help trouble shoot challenges. It is best to provide written concerns prior to a TeleVisit with a consultant.
DLG Community
A dedicated discussion platform for either eldercare professionals or family and caregiver (all are welcome, but the focus varies). Bring those challenges, the situations that have not smoothed out. The community and DLG professionals will contribute their expertise and experience to bring new ideas and support. “Mom won’t stop driving. Mom is not sleeping. My husband is paying the caregiver $1000 extra a week! Bob is still in pain and the doctor says he cannot do anything more. Sue is on 30 pills a day! Help.”
Monthly, there will be 2 Zoom support groups and a Ask Dr Liz: A Geriatrician can help Q & A session for urgent questions.
Living in the Moment
Like “What to Expect… for Dementia”. There are many dementia care guides. Most do not address the sticky issues. What to do when the doctor says, “It’s just old age, not dementia and the MMSE is 25/30”… but Joe is spending recklessly, acting impulsively and is much more angry than he used to be. LIM addresses the types of dementia and what steps are needed for diagnosis (it is not just a 10 minute test in the doctors office). LIM reviews medications and which can make an elder look like they have dementia, or make their behavior worse (ie it’s not just the dementia causing aggression). A detailed review of medications, the uses and the side effects, trouble shooting difficult care situations, a review of care venues, benefits and drawbacks, advance care planning, preventing financial abuse, and finally, what to expect from hospice.
Folks who have bought a copy for care of a family member …. have come back to buy four more for friends facing similar situations.
There is help. We have been there. We have seen thousands of elders struggling without the understanding and care team to sort out the challenges.
There are solutions. We are here for you.