Agitation in Dementia- Causes, Symptoms, Triggers & Solutions

Agitation is extremely common for someone with dementia and can cause great frustration, both for the sufferer, as well as to the caregiver.

While some people experience mild agitation, others end up with full blown psychosis that can be dangerous if you do not know what to expect.

Most Common Symptoms of Agitation

Some of the most common symptoms of agitated behavior include feeling frustrated and angry, irritated or restless. The exact symptoms largely depend on the person and the situation, but fidgeting, pacing and hand-wringing and overall feeling of grumpiness are common.

What Causes Agitation in Dementia?

People with dementia experience the world differently than we do due to neurological changes. Their sensitivity to the environment can be extreme and their interpretation of what they see and hear can be distorted.

Low-stress thresholds are common; for example, something as simple as a loud TV can be overwhelming. They often misinterpret what they see and frightening hallucinations can trigger a major upset.

How Do You Calm Someone Down with Dementia?

If someone becomes agitated you should:

Do: Back off and ask permission; use calm, positive statements; reassure; slow down; add light; offer guided choices between two options; focus on pleasant events; offer simple exercise options, try to limit stimulation.

Say: May I help you? Do you have time to help me? You’re safe here. Everything is under control. I apologize. I’m sorry that you are upset. I know it’s hard. I will stay with you until you feel better.

Do not: Raise voice; show alarm or offense; corner, crowd, restrain, demand, force or confront; rush or criticize; ignore; argue, reason, or explain; shame or condescend; or make sudden movements out of the person’s view.

There is hope for a calmer day if you can learn to see the world through their eyes. This takes training – and you can start here, where you’ll find explanations and advice from others who have been there before and are willing to share strategies that worked for them.

Not everyone is bothered by the same stimuli or events, so the first step is to find out what’s upsetting the person you care for. Then you can remove the trigger(s) and the associated agitation. You’ll both experience less stress and, hopefully, a calmer day.

What are the Most Common Agitation Triggers?

Common triggers include environmental conditions, boredom, over-stimulation, physical pain, medical issues, medications, and tasks that are too complicated for the person’s current abilities.

At some point, the person may no longer recognize their own image or misperceive what’s there. For example, he or she may see a stranger and not themselves in the mirror.

They may perceive people in photographs as real and refuse to undress or even get upset if the photograph doesn’t respond when spoken to. If a violent TV show is on, they may think the event is actually happening right in their room! Or some think their own reflection in a dark window at night is a stranger. And some may see frightening shapes, like a crouching person in a large house plant or a snake in a swirling, patterned fabric or carpet. The person may become so frightened that they call the police.

In their own words:

“Sometimes the sound of the radio makes my head almost scream…and my brow starts twitching. It really increases the confusion in my brain and I have difficulty processing my thoughts.”

“Showering tends to overload my brain…….the onslaught of the water on my body…and the noise.”

“There are people in the room. I am not undressing in front of them! Are you crazy?” (person referring to images in a photograph)

5 Common Environmental Triggers & Solutions

People with dementia are extremely sensitive to their surroundings. But not everyone is bothered by the same stimuli or events, so the first step is to find out what’s upsetting the person you care for.

The next time the person is agitated, take a look at or think back to exactly what happened just before they got agitated. Then you can remove or change the trigger(s) and the associated agitation. You’ll both experience less stress and, hopefully, a calmer day.

Here are five common environmental triggers known to cause agitation in persons with dementia.

1. Environmental Hallucinations and Misperceptions

A hallucination is the perception of things that are not there and may be triggered by something in the environment. Truly believing that what they see is real, sometimes a person with dementia can be so frightened they call the police. For example:

  • Some persons have difficulty telling reality from representation. They may perceive family photos in the room as “watching” them undress or mistake television shows for reality.
  • Swirling patterns on carpets or furnishings can be seen as frightening reptiles, like snakes.
  • They may see a crouching person hiding in a large houseplant if the room is dimly lit.
  • They may not recognize their own image in the mirror or in a reflection in a window at night.

Caregiver Tips

  1. “When Mom refused to get undressed (she thought people were watching), I turned the photos in her room to the wall, and she relaxed.”
  2. “Marge doesn’t see the “spooky” shadows when the room is well lit.”
  3. “Gus thought the TV shows were real and got upset every time someone got shot. Now we only watch comedies and travel shows.”
  4. “Bessie began complaining about seeing a stranger in her room. I didn’t pay it much attention; I just thought it was her Alzheimer’s. But one night when I wasn’t home she called the police. Turns out that the stranger was her own image in the mirror that she no longer recognized. Now that I covered the mirror with a cloth, everything’s OK. I wish I had known earlier.”

2. Noise

Noise is a known stressor to people with dementia. Sounds that we normally hear every day can cause a major upset. Some are so hypersensitive to sound they cannot focus on anything else until the sound is removed. Others may not hear the actual sound but something else; a telephone ring may sound like a dog barking. Even pleasing sounds, like a person’s favorite music, can be upsetting if the volume is too high.

Caregiver Tips

  1. “We used to have the TV on all the time. Now I only play soft music, especially at meal times, which Jim really likes.”
  2. “After Gus got so agitated when I used the vacuum, I never use any appliances – not even the blender – when he’s around. I even replaced the vacuum with a “quiet” model.”
  3. “Sally jumped every time the telephone rang, so I changed it to a low ring. I can still hear it and she doesn’t get so startled now.”
  4. “I only plan small family gatherings after Mom got overwhelmed with all the noise and people the last time. It’s better for her – and for us. We still go out to restaurants, but we go early before the crowds. It’s quieter then.”

3. Dementia-Unfriendly Bathing

Bathing is a caregiving activity that often triggers agitation. Common triggers are:

  • feeling cold
  • lack of privacy
  • feeling rushed
  • running water on the face
  • confusion about the task and/or not knowing what to do

Learning to assist in a dementia-friendly way will make a huge difference in their stress levels, and yours.

Caregiver Tips

  1. “Sally would yell when water got into her face and ears. I now use a handheld shower hose, which I point away from her face! She’s so much calmer now.”
  2. “Mom got upset when I tried to help her shower, she refused to take her clothes off. She was always modest and it was awkward for us both. Now she uses a special bathing outfit and it’s great. It gives her privacy and because it’s really just a bib with Velcro and a wrap-around skirt, it’s still easy to get clean everywhere.”
  3. “I never wash Bob’s hair in the shower anymore – he gets too upset. I wash it later in the bedroom, using a no-rinse shampoo. It really works.”

4. Searching for Lost Items, Dysfunction & Clutter

It’s common for persons with dementia to forget where they’ve put their belongings and then to wander about searching for them (and to blame you for stealing things), especially in cluttered environments. Or if they’ve lost the ability to structure their day, they may wander aimlessly, rummaging through piles of things.

This wandering and searching behavior can be distressing to the person and to you, the caregiver. And due to neurological changes, sometimes a cluttered dining table or sink causes dysfunction. With so many objects in view at once, the person may get the objects mixed up, for example, and mistakenly put hair gel on their toothbrush.

Caregiver Tips

  1. “Mom kept losing her keys, and it was upsetting searching for them – the place was so messy. So I bought her a key finder. Now when I visit her, I enjoy my time with her instead of getting frustrated looking for her keys.”
  2. “Ted used to wander about the house – sort of lost, looking for something. Then I had an “Aha” moment and set up a “work station” for him– he used to be a plumber – and it’s filled with all kinds of plastic pipes and connections. Now he can spend hours happily engaged, instead of wandering around.”
  3. “I bought Sally large baskets to put some of her stuff in that she didn’t want to part with, and I put big labels on them. It helps keep the place tidier – and she spends more time rummaging through the baskets instead of the house.”
  4. “I leave out only the essentials on the sink. Everything else is put away. Now Mario can brush his teeth by himself.”

5. Room Temperature

People with dementia can become upset if they experience the indoor temperature as too hot or too cold – even if you think the room’s temperature is pleasant. And sometimes, due to low vision, they can’t read the small print on the operating controls or forget how to operate them. Sometimes they turn off the heat or the air-conditioning by mistake.

Caregiver Tips

  1. “Mario gets upset when he’s chilled, so I bought a small heater and now I get the bathroom nice and toasty before his shower.”
  2. “Mom’s house was hot last summer – I was getting worried. She seemed anxious using the air conditioner and I thought it was due to her memory problems. But I saw her squinting at the controls, so I put large on/off labels– black type on a white label – right next to the thermostat. She was able to independently operate the air conditioner for another year.”
  3. “When I visited Dad this fall, I was alarmed at how cold the house was. He had mistakenly turned off the furnace, didn’t remember, and didn’t know what to do. I put a child safety cover over the switch so it won’t happen again. I’m thinking of getting a remote alarm that would send me an alert as a backup, just in case he fiddles with the safety cover. This could buy us a little time before we have to move Dad out of his home.”