Agitation in Older Adults with Dementia Caused by Environmental Stressors

People with dementia are very sensitive to their environment.  They are less able to handle changes, uncertainty, and other situations that they could manage when they were well.  As a result, they may become restless, and may need to move around a lot or pace.  Behavior management experts define “agitation behavior” as inappropriate verbal or motor activity, such as:
  • Non-aggressive Verbal Behavior: Incoherent babbling, screaming or repetitive questions
  • Non-aggressive Physical Behavior: Pacing, wandering, repetitive body motions, hoarding or shadowing
  • Aggressive Verbal Behavior: Cursing and abusive language
  • Aggressive Physical Behavior: Physically aggressive behavior such as hitting, scratching, or kicking

Environmental causes of agitation in older persons with dementia include: sensory overload, such as too much noise, activity, or clutter, or too many people in the environment; unfamiliar people, places, or sounds; sudden movements, startling noises; feeling lost, insecure, or forgotten; difficulty adjusting to darkness from well-lighted area and vice versa. Another interesting finding indicates that the television, mirror image, dolls or figurines may represent extra people in the environment. While this list is not exclusive, it identifies some of the most common triggers of agitation. The person with dementia is experiencing a profound loss of their ability as a result of the disease.

The ideal environment for a person with dementia is a clear, calm, comforting structure. Routine is very important since changes in schedule or rushing can cause extreme disappointment, frustration, or fear. A physically comfortable environment is important.  Some suggestions for structuring the physical and psychosocial environment include:

  • providing a predictable routine for the patient; separate disruptive and noisy persons from quieter persons; simplify tasks and routines;
  • monitoring personal comfort by checking for pain, hunger, thirst, constipation, full bladder, fatigue, infections and skin irritation;
  • providing familiar objects such as family pictures and orienting stimuli (e.g., clock, calendar);
  • providing bright daytime lighting; use a nightlight in the bedroom during hours of sleep;
  • avoiding noise, glare and background distraction that might trigger agitation;
  • being sensitive to fears and frustration while trying to express themselves.

The Alzheimer's Association website has additional information on dementias.

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