Agitation in Older Persons with Dementia Caused by Physical or Medical Problems

More than six million older Americans are currently diagnosed with a type of dementia (Alzheimer’s Association, 2013).  Dementia is a general term for a decline in mental ability severe enough to interfere with daily life.  Dementia is not a specific disease. It's an overall term that describes a wide range of symptoms, including decline in memory and other thinking skills, thatoccurs most often in later years.  Some memory loss is normal as we age, but dementia is not.  Dementia is always caused by an underlying disease that damages brain tissue, leading to disturbed brain functioning.

Many people with dementia experience emotional distress or behavioral changes best summed up by the term agitation. Very mild agitation may seem like a personality change in a person.

Four problems* that can cause agitation are physical and medical problems, environmental stresses, sleep problems, and psychiatric syndromes.  In all these situations, a person with dementia is more easily agitated because the brain has physically changed and no longer functions in a healthy manner.

If a person with dementia has recently become agitated for the first time or has a change from his or her usual behavior, one thing to look for is a medical or physical problem.

Sleep problems are common in dementia. One type of problem is insomnia—trouble falling asleep at night or waking up throughout the night. Although the cause is often unclear, it is sometimes possible to pinpoint a reason. Physical or medical problems, such as depression, nervousness, or physical pain can cause insomnia.
Sundowning is another type of sleep problem. Sleep patterns are controlled by an internal clock in our brain that senses day and night, telling us when to rest and when to be active. This clock is often damaged in dementia. The person may be awake and overactive at night, thinking it should be daytime and trying to get dressed and out of bed. This type of confusion, disorientation, and agitation is called sundowning because it usually begins in the early evening.

To reduce agitation caused by sleep problems, the following strategies are suggested: Schedule later bedtime; allow for activities or tasks that can safely be done at night, plan more daytime exercise; adjust the temperature in the room; use night lights; reduce or eliminate caffeine; provide nighttime snacks; ensure a clear, well lit pathway to the bathroom; and eliminate or limit naps.Sudden illnesses may weaken the brain, causing worsened agitation. The most common medical problems that can cause agitation are bladder infections, bad colds, bronchitis or pneumonia, pain, and dehydration or poor nutrition. It is also very important to make sure that someone who has become more agitated has not recently had a stroke or been injured in a fall.  Finally, flare-ups of chronic diseases, such as diabetes or diseases of the heart, liver or kidneys can cause agitation, especially if a person with dementia does not take medications consistently or fails to follow a special diet.

A toxic reaction to medication is an important cause of sudden confusion and agitation. Older persons often take many different medications that can interact with each other.  It is crucial to find out if side effects of a new prescription, interactions between medications, or taking the wrong dose have led to a bad reaction.

Common physical problems that cause pain, discomfort, worry, or lack of sleep can lead to agitation by making the person upset or fatigued.  Examples of such problems include arthritis, sitting all day in an uncomfortable position, constipation, and impaired vision or hearing.

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