Irritability and agitation may become frequent occurrences as a patient’s dementia progresses. There are many common signs associated with irritability, usually stemming from a need not being met. These signs can range from hostile speech to physical restlessness. The first step in these instances is to identify the cause of the irritability, and then work to address it. It can also be helpful to take notes of their irritable behaviors and what solved it, so you can track if there are specific repeat behaviors that indicate a certain need.

What Causes Irritable Behavior?

Agitation and irritable behavior often have a cause, and identifying these causes can help prevent or reduce future outbursts. Here are some potential causes of agitation and irritable behavior in your care recipient:

• Feeling depressed, stressed, or in pain.
• Not having gotten enough rest during the day.
• Still adjusting to a new environment, such as recently being moved to a nursing home.
• Feeling scared or tired due to the challenges of living with dementia.
• Experiencing loneliness due to a lack of social contact.
• Getting agitated by too many strange people or too much noise in a room.
• Experiencing loss, such as the freedom that comes with being able to drive.
• If they’ve recently started a new medication, there may be a side effect that’s bothering them. Make a detailed note of what is happening and how recently it came up after beginning the medication and bring it up with their doctor.
• They may be feeling pushed or coerced into doing something they don’t want to. Or they are being forced to do something that has become much more difficult after the onset of their dementia.
• If they were being bathed, perhaps they felt their personal space was being invaded. Remediate this by breaking the activity into smaller tasks and explaining what you are doing at each step.
• Sudden loud noises from the television or radio may make them think that they are in danger.

It’s important to recognize these signs early and address any underlying issues before behavior becomes problematic, as ignoring the problem may only make things worse.

Signs of Irritability and Aggression

There are a number of indicators a patient is agitated or depressed. These aren’t too different from typical signs of frustration, but it still pays to be mindful of how your loved one’s ways of expressing themselves may have changed as their dementia progressed.

• Increased verbal or physical aggression: This may include yelling, screaming, or hitting objects or people.
• Restlessness or pacing: They may seem unable to sit still or frequently pace back and forth.
• Changes in sleep and wakefulness: They may have difficulty falling asleep or may wake up frequently during the night.
• Changes in appetite: They may refuse to eat or drink, or may eat more than usual.
• Increased confusion or disorientation: The person may bump into objects more frequently or suddenly become disoriented over commonplace things, such as an aspect of a daily routine.
• Difficulty with communication: The person may have trouble finding the right words, or may become more argumentative or confrontational in conversations.

It’s important to remember that everyone is different, and the specific signs of irritation or agitation may vary from person to person. If you are concerned about your loved one, it’s important to observe their behavior and communicate it to their doctor for guidance.

Strategies for Dealing with Irritability and Aggression

• Listen to them. Sometimes the issue at hand is the result of a basic barrier in communication. Stay calm and collected and ask for clarification or if there is anything bothering them.
• If they seem confused or disoriented, try reassuring them. Speak in a soft tone of voice and listen to their needs and frustrations. Show that you understand why your loved one is irritated, agitated, or angry.

Like anyone else, frustration and irritability in a dementia patient is often a response to something they feel is out of their control.

• Do not take away any control or autonomy while they are expressing frustration unless there is a danger present to yourself or others. Responding to their frustration with punishment without addressing the root cause of the issue may make it worse.
• Create a comfortable environment for your loved one by eliminating as many stressors as possible. Try moving them to a quieter, calmer, and safer place. You can also offer them a comfort object, some privacy, or rest. Monitor their diet to see if there was something they ate or drank — such as a caffeinated beverage or something high in sugar — that may have contributed to their bad mood.
• Try eliminating any environmental triggers. Background distractions, noise, or too many people in one space can trigger and confuse them.
• Restlessness can be caused by a lack of physical activity. If they seem to be developing “cabin fever” — feeling claustrophobic, physically restless, and annoyed in the house — plan some light exercise or a walk outdoors. Some other options include gardening, helping with the cooking, visiting a nearby park or lake, or seeing a friend or relative. If these activities are too physically strenuous, try moving them to a room with more sunlight or taking them for a brief drive around the block in your car.

What should I do if they become physically aggressive?

• Remove yourself from the situation if you feel unsafe. Giving the patient space when all other methods fail is the best course of action in keeping both of you safe. Do not physically restrain them unless you must do so to protect yourself and others.
• Keep sharp or heavy objects around the house locked up.
• Stay calm and speak in a soothing tone of voice. Avoid reflecting their anger, as this can escalate the situation.
• Try to understand the cause of the behavior, especially if it’s sudden: sudden escalation in aggression can be a sign that the patient is experiencing extreme stress or discomfort.
• If it reaches a point where calling for outside help is necessary, make it clear to any staff or the phone operator that the individual has dementia.

Conclusion

It’s important to recognize the signs of irritability and agitation in a dementia patient and work to address the underlying causes. This includes identifying and addressing physical or emotional needs, creating a calm and consistent environment, and using distraction and communication strategies to calm them down. It is also important to involve the patient’s healthcare team in managing their behavior and to observe and record any changes for future reference and guidance. By understanding and addressing the causes of irritability and agitation, you can improve your patient or loved one’s quality of life and better understand the changes experienced through dementia.

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