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Alzheimer's patients are very sensitive to their environment. They can get upset very easily. Besides other challenges of handling an Alzheimer's patient, handling their agitation and anxiousness and other behavior problems associated with dementia and Alzheimer’s becomes very challenging for a caregiver. Agitation symptoms include insomnia, pacing back and forth, and restlessness. Similarly, anxiousness or anxiety is a feeling of nervousness, fear, or uneasiness. Anxiety and agitation have proved to be very harmful to the health of the patient.

Most of the time, an Alzheimer's patient fails to express how he/she is feeling. Hence the caregiver needs to be very alert. The caregiver needs to observe and find out if there are any symptoms of uneasiness, or if there is any change in the behavior of the patient. Some symptoms of anxiety and agitation include: irritability, wandering or repeating the same thing, not staying still, sleep deprivation, muscle tension, avoidance of social gatherings.

Courtesy Wikipedia

Causes and Prevention of Anxiety and Agitation among Alzheimer's patients

• Changes Based on Environment
  Alzheimer's patients are very sensitive to their surroundings. Even a small change in their surroundings can enhance the feeling of anxiety or agitation among them. Some of the environmental changes that can trigger anxiety include: traveling, hospitalization, a new caregiver, isolation or no activity, light changes (such as too bright, not bright enough, light creating shadows), too much noise, clutter in their surroundings, presence of guests in the house.
• Misperceived Threats
  Fear and fatigue while trying to understand what's happening around them. Sometimes the fear of not being able to do something like driving or doing basic routine tasks also causes agitation.
• Pain
  Constipation or even dirty diaper
  Being forced to do any activity or being forced to remember someone or some event of their life.
  Reaction of medicines
  As a caregiver, one has to be very careful about the initial symptoms of agitation and anxiety in Alzheimer's patients. The earlier the signs get recognized, the easier it would be to handle.
  In case you find it difficult to handle Alzheimer's patients by yourself, then you can always go for professional help. Many assisted living facilities are there to help such patients.

Tips to Prevent Anxiety and Agitation

Once you have identified the reason behind the anxiety and agitation of the patient, you can work out a plan to prevent such a situation from happening in the future. If your first strategy doesn't work, no issues, try something new. In case you fail to get any success, consulting a doctor would be more appropriate.

Strategies that might help you in reducing the anxiety or agitation in Alzheimer's patients:

• Calm Environment
  If the anxiety is triggered because of some environmental factors, then removing the factor or the patient himself/herself can be very effective. A good example of a proper environment can be taken from secured Alzheimer’s units present in many memory care communities today. For example, if too many guests are the reason for the patient's discomfort, then move the person to a quieter place. Remove the stressor or triggers. Try to make patient rest, give him/her privacy, or offer security. You can even try using calming rituals. Sometimes, limiting caffeine intake also helps in preventing agitation. Last but not least, try indulging the patient in some kind of physical or mental exercise.
• Avoid Trigger
  Another easy way to prevent agitation and anxiety among Alzheimer's patients is by avoiding environmental triggers like noise, bright light, shadows, darkness, insecure space, and things with too many background distractions like TV
• Personal Comfort
  Personal discomfort can be another major cause of anxiety and agitation among patients. Hence, monitoring the patient for personal comfort can be very helpful. This can be done by checking the patient for thirst, hunger, pain, infection, soiled diaper, constipation, or full-bladder. Making sure that the room temperature is as per the patient's comfort.
• Be careful in avoiding clutter, confusion, misperceived threats or fears
• Tasks
  Sometimes, too many or no activity can also cause anxiety among patients. Hence, planning simple and enjoyable tasks can help to prevent agitation.
• Exercise
  Studies have shown that exercise helps in reducing stress and anxiety. Hence, try to indulge the patient in some kind of exercise like yoga, walk, dancing or gardening.

How to Respond

Patience and not getting panicked can be very helpful if you have to face an agitated Alzheimer's patient. Here are some dos and don'ts about how to handle an agitated or anxious Alzheimer's patient.

Dos:

• Get back and seek permission
• Use positive, reassuring and calm statements
• Slow down
• Add light
• Make use of verbal or visual cues
• Offer guided choices between 2 possibilities.
• Offer simple exercises
• Try to concentrate on pleasing events.

Don'ts:

• Raise your voice
• Corner
• Crowd
• Take offense
• Ignore
• Restrain
• Argue/Reason
• Teach/explain
• Criticize
• Disagree
• Make sudden movements

Try to be polite and use the following lines:

• May I help you?
• You are safe here.
• I am there with you.
• Everything is under control.
• I apologize.

Listen and Reassure

Be a good listener and try to find out the reason behind their agitation. Besides this, try to give reassurance, make the patient feel that you are there with him/her. Use of soothing phrases like "I am there with you", "You are safe here", etc. can be very helpful.

Involve in an Activity

Sometimes, distraction can also be very helpful in calming an agitated patient. Try indulging the patient in an activity that he/she enjoys doing like painting, listening to music, etc. This would act as a distraction and help the patient in diverting his attention.

Modify the Environment

Reduce volume, switch off the television, take the patient to a more secure place.

Doctors Attention

Handling an agitated Alzheimer's patient can be very difficult. In case you are not achieving any success in calming the patient, then calling a doctor would be more appropriate. A doctor might not only help in calming the patient but would also help in checking if the agitation is caused by any physical factor (pain, skin infection, etc.) or due to any medication.