I read some helpful ideas on working with residents with dementia in the most recent Psychologists in Long-Term Care newsletter (Vol. 25, Issue 2-3). Psychologist Nancy Hoffman, PsyD, discusses research findings and her interview with Lucy Andrews, RN, MS, owner of At Your Service Homecare in Santa Rosa, California. The main points to consider:
- Agitation often reflects underlying physical needs such as thirst, hunger, or pain, or an undiagnosed infection such as a Urinary Tract Infection (UTI)
- Many LTC residents suffer from sensory deprivation, boredom, and loneliness
- Behavior interventions aim to treat to underlying needs that are causing inappropriate behavior
- We should provide positive attention when residents are calm so they don’t need to become agitated in order to gain attention
- It works better to distract agitated residents rather than to reason with them
- Soothing music, toys, gentle touch, or favorite personal items can be helpful coping tools for residents with dementia
- Asking closed questions is more effective than open-ended questions that can leave the resident struggling for an answer
- Reminiscence therapy focused on pleasant and meaningful experiences can address underlying emotional needs, as can therapeutic activities such as art, exercise, and music
What are you doing in your nursing home to help residents with dementia have a meaningful, agitation-free day?
All these suggestions are great. Unfortunately, a lot of people believe that psychotropic medications are the “most efficient” way to reduce agitation.
Trying to remain empathic and calm also helps if a resident is just beginning to show signs of agitation. As many caregivers may have realized, their loved ones’ agitation is often a reflection of our own anxiety and agitation.
C, the big difference I see in how agitation is handled is in terms of staff training, and also if a unit or floor is modeled specifically for residents with dementia. In my experience, when the “day room” looks more like a living room, the staff are trained to understand dementia, and the staffing ratio and programming reflects the needs of the group, there is generally less agitation than when the residents are in a sterile, under- or over-stimulating environment with staff members who mostly ignore the residents unless they become agitated and problematic.
Dr. El,
I have experienced first hand the benefits of engaging residents with dementia in art, music and pet therapy. I would like to caution your readers in the use of “toys” with residents who have dementia. Although a toy may meet the cognitive needs of an individual, it is usually inappropriate and undignified to give an adult a toy that is made for a young child or an infant.
Does your free download offer “Stop Agitating the Residents” explore this in more detail? I guess I should find out for myself and download it already!
Sue, good point about the toys. There are “grown-up” versions of many children’s toys, like wooden Jenga blocks instead of wooden alphabet blocks, or larger size jigsaw puzzles with nature photos, or simple books that are written for adults with dementia.
And YES, there are suggestions for reducing agitation in all residents in my FREE Stop Agitating the Residents download. You could have it on your screen in a minute by signing up.
Meeting the resident’s needs before they get to the point of agitation is key. If we can keep them warm, dry, clean and fed, they are happier and the shift goes more smoothly.
As you said, staffing and staff training are key. If you have enough people, keeping the resident’s comfortable is easier and if someone does get upset, the staff knows how to help them without resorting to medication.
Most of the time, I have the best luck with holding their hand and listening to what they have to say. Easier to do when I have an extra pair of hands to rely on versus when I’m the only pair of hands.
Tracy, I wish I could emblazon your first line on the walls of every nursing home. Maybe in invisible, subliminal print! “Meeting the resident’s needs before they get to the point of agitation is key.”
Exactly! I feel for coworkers who have the heart and the skill, but not the time to keep residents calm and content. When bad things happen, nursing assistants are often the first ones to get blamed. What management doesn’t seem to understand is that “prevention” is often more cost-effective than “intervention” in the long-run.