Anyone who cares for someone with dementia knows that agitation is often part of the package. Nearly 20 percent of those with faltering cognition experience behavioral symptoms (anxiety, agitation, delusions, paranoia) severe enough to merit medical treatment. In care communities, the figure is 40 to 60 percent.
It can be profoundly upsetting to deal with an elder beset by both dementia and agitation. Reassuring the elder can be next to impossible. And of course, it’s painful to see a vulnerable person so upset.
The most common treatment for this problem is Ativan (lorazepam), a medication class of tranquilizers called “benzodiazepines.” Other “benzos” include Xanax/alprazolam, Valium/diazepam, Klonopin/clonazepam.
In my practice, I have found that Ativan and these related drugs make agitation worse. Given a “benzo,” an agitated elder may calm down for a while. But when the medication wears off, the anxiety comes roaring back with a vengeance.
It’s much more effective to explore the reasons for the agitation. Elders with dementia have trouble expressing what’s bothering them. The first step should be to look for the origins of anxiety. Is the person in pain? Or are they bored? Not active enough? Is the environment too noisy?
Often, it is possible to minimize behavioral symptoms with practical solutions.
If a person is overstimulated, maybe it means resting alone in the afternoon, so that evening socializing isn’t overwhelming.
If a person is bored, maybe they need to engage in more fun activities such as music or chair yoga.
If the common room is bustling with activity—TV, conversations, games—the noise may too much for some elders.
Many elders do not engage in enough physical activity. Exercise adjusted to abilities can help to ease agitation. Walks, balloon volleyball, gentle aerobics—these all have a calming effect.
If your loved one is anxious and upset, don’t turn to medications first. Try adjusting their environment, their schedule, or their medical care.
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Elizabeth (Dr Liz) has over twenty years of experience in providing medical care to the elders. She is board-certified in Internal Medicine, Geriatric Medicine and Palliative Care Medicine. Dr Landsverk founded ElderConsult Geriatric Medicine, a house calls practice, to address the challenging medical and behavioral issues often facing older patients and their families.