Agitated behaviours

What is agitated behaviour?

Changes in the behaviour of people with dementia are very common. Sometimes they can become upset and display behaviours such as pacing and fiddling.

Constant vocalisations such as talking constantly, repeating words and phrases, crying or cursing and screaming are also types of agitated behaviours.

Repetitive questioning, such as being asked continually what day it is, or when dinner will be ready, is another type.

All of these behaviours can be distressing and a constant annoyance for families and carers. Remember they can also be a sign of some distress for the person with dementia, so it is important to be able to understand why these behaviours occur and ways to manage them. 

What causes these behaviours?

There are many reasons why behaviours change. Every person with dementia is an individual who will react to circumstances in their own way. Sometimes the behaviour may be related to changes taking place in the brain.

In other instances, there may be events or factors in the environment triggering the behaviour. In some situations a task, such as taking a bath, may be too complex. Or the person may not be feeling well. 

Understanding the behaviours

It is important to try to understand why the person with dementia is behaving in a particular way. If family members and carers can determine what may be triggering the behaviour, it may be easier to figure out ways to prevent the behaviour happening again. 

Some frequent causes of agitated behaviours are outlined below:

Health factors

  • Fatigue
  • Disruption of sleep patterns causing sleep deprivation
  • Physical discomfort such as pain, fever, illness or constipation
  • Loss of control over behaviours due to the physical changes in the brain
  • Adverse side effects of medication
  • Impaired vision or hearing causing the person to misinterpret sight and sounds
  • Hallucinations

Defensive behaviours

A person with dementia may feel humiliated because they are forced to accept help with intimate functions such as bathing, toileting and dressing. They may feel their independence and privacy are being threatened.

Sense of failure

Because they are no longer able to cope with everyday demands, a person with dementia may feel pressured.

Misunderstanding

No longer understanding what is going on may lead to bewilderment, or the person may become distressed by an awareness of their declining abilities.

Fear

They may become frightened because they no longer recognise certain places or people. They may be recalling an earlier life experience that is frightening or uncomfortable to remember.

Need for attention

A person with dementia may be trying to let someone know that they are bored, distressed, have an excess of energy or feel ill.

Avoiding agitated behaviours

  • A medical examination will help identify any physical problems, or unwanted side effects of medications
  • Agitation can be a symptom of depression. If you suspect that depression may be a problem for the person with dementia discuss it with the doctor. It is important to investigate and treat depression where it is suspected
  • Be aware of the warning signs of agitated behaviour and try strategies to stop its development
  • Try to reduce the demands made on the person whilst still enabling them to make worthwhile contributions
  • Ensure that there is an unrushed and consistent routine
  • If possible, address the underlying feeling
  • Spend time explaining what is happening, step by step, in simple sentences. Even if they can’t understand your words your calm tone will be reassuring
  • Avoid confrontation. Either distract their attention or suggest an alternative activity
  • Make sure the person gets enough exercise and participates in meaningful activities
  • Make sure they are comfortable.

Preventive measures may not always work. Do not blame yourself if the person still becomes agitated. Concentrate instead on handling it as calmly and effectively as possible.

Dealing with agitated behaviours

  • Stay calm. Speak in a calm, reassuring voice
  • A simple activity such as having a cup of tea or looking at a magazine together may help. Distraction and avoidance are often the most useful approaches
  • Use what works for you. Answering repetitive questions works for some. For others, ignoring the question helps. It can be useful to look behind the questions to see whether the person needs some reassurance about something they are unable to express verbally.