This document discusses agitation and aggression in dementia patients. It defines agitation as emotional distress with increased activity that is abnormal but non-aggressive, while aggression involves hostile actions directed at people, self, or objects. Agitation is twice as likely in men and often occurs in the middle stages of dementia. The signs of agitation include pacing, yelling, hand wringing and repetitive behaviors. Triggers include relocation, pain, boredom, and inability to communicate. Responses should remove the patient from stress, distract them, check for needs, speak softly and use touch and eye contact. For aggression, identify yourself calmly and give no-choice instructions while approaching slowly. Preventing agitation involves avoiding triggers, establishing

1. Managing
Agitation and Aggression
Dr. DrewChenelly
2.0

2. What is agitation?
Emotional distresscombined
with increased activity.
Behaviors are abnormal and non-
aggressive.Can be verbal or
physical.

3. What is aggression?
Yelling
Cursing
Threats
Demanding
Insults
Punching
Kicking
Slapping
Biting
Grabbing
Hostileaction directed toward a person, self orobject
Verbal Physical

4. Who becomes agitated?
Twice as likely to occur in men.
Most often during the middle
stagesof a progressive dementia.
50% of all dementia patients.
Severe agitation is the primary reason for NH placement

5. What are the signs of agitation?
Pacing…Wandering
Yelling
Anguished expression
Help seeking
Repetitive verbalizations
Hand wringing
Restlessness
Frantic attempts at communication
Picking…Pulling
Patting…Rubbing
Shaking locked doors
Shadowing
Demanding
Hoarding
Disrobing
Moving objects

6. What causes agitation?
First rule out:
Delirium
Sudden onset…fluctuation…visual hallucinations
Depression
Insomnia…loss of appetite…depressed appearance
Psychosis
Delusions…hallucinations…bizarre behavior
Pain

7. What triggers uncomplicated agitation?
Relocation…Lost
Pain or discomfort
Boredom…Loneliness
Fatigue…Hunger
Needtotoilet
Overstimulation…noise
Overwhelming task
Inability to communicate
Responseto caregiver upset
Misinterpreting others
Change in routine
Clutter…Crowding
Shame
Restrictions
Feeling rushed
Sensoryimpairment

8. Medications
Match drug to features
Anticonvulsants
Neuroleptics
Antidepressants
Anxiolytics
Beta blockers
Cholinesterase inhibitors

9. Responding to Agitation1
Remove from stressful or over stimulatingsituation.
Distract withconversation, task, music, familiarobject
or food.
Checkfor discomfort or basic need.
Speak softly..use familiarwords and short simple
sentences.
Smile..usegentle touch anddirect eye contact.

10. Responding to Aggression
Identify yourself and use the resident’s name.
Do not ask questions..useno choiceinstructions.
Move slowly..approachfrom the front…armsat your
sides.
Use gestures andvisual cues.
Directeye contact…firmbut non-threatening tone of
voice.
Provide object to handle.

11. The right way vs. The wrong way

12. Preventing Agitation1
Identifytriggers and avoid or satisfy.
Frequent, brief, reassuring contacts.
Avoid complex tasks.
Establish predictable routine.
Schedule adequate rest.
Soothing environment inroom.
Never rush.
Regulate temperature and light.

13. Preventing Agitation2
Pleasurable activity to discharge excess
energy.
Reducerestrictions.
Allow choiceswhenever possible.
Attend to privacy issues.
Keepthings positive.

14. What can we do to help?
What are the:
agitation signs
triggers
patient needs
possible responses