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COPING WITH ANGER AND AGITATION
by Dan Kuhn, ACSW Chicago Area Chapter Social Worker
Angry and agitated behaviors are fairly common symptoms of dementing illness and present great
challenges to family members and helping professionals. Understanding the many possible causes of
such behavioral problems can lead to effective coping strategies. At best, understanding these
possible causes may help prevent anger and agitation altogether.
First of all, medical or physical causes need to be examined. Lack of control over anger and agitation
may well be due to the ravages of the disease in the brain. However, anger and agitation can be
triggered by bodily discomfort such as pain, fever, or constipation. Also, hunger, thirst, fatigue, and a
disrupted sleep-wakefulness cycle can be factors. Of course, adverse side effects of medications
always need to be considered as well. These possible causes need to be addressed through a complete
medical evaluation.
The anger or agitation expressed by a cognitively impaired person can sometimes be attributed to any
number of -environmental causes. The impaired person cannot sort out information in a normal way
and may have difficulty communicating effectively. He or she easily suffers from sensory overload
(too much noise, activity, or people) and can become increasingly confused. Unfamiliar people,
places, or sounds can be disorienting and induce a hostile reaction. When out of familiar
surroundings or out of sight of familiar people, the risk of feeling lost is increased. Under such
frightening circumstances, anger and agitation may be considered an appropriate yet troubling
response.
Rather than trying to change the impaired person's response to an upsetting situation, it is better to
find ways to alter the environment. Reducing stressful noise and activity and establishing a simple,
daily routine can be most helpful in this regard. However, temporarily distracting the patient's
attention from a distressing situation may prove to be the quickest and easiest solution.
Finally, anger and agitated behaviors may be due to communication difficulties between the patient
and his or her caregiver. Asking questions of an impaired person that rely on recent memory are not
realistic and usually produce frustration for both parties. Trying to reason or rationalize and
requesting that several steps to a task be done in sequence may well be beyond the impaired person's
capacity. Those with dementia often have difficulty knowing what is expected of them and easily
become frustrated with their inability to make themselves feel understood. It is important to accept
their view of reality and find ways of reaching them that communicate concern and caring.
It should be noted that the most sensitive approach and best intentions may not always prevent or
alleviate anger and agitation. Such behaviors may be impossible to explain at times and the impaired
person may not respond favorably to any kind of intervention. In such cases, further consultation
with other knowledgeable persons is clearly indicated.