Supervising Activities

People who are getting agitated can sometimes feel better if they have something useful or interesting to do. However, they usually need direction to find appropriate activities and to prevent frustration. Here are some suggestions that can help:

Structure and routine. Try to follow regular predictable routines that include pleasant, familiar activities. Remind the person that everything is going according to plan.
Pleasant activities. Make time for simple pleasant activities the person knows and enjoys—listening to music, watching a movie or sporting event, sorting coins, playing simple card games, walking the dog, or dancing can all make a big difference.
Keep things simple. Break down complex tasks into many small, simple steps that the person can handle (e.g., stirring a pot while dinner is being prepared; folding towels while doing the laundry). Allow time for frequent rests.
Redirect. Sometimes the simplest way to deal with agitated behavior is to get the person to do something else as a substitute. For example, a person who is restless and fidgety can be asked to sweep, dust, rake, fold clothes, or take a walk with the caregiver. Someone who is rummaging can be given a collection of items to sort and arrange.
Distract. Sometimes it is enough to offer a snack or put on a favorite videotape or some familiar music to interrupt behaviors that are becoming difficult.
Be flexible. Your loved one might want to do some activity or behave in a way that at first troubles you, or may refuse to do something you have planned, like taking a bath. Before trying to interfere with a particular behavior, it is important to ask yourself if it is important to do so. Even if the behavior is bizarre, it may not be a problem, especially in the privacy of your own home.
Soothe. When the person is agitated, it may help to do simple, repetitive activities such as massage, hair-brushing, or giving a manicure.
Compensate. Help the person with tasks that are too demanding. Don’t put the person in a position where demands will be made that he or she cannot handle.
Reassure. Let the person know that you are there and will keep him or her safe. Try to understand that fear and insecurity are the reasons the person may “shadow” you around and ask for constant reassurance.

Getting to doctor appointments. Is the person upset about going to the doctor or dentist? Here are some helpful hints: Emphasize the value of a check-up, rather than a test for a specific problem.

Providing the right environment

It is important to evaluate the person’s environment—his or her bedroom, daytime areas, and schedule—to see if any of the following problems may be contributing to agitation:

  • Some individuals become particularly agitated at specific times of the day. Would it help to change the person’s routine to avoid these problems? It is helpful to try to do things in the same place at the same time each day.
  • Agitation may result from thirst or hunger. If a person with dementia forgets to eat, offer frequent snacks and beverages.
  • Agitation may result from physical discomfort. Has the person remembered to use the bathroom? Is he or she constipated? Could there be aches and pains from sitting in one place?
  • Does the person have a regular, predictable routine? Unexpected changes or last minute rushing can cause those with dementia to become scared and disoriented.
  • Getting dressed can be frustrating for someone with dementia. Try to simplify this task, for example, by using Velcro fasteners and not insisting on matched outfits.
  • Is the person feeling rushed, overwhelmed, hungry, tired, scared, constipated, cold, or hot? Does he or she need to use the bathroom? Fresh air or air conditioning can minimize agitation. It is also important not to rush individuals with dementia. Simplify dressing by using Velcro fasteners. Don’t insist on matched outfits.
  • Is there a chance for regular exercise? Walks and simple exercises are good ideas. If a person wants to pace and isn’t disrupting anyone, that’s OK, too.
  • Is the room well lighted? Good lighting can help to reduce disorientation and confusion. Provide night-lights.
  • Is the air temperature comfortable? Try to provide fresh air, heating, or air conditioning as needed.
  • Is the environment too noisy or confusing? Are there too many people around? It may be helpful to use picture cues, to personalize the room, and to decorate and highlight important areas with bright contrasting colors.

Is the environment safe? If not, take the necessary steps to ensure the safety of the patient and caregiver (e.g

Learning how to talk to a person with dementia

People with dementia often find it hard to remember the meaning of words that you are using, or to think of the words they want to say. You may both become frustrated. The following tips can help you communicate more effectively with a person who has dementia:

  • It is understandable that you may feel angry; but showing your anger can make the agitation worse. If you are about to lose you temper try “counting to ten,” remembering that the person has a disease and is not deliberately trying to make things difficult for you.

Try and talk about feelings rather than arguing over facts. For example, if the person with dementia is mistakenly convinced you didn’t see him yesterday, focus on his feelings of insecurity today: “I won’t forget you.”

  • Identify yourself by name and call the person by name. The person may not always remember who you are; don’t ask “Don’t you remember me?”
  • Approach the person slowly from the front and give him or her time to get used to your presence. Maintain eye contact. A gentle touch may help.
  • Try to talk in a quiet place without too much background noise such as a television or other people in conversation.
  • Speak slowly and distinctly. Use familiar words and short sentences.
  • Keep things positive. Offer positive choices like “Let’s go out now,” or “Would you like to wear your red or blue cap?”
  • If the person seems frustrated and you don’t know what he or she wants, try to ask simple questions that can be answered with yes or no or one-word answers.
  • Use gestures, visual cues, and verbal prompts to help. For example, if suggesting a walk, get out the coats, open the door, and say “Time for a walk.” Set up needed supplies in advance for tasks such as bathing and getting dressed; have a special signal for needing to go to the bathroom. Try to break up complicated tasks into simple segments; physically start doing what you want to happen.
  • If a subject of conversation makes a person more agitated or frustrated, it may help more if you drop the issue rather than keep on trying to correct a specific misunderstanding. He or she will probably forget the issue and be able to relax in a short while.

Exercise and Chronic Disease

Contrary to traditional thinking, regular exercise helps, not hurts, most older adults. Older people become sick or disabled more often from not exercising than from exercising. Those who have chronic disease or health problems may actually improve with regular exercise, but they should check with a physician before increasing their physical activity.

There are few reasons to keep older adults from increasing their physical activity, and being “too old” and “too frail” aren’t among them. Almost all older adults, regardless of age or condition, can safely improve their health and independence through exercise and physical activity.

Is It Safe for Me to Exercise?

Most older people think in terms of getting their physician’s approval to start exercising, and that’s always a good idea. A physician can talk to seniors about the benefits of exercise and suggest an appropriate exercise program.

Chronic Diseases: Not Necessarily a Barrier to Exercise

Chronic diseases are illnesses that can’t be cured but usually can be controlled with medications and other treatments. They are common among older adults and include diabetes, cardiovascular disease (such as high blood pressure), and arthritis.

Traditionally, exercise has been discouraged in people with certain chronic conditions. But researchers have found that, in many older people, exercise can actually improve certain chronic conditions, as long as it’s done during periods when the condition is under control.
If the person in your care has a chronic condition, you are probably asking yourself how you can tell whether their disease is stable. How do you know if exercise would be beneficial or harmful for the elderly person?

Get a Physician’s Advice

When to Check with a Physician
Before starting an exercise program, or increasing physical activity, check with a physician if:
  • You have a chronic disease ? for example, heart disease or diabetes.
  • You have a family history of chronic disease.
  • You have other factors which put you at high risk for certain health problems (for example, if you smoke or are obese).

The physician can recommend a suitable exercise regimen, or refer the senior to a qualified professional who can customize an exercise program for them.

A physician can also inform the senior of symptoms that may mean trouble ? a flare-up, or an acute phase or exacerbation of the disease. For example, if the person you are caring for has congestive heart failure (CHF), the acute phase of this disease should be taken seriously. A CHF patient should not exercise when warning symptoms of the acute phase, or any other chronic disease, appear. It could be dangerous. When they are free of these symptoms ? in other words, stable or under control ? this is the time to exercise.

Other circumstances require caution, too. Nobody should exercise until checking with a doctor if they have:

  • Any new, undiagnosed symptoms.
  • Chest pain.
  • Irregular, rapid, or fluttery heartbeat.
  • Severe shortness of breath.
  • Significant, ongoing weight loss that hasn’t been diagnosed.
  • Infections, such as pneumonia, accompanied by fever.
  • Fever itself, which can cause dehydration and a rapid heartbeat.
  • Acute deep-vein thrombosis (blood clot).
  • A hernia that is causing symptoms.
  • Foot or ankle sores that won’t heal.
  • Joint swelling.
  • Persistent pain or a disturbance in walking after a fall; there might be an undiagnosed fracture and exercise could cause further injury.
  • If certain eye conditions are present, such as bleeding in the retina or detached retina; or if there has been a cataract or lens implant, laser treatment, or other eye surgery.

Men over 40, and women over 50 should check with a doctor first if they plan to do vigorous, as opposed to moderate, physical activities. Vigorous activity could be a problem for people who have “hidden” heart disease (some people have a heart disease, but are unaware because there are no symptoms).

How can you tell if the activity planned is vigorous? An activity that causes you to breath and sweat heavily is considered vigorous. Keep in mind people have varying levels of fitness. Running is a vigorous activity for some people, but for others, walking is as vigorous. It depends on the individual’s physical and medical condition.

Exercise Can Enhance Rehabilitation After a Heart Attack

If the person you are caring for recently had a heart attack, the physician or cardiac rehabilitation therapist should have assigned specific exercises to do after being discharged from the hospital or as part of a cardiac rehabilitation program. Research has shown that exercise done as part of a cardiac rehabilitation program can improve fitness and reduce the risk of dying. If the senior didn’t get instructions before leaving the hospital, make sure they call the physician to discuss exercise before increasing physical activity.

When Exercise Is a Bad Idea

For some conditions, vigorous exercise is dangerous and should not be done, even in the absence of symptoms. Check with a physician before beginning an exercise program if you have either of the following conditions:

  • Abdominal aortic aneurysm, a weakness in the wall of the heart’s major outgoing artery (unless it has been surgically repaired or is so small that your doctor tells you that you can exercise vigorously.)
  • Critical aortic stenosis, a narrowing of one of the valves of the heart.