Wellness Strategies Group has developed an essential guide to help older adults and their families navigate dementia in Maryland.
Dementia has stolen my ability to communicate my needs in a way you are used to.
I may be unable to speak clearly or find the right words, or maybe I can’t speak at all.
Sometimes, agitation is the only way to communicate with you when I’m not well.
I’m asking that you listen to me as a behavior detective and support me as I struggle to relay what I need.
Look at my physical needs first.
Am I sick?
Am I in pain?
Is the room too hot or too cold?
Am I thirsty or hungry?
Assess my environment.
Is it too noisy?
Are you asking several questions, and I can’t process what you are saying?
Are there too many food choices on my plate, and it’s overwhelming?
I often see people living with dementia have a change in their behavior. The caregiver reports it to the physician, and psychotropic medication is ordered.
This, in my opinion, is not the best path.
I understand that seeing someone you love who once was polite and calm now displaying agitation is quite scary and upsetting.
The practical response is, “We need to fix this.”
However, I firmly believe there needs to be a formal evaluation by a healthcare professional trained in dementia care before starting a new medication.
This should include a physical assessment (with possible lab studies), an environmental screening, a review of medication, and an evaluation of data from a behavior calendar.
All these assessments are pieces to a puzzle.
If you add medication to the puzzle without finding out if something else is contributing to the change in behavior, the pieces to the puzzle won’t fit.
If the evaluation is omitted, you may overlook providing treatment for an infection or identifying an essential trigger in the environment that could be prevented.
While there certainly are times when psychotropic medication is necessary to help someone struggling with persistent agitation, it shouldn’t be the immediate response when the behavior changes are just beginning.
These medications can be sedating when not at the appropriate dose (it may take some time to find the right dose and medication).
Sedation can contribute to one’s inability to participate in activities of daily living, or it may increase the risk of falls. It can also mask an underlying medication condition.
It’s our job to advocate and be the voice for those who don’t have one.
Listen when their communication style differs from yours and reserve medication for agitation only when all other contributing factors have been ruled out.
See my blog “8 Questions to Ask When New Medication is Prescribed” when it’s time to add medication.