21 Nov Agree, Apologize, Align, Attract (to something better)
Agree, Apologize, Align, Attract to something better
I’m often asked how to diffuse agitation for someone living with dementia. Certainly, the best strategy is to avoid it altogether, but even with the best care, moments of anxiety in a person living with dementia happen, sometimes, seemingly out of nowhere. Some strategies can minimize anxiety and escalation to agitation:
paying attention to our client’s or loved one’s level of engagement in activities which promote purpose and choice
ensuring a positive interaction WITH EYE CONTACT every 20-30 min (negative feelings linger longer than positive feelings, so frequent positive interactions are essential to optimize well-being)
changing the lighting toward the end of the day
using music before and during activities that might induce anxiety
watching for underlying reasons for agitation that could go inarticulated by the person living with dementia—pain, constipation, fatigue, hunger, thirst, temperature discomfort, and infection (commonly, urinary tract infections or upper respiratory infections.)
In the world of dementia, feelings are more important than facts. The person with dementia will know he feels anxious, but may not have the capacity to comprehend or verbalize the actual underlying cause. He will very reasonably take facts or stories from pre-dementia days (experiences he’s had, movies he’s seen, shows he’s watched, or books he’s read)—facts that are in his mind somewhere which were associated with the same sense of anxiety that he’s feeling now. Those facts (which might seem crazy to us) are his best way of coping with his disability in trying to give himself context to make sense of his own feelings and the environment around him. He can act on those facts for why he’s feeling anxious, using his sense of agency and autonomy, to try to fix the problem. If the fact he (unconsciously) chooses to help him cope with the anxiety is that “the neighbor took my car and I want to get my car back!” it makes perfect sense that he’d want to exercise his sense of agency, go over and talk to (or confront) the neighbor and get his car back.
Agree: “You want to get your car back!” (repeating his exact same words with the same emotional intensity so he knows you’ve heard him.) “Of course!”
Apologize: “I’m so sorry this happened.”
Align: “Let’s see if we can call Joe and get this straightened out.”
Attract to something better: If you happen to know he used to own an old noisy car, you could try a general, vague statement like, “some old cars make the strangest noises…” (the common mistake we make is trying to DISTRACT right away while people are still distressed. Without JOINING them first, distraction is, at best, only a temporary fix. We also easily make the mistake of using information about them that might cause them to wonder how we know “You used to have such a noisy old car.” (How do you know that? I don’t even know you!) The kind, humble, and far more effective approach is to join our clients or loved ones in their predicament so that they know they have a friend in this who will be with them in figuring it out.)
What if he wants to get the car back and it’s 2 AM? We could call Joe at the Alzheimer’s Association 24 hour hot-line number (1-800-272-3900) where trained staff know to go along with helping us implement our strategies to “get the car back” now or in the morning. If we have a good friend or family member “on call” for such events, we could be thankful! and call Joe at that number… or we could call Joe with no connection to someone on the other end to be able to ensure that we are taking care of it with the same sense of urgency that our client or loved one is feeling. He’s reading our nonverbal communication even more than our words, so remaining calm and in control enough to instill confidence, while matching his emotions with our tone of voice and actions, shows that we empathize with the gravity of the situation. When we are humble enough to go along with our client’s or loved one’s reality, rather than trying to force him to come back to ours, we are showing that “being kind is more important than being right.” Assure him with “thank goodness! Joe (the person on the other end of the phone call) can handle this for us so we can get a little more sleep. What a relief!”
Does it always work in real life as well as it works on paper? That was a rhetorical question. The exact words as typed may not work…but the general mantra to “AGREE, APOLOGIZE, ALIGN, ATTRACT (to something better)” is a helpful tool to add to your toolkit of ways to effectively reduce agitation and anxiety. To simplify that mantra even further, we could also just use a SPECAL® (Contented Dementia) mantra which highlights the most important principle: “Join the Club.” Joining the club will often bring you toward discovering the underlying cause of agitation…and it is an approach based on humility and kindness that will often bring your client or loved one back to a state of contentment and well-being…And isn’t that the goal?
“With humility comes wisdom.” Proverbs 11:2
“Put on a heart of compassion, kindness, humility, gentleness, and patience…” Colossians 3:12
