Agitation and Confabulation (aka “making stuff up”) are common symptoms in a person with Dementia. These are formally called Behavioral and Psychological Symptoms of Dementia (BPSD) and are also referred to as “Neuropsychiatric symptoms” (NPS). Up to 90% of Dementia patients are affected by BPSD or NPS (1) – NPSs affect people from mild to severe stages of Dementia and cause frustration, poor outcomes, and high-stress levels in your loved one, family, and professional caregivers.
It doesn’t have to be this way – with an improved understanding of these, you will find that Agitation and Confabulation in your loved ones’ Dementia can in fact be managed effectively via 1-1 in-home care – potentially much more effectively than in other settings.
Agitation is a disturbing behavior characterized by excessive motor activity or anxiety and verbal or physical aggressiveness, severe enough to harm social relations and daily life activities.
It is the third most common (NPS) in Dementia with a prevalence of about 30%, after depression and apathy. (2)
Managing Agitation In Your Loved Ones
To manage agitation in your loved ones via in-home care, start by understanding their behaviors, knowing their causes, and then responding accordingly to calm them.
- Repeating the same phrases or words again and again
- Oppositional behavior
- Inappropriate language
- Verbal and/or physical aggression towards you or caregivers
Knowing the cause will make it a lot easier for you to manage your loved one’s agitation. Some common causes are:
- REACTIONS TO MEDICATION:
Changes in the titration of your loved one’s medications can be a frequent reason for their agitation. Sometimes it occurs as a side-effect of the changed medication.
- FEAR and CONFUSION
With extensive or shorter-term memory loss, fear and confusion are commonplace in dementia patients – examples: fear of unrecognized people approaching or touching them, changes in the environment, or a changed caregiver also causes confusion.
Does your loved one find difficulty in sleeping? Do they often get tired? This affects their routine adversely and they get agitated.
- EMOTIONAL PAIN:
Agitation due to loneliness, depression, or frustration.
- PHYSICAL PAIN:
An unmet need, hunger, pain, irritation, infection, illness, constipation, or noise, etc…
- DISCOMFORT ON A CERTAIN TASK:
Dementia patients often become uncomfortable performing a specific task in their routine, for example, bathing, bedtime, getting dressed, etc. This can lead to frustration and agitation.
In the late afternoon or in the evening agitation starts appearing in dementia patients due to sundown syndrome.
- VISION OR HEARING LOSS:
If your loved one has challenges hearing and seeing, they will get agitated and might cry for help.
- DEFENSIVE BEHAVIOR:
As your loved ones lose their independence or freedom of everything, they easily get defensive.
HOW TO RESPOND
How you respond as a caregiver when you notice agitation in your loved one, impacts a lot in managing the situation. You can try these approaches:
- UNDERSTAND CAUSE:
If you understand why your loved one is getting triggered, then you will be able to respond properly by fulfilling their needs or you could handle things even before they get agitated.
- GENERAL THERAPIES:
Help them with therapies like music therapy, touch therapy, aromatherapy, pet therapy, etc…
It can be difficult to calm them at that moment but try to reassure them that “everything is fine”. and “I am here for you”.
- STAY CALM:
Stay calm, approach slowly, make them relaxed, and then ask for their needs. It can be hard but really effective.
Try to connect them with the surroundings, memories, familiar objects. Minimize the distractions like noise, or strangers, etc… to keep them oriented.
In the later stages of dementia, your loved ones mix up things with their (false!) imaginations to fill in memory gaps, which they believe to be true. This behavior in dementia is known as “confabulation” or is also referred to as “honest lying”.
Managing Confabulation In Your Loved Ones
It can be a huge task for you and your caregivers to manage confabulation in your loved ones, because they seem otherwise fine – they may even complain to your sibling that you or a professional caregiver is out to get them. Managing confabulation is much harder than managing Agitation and needs a lot more patience, empathy, and a calm compassionate approach.
1- VERBAL CONFABULATION
This behavior refers to actions that are verbal.
- Provoked Confabulation: A condition in which your loved one feels pressured to answer or recall something – for example, they will make up stories when someone asks them “how do you get that bruise?” or “where are your spectacles?”.
- Spontaneous Confabulation: The condition in which your loved one starts making stories by themselves and continues them without knowing that they are lying. Spontaneous confabulations usually sound fanatic and can even sound bizarre – for example, stories of their last visit to the doctor yesterday, even though they didn’t even go there for months.
2- PHYSICAL CONFABULATION
This behavior refers to physical actions in response to false memory – for example: Celebrating your birthday which was months ago or mourning the death of a living person.
- The information does not encode well enough into the brain – it is over-learned into the brain as specific memories persist and overtake the truth.
- Frontotemporal dementia (FTD).
- Other behaviors of dementia e.g: agitation or delusion.
- Korsakoff syndrome (a dementia type associated with alcohol abuse).
HOW TO RESPOND
- VALIDATION THERAPY:
“Go with the flow” and accept your loved one’s reality – don’t argue with them that there is a different reality from the one that they are experiencing.
- UNDERSTAND THE PURPOSE:
Understand the reasons for their confabulation – figuring this out is singularly critical in responding better and helping them effectively.
- CREATE BACK A MEMORY:
Make a diary or a memory book with pictures from days long ago – this can help them have a track of life and be able to come back to if their recollection of the past is way off from what actually happened.
- SUPPORT SYSTEM:
Try to be their support system so they can trust, understand or listen to you while confabulating – don’t laugh or make fun of their far fetched stories, since, in addition to being unkind, this will likely lead to a backlash
- POSSIBLE CHANGES IN ENVIRONMENT:
Go with any possible approach that may help your loved one – e.g: Make the environment more conducive to them by removing noise, people, or any hateful object. Use simple language, keep yourself calm, and give them time to process new information. Be careful to remove a trusted caregiver who has been taking care of your loved one, only due to confabulation – this can possibly make matters worse than where you were at the start.
Remember, it is not your loved one who is behaving differently when they are agitated or confabulating – it is the progression of their disease triggering these behaviors. So, try not to take anything personally! Professional caregiver or in-home care service, to help deal with agitation and confabulation of your loved one at home would be highly advisable.
Do you live in the Dallas Fort Worth area? Care Mountain provides award-winning in-home care providers with deep experiences in caring for those with dementia and Alzheimer’s. We are a high-quality in-home care provider with 16 years of experience providing personalized care for 3,000+ DFW families. We have highly experienced caregivers available to support you and your loved ones’ care needs.