By Shay Jacobson, RN, MA, NMG

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We say we do not know what to do with this outburst-prone behavior and yet we do.  An older person who does not understand their environment is similar to an infant who has not yet learned to interpret or control theirs.  Their dependence on their caregivers is universal.  So why not learn from the strategies that have developed over time to help the caregiver cope and provide comfort for the colic that afflicts both worlds?

Coping with Colicky Dementia

The first thing to do is a complete and thorough assessment of the person to rule out medical conditions that are causing discomfort. One of the most common causes of dementia-related agitation is a urinary tract infection.  They have difficulty communicating the symptoms of frequency, burning and pain.  Instead, they become agitated, irritable and confused. Other conditions such as acid indigestion, sore feet, arthritis, and even hemorrhoids can be easily missed by the caregiver when the communication of symptoms is so foggy.  

One also must do a psychological assessment to rule out contributing mental health conditions such as depression, bi-polar symptoms, and substance withdrawal. A person with dementia is also a person with a possible mental health history that cannot be ignored.  Untreated mental illness can be the major contributing factor that results in colicky dementia. Imagine the person with an anxiety disorder such as obsessive compulsive disorder who is plagued with a short-term memory deficit that prevents them from completing their self-soothing rituals.

Family dynamics are also important when one sees the picture of colicky dementia.  Even if the person with dementia does not understand all of the nuances of the situation, the emotional response to discord can be very clear.  When there is a feeling of disharmony, the person can react with a need to try to control the situation with emotional outbursts of their own.  Care providers must help to calm the environment and have the person feel as safe as possible.

What is it all about?

• Changes in mood – Do the mood changes seem to coincide with environmental changes, the time of day, or in relation to food or sleeping patterns? For example, if your loved one is cranky in the late morning, watch to see if she or he is sending signals that you are missing—like an isolated yawn or eye rubbing, rocking, etc.

• Reactions to different situations and environments – People often send signals that we just don’t notice. He/she might get over stimulated if too many people are around or become especially upset about schedule changes.

• Differences in the quality and nature of the outbursts – At first all will sound the same; but, gradually, you will hear how the “I’m hungry”  is very different from the “I’m tired.” Notice noise level, pitch and intensity of the voice as well as body language and facial expressions.

 

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