Understanding Restlessness in Dementia

Hey everybody! Welcome to another new episode

of the Truth, Lies, and Alzheimer's show. I'm Lisa

Skinner, your host, and today we are talking about understanding

restlessness. And we all know that people with dementia

experience restlessness, right? It includes digiting, pacing,

and trying to leave the place where they live. Very, very

common. Now, this can be extremely upsetting for the

person living with dementia, especially if they are prevented

from moving around the environment, but it's also quite

upsetting for family members and care partners who may worry

about the person's well-being and, of course, safety.

Restlessness can occur for many, many different reasons, so I'm

going to go over those with you. Perhaps they're hungry or

thirsty. Now, people with dementia forget to eat or drink.

They don't realize they are hungry or thirsty, or they may

not recognize the signs of hunger or thirst. So here are

some tips that might help: offer smaller portions or snacks, like

finger foods, if the person does not want to eat their full meal,

or they're resisting even sitting at the table. Make sure

there is always a drink close at hand, and encourage them to take

sips. They may not voluntarily do it, but sometimes, you know,

with prompting, they will go ahead and take the sips. Make

sure that you keep caffeinated drinks to a minimum, as these

may increase their restlessness. And in the later stages of

dementia, when chewing and swallowing may be affected, use

ice chips or artificial saliva to stop the person's mouth from

becoming dry and uncomfortable. They may be too hot or too cold.

You always want to check the temperature in the room. Help

them choose appropriate clothing for the weather. I've seen this

so many times. They often underdress or overdress because

they don't really pay attention or they're not cognizant of the

weather. So giving them an either-or choice can help here.

With you know, do you like the blue blouse or do you like the

yellow blouse? People with dementia sometimes get confused

about what they should wear and what's appropriate for the

weather of the day. They may be in pain. Pain is a common reason

for restlessness. So think about what might be causing the person

their discomfort, especially as many people with dementia also

have other conditions alongside the dementia, like arthritis,

joint pain, heart conditions, stomach or bowel problems, they

they often suffer from dental issues. Maybe they wear dentures

and they're you know not fitting them properly, or they have a

cavity that's causing them pain. So it's always something to

check out. They may be experiencing bladder or bowel

problems. So encourage your person to eat a balanced diet

with plenty of fruit and vegetables and regular drinks,

and encourage them to move around and not stay sedentary if

that's possible to prevent constipation. Look for signs of

problems like a urinary tract infection, or if they seem to be

constipated, for example, they're needing the toilet more

often, or pain when they are passing urine or opening their

bowels. So definitely consult with the physician if you're.

Noticing any of those signs, and also what is helpful is ask the

person on a regular basis if they need to use the toilet, and

then support them if necessary. They might need help locating

the bathroom, for example, especially if they're in an

unfamiliar environment, or if all the doors in their home look

similar, this is a big one. They may simply be bored, so support

your person with dementia to have a change of scenery. You

could go out for a walk, sit in the garden, play some familiar

music as you walk around the home together, or just move to a

different room. That's a change of scenery, right? Find

meaningful activities that you can engage with one another in.

This could be anything from voluntary work in the early

stages of dementia to helping in the garden or the kitchen, doing

jigsaw puzzles, or just simple crafts. Baking is great, and

then you get to eat the treats. Encourage visits from friends

and, of course, family. But do be aware that some people with

dementia may be unsettled by unexpected visitors. It may be

best if people do not drop in without advance notice, and

then, of course, before you even open the door, let your person

know. Oh, Julia's here! Yay! She's come to visit.

Let me go let her in. Is that okay with you? Look for new

opportunities for social contact and mental and physical

stimulation, like support groups for people with dementia and

their care partners, day centers, memory cafes, and

singing groups. They may also be feeling anxious and in distress.

It is often thought that people with dementia do not experience

anxiety or depression. Oh, we know that's not true, but this

is absolutely not the case. They may just not be able to express

how they truly are feeling. So here are some tips that may

help. If the person is unfamiliar with their

surroundings and this is making them feel anxious, try returning

them to a familiar environment. Ask the person how they are

feeling, and listen carefully to their answer. Even if they

cannot fully express their emotions. Being asked may end up

validating their feelings and ease some anxiety. You recognize

that something's wrong, and you're offering help. Try to

establish if something in their environment is causing their

sudden anxiety, like loud noises, like someone doing some

kind of a project outside, strong cooking smells, or even

bright lights trigger anxiety, and remove the source of

distress if If possible, remove the source of distress or remove

the person from the source of distress. If you can't remove

the source of distress, check their clothing for sources of

irritation like a scratchy label. Sometimes we wouldn't

even think about that, or a tight waistband. They're

uncomfortable. Simple fix, and then sit close to them, hold

their hand, stroke their arm, or give them a gentle hand massage

to provide reassurance. Playing music is such a relief for

anxiety, for calming, for comfort. You can read to them,

watch a film together, or look at photos and tell stories. Give

them something comforting to hold, like a cuddly toy or soft

blanket. Something that is familiar to them; they recognize

it. And if there are children or young people in the home who are

becoming too noisy, encourage them to do something quiet in

another room, or use headphones when listening to music or

playing video games. So here's a tip of what to do when somebody

is moving around. They're just kind of walking around. So

pacing, we call this pacing. It's very common in people

living with dementia, and there's several different

reasons why they're doing it. This one of them is that this is

a self-soothing behavior, but it can be upsetting for both you

and for them. However, there's always a reason for it, even if

the person cannot identify or communicate it. So, here are

some thoughts. Spending a lot of time inside sitting down can

cause frustration, especially if the person is younger and used

to be being active, so it's okay to let them walk around as long

as they are not in any danger and it is not causing distress.

You may need to walk together to ensure that they remain safe.

Make the person's home environment as safe as possible

to prevent any risk of falls. For example, by tucking trailing

wires out of the way, removing rugs, or using grippers to

secure them. Also, consider fitting handrails on steps.

Also, check that the person's shoes and slippers are sturdy

and well fitting. This is a huge cause of falls, ill-fitting

shoes and slippers. And then try to establish whether the person

has an unmet need that they're trying to communicate to you

that you can help them with. For instance, they may have stood up

to go to the bathroom, but forgotten why they got up. So

you could assume that that might have been the reason, and start

escorting and guiding them over to the bathroom, and they may

give you some kind of indication that that's not where they want

to go, or it is where they want to go. They may have been

sitting down for too long, and need to stretch their legs, or

simply feel at ease just by moving about. So coping with

wanting to leave the home this is a big thing. A particular

worry for many families is the person with dementia wanting or

desperately trying to leave their home.

This may happen if they are unaware of the risks of going

outside alone, or if they are confused about the time and

place, and here's an example: They may be retired, but they

could still think that they need to go to work, or that they need

to pick up their children from school, even though they are

older adults. Maybe their short-term memories have

short-circuited on them temporarily, and they're back to

when they were an active parent. And it's time to go pick the

kids up from school. They may have become disoriented and not

recognize that where they are is their current home. They're

looking for something that is familiar to them, and this home

is not for a variety of different reasons. They may be

thinking about somewhere that they lived in the past, and they

want to get back there so they will again feel safe and secure.

So the following tips may reduce the person's desire to leave the

current environment. You could put the coats and bags away in

the cupboards rather than keeping them near the front

door. For some people, seeing these items makes them think

that you're about to go somewhere, and they're anxious

to go. I think that stands to reason. Hang curtain rails above

the person's front door, and pull the curtain in the evening

or at other times when they often try to leave the home,

hiding the door may stop them wanting to open it. You can do

this with murals. There are stick-on murals that are

available on Amazon, and once you put them on the door, they

look like a bookshelf. There are several different scenes that

they make them in, and then they won't recognize it as an exit

and try to open it. That's a simple fix. Involve the person

in an activity like gardening, watching a sport on TV, or

helping prepare a meal. Help them feel like they still have a

purpose and meaning. This can make them feel so included and

purposeful, and also distract them from wanting to leave the

scene, keeping them busy. Ask a person about the place they want

to go to, and listen carefully to what they say. Speaking about

their memories of important places may help them feel

reassured and less restless, and also reground them in the

correct time and place. And then, if possible, give the

person opportunities to leave the house safely with you or

another family member or friend for support. And I'm going to

just close by saying that it is very important to have a plan in

case the person with dementia does leave their home alone when

it is unsafe to do so. You could talk to their neighbors about

the situation and exchange phone numbers so they can contact you

if they see the person leaving home alone and are worried about

their welfare. And I'm going to share a quick story with you.

This happened to my mother-in-law. She lived in her

home for 4050, years, and one of her habitual routines was to

take her dogs out for a walk every morning. Well, she had

been diagnosed with dementia, but at the time we weren't aware

that it was further along than it actually was. So this one

particular morning, and it turns out my sister-in-law had just

moved back in to the home to help care for my mother-in-law

because my father-in-law had passed away, so my mother-in-law

was completely alone. Well, she went out to take the dogs for a

walk, and she got halfway down her usual route, and her

short-term memory failed her. Just kind of short-circuited.

She didn't know who she was. She didn't know her name. She didn't

know her address. She didn't know how to get back to her

home. And one of her longtime neighbors noticed her just

walking around, looking really confused. So she went out and

said, "Maryann, can I help you with something? Is there

anything wrong? Marianne didn't know to tell her her name. She

could not remember. Well, fortunately, the neighbor had

her home telephone number and called, and my sister-in-law

Alice answered the phone, and the neighbor said, "I've got

your mom here with me, and she is seems so confused. She

doesn't know her name, where where she lives. She can't tell

me an address. She can't tell me anything.

So I'm going to bring her home. I just want to make sure you're

there. And my sister in law never let her take those dogs

out for a walk by herself again, and my point here is it can

happen like that, out of nowhere, with you know just

completely unexpectedly. So we need a plan for things like

that, and there are resources out there that can help. There's

a return home safely program in most of our communities where

you register your loved one with the police and they have the

information. GPS trackers are really effective, but anyway, I

just wanted to to point this out because. It is definitely part

of the restlessness behaviors that we see with dementia, and

once they are determined to get out, they're gonna go to extreme

lengths to try to get out of wherever it is they are feeling

insecure and unsafe about. So that concludes our episode for

today. I hope this has been extremely helpful and valuable

for you, and that you know you've learned some new nuggets

today to help with your dementia journey. And I will be back next

week with another new episode for you. But in the meantime,

have a great rest of your week. Thanks for tuning in to the

Truth, Lies, and Alzheimer's show. I'm Lisa Skinner, your

host, and as I always say, please be happy and try to stay

as healthy as you possibly can. We all need you, so bye for now.