Agitation
Agitation
In life and in work, we sometimes come across people who just won't listen to reason. This is often due to agitation. Agitation refers to frustration, inner restlessness, and tension. It can make someone feel like they need to escape or lead to being easily irritated, angry, or otherwise emotional. With elders this can result in hitting, yelling, wandering, falls, or refusal to accept services. It is important to remember that this is normal and happens to us all at times. However, it can be hard to be on the receiving end of agitation because it seems illogical or overblown.
Recall our brain model. The amygdala sets off the strong emotional reactions and fight or flight response in our bodies. It's the frontal lobe's job to regulate this, but when there is too much raw emotional input, the frontal lobe struggles to maintain control and we can end up flipping our lid. The frontal lobe hypothesis of aging suggests that our frontal lobes age more quickly, which means that it can be harder for seniors to control the impulses from their amygdala and reduce their agitation.
In our work, causes of agitation can include: frustration, confusion, anxiety, anger, pain, sadness, hunger, or even boredom.
Working with Agitation
You can't always control for agitation and sometimes you need to do your best to deal with it.
- Reasoning and logic won't work - the frontal lobe is not in control here. It's similar to trying to reason with a kid during a tantrum. When someone has flipped their lid, their ability to reason is reduced.
- Demanding that people stop or calm down usually doesn't work.
- Instead, try to connect with them - understand why they are upset and acknowledge that you see their frustration or pain.
- Don't dismiss or deny their concerns - their concerns may be exaggerated or unreal, but it will still be more effective to let them be heard. If they can explain their situation at their own pace, it can help their brain to calm down and start sorting out the information.
- Our goal is to engage them, not enrage them - ask questions, request alternatives, and negotiate a bit if necessary.
- Movement is okay - we have an innate drive to move when we are under stress (think about when you stub your toe). They may need to work our some of their agitation by pacing or moving around.
- Your attitude and mood are felt by the other person and impacts their response.
Distraction and Redirection
- First, allow them to be heard - sympathize, empathize, or agree with them. You may not be able to fix it right away, but allow them to say their piece.
- Next, move them in a different direction - get them off the topic by asking questions about something else, such as the art in their home. Find something else to grab their attention.
- Lastly, redirect them - gently guide them in the direction you want them to go. Perhaps they would be willing to fill out paperwork after having a bite to eat. Or maybe they can agree to pay their bills this one time and you will promise to look into solutions for their grievances after that.
Final Tips
- Get a good history - are there factors like hunger, pain, or other personal issues that are fueling the agitation. What happened before you arrived?
- Getting other people away from the client while you work with them may relieve some pressure and create a calmer environment. This also allows them more time to respond without pressure.
- Use distraction and redirection first when faced with significant agitation.