RESTLESSNESS AND AGITATION
Restlessness and agitation are common in people with dementia. Cohen M et al(1986) attempted to define restlessness and agitation as “ inappropriate verbal, vocal or motor activity associated by 29 behaviours including general reslessness, constant attention seeking, complaining, negativism, pacing and screaming.
In my nursing placement I experienced a case of vascular dementia. The name of patient, the name of the ward and hospital should remain unmentioned in the essay in order to maintain confidentiality. Mr Hastie (not real name) an 80 years old man attracted my attention with his sudden periodic out bursts of anger and restlessness. At the time of these outbursts he used to pace round the ward, shouting abusive language at anyone who stood in his way, whether it was a member of staff or other patients. During these periodic outbursts he used to become very aggressive, show his fist to staff trying to stop him, try to lift any furniture around, i.e. TV, Piano, and Chairs. I was very curious as to why he behaved in the way he did. I observed him for a couple of days. I also read his case note, talked with his carers, which helped me to understand more about his physical and mental state. I found out that he had these sudden outbursts of anger and restlessness, when he was not busy and active. I also found out that his two daughters whom he loved very much could calm him down very easily, while the staffs at the home had never managed to do so. By reading his past history, I found out that as a young person, he had a very active and busy life as a bar staff, and a cab driver. During his outbursts he seemed to be living in his past, thinking he was a bar staff and doing his job staking all the furniture before the closure of the bar. He seemed to get very angry when he felt he was ignored or interfered with.
Knowing all these things helped me decide my role better. He used to become very agitated when the ward was more busy, as the staffs in the ward have less time to spend with him and thus he feel ignored. Because I was a supernumerary staff I had much more time to spend with the patient than other nurses and carers in the ward. I tried to calm him down by talking to him calmly, asking him questions in the topics which he liked to talk about, i.e. about his daughters, his previous job as a etc. When he started stacking furniture, I used validation therapy( Day 1997) to intervene. I found a way to calm him down by saying it wasn’t time for closure of the bar yet, and there would be more customers coming. He would stop stacking saying “is it!” Feil (1992) emphesized the importance of validation therapy as an intervention technique “to respect the world and feelings of the person with dementia and to validate these feelings by focussing upon that person’s experiences of here and now”. It was at this moment I talked to him about his daughters and work as a cab driver, asking him about tourists attraction places in London etc. He shocked me by his knowledge about all these places and he remembered every single of them. Diversion is an effective form of management of agitation ( Jacques A 1992).The people with dementia have a poor concentration span and may forget distress quite soon. Sometimes to change the subject, to divert the persons attention onto some other activity or conversation away from what is distressing them (Jones 1992). Mr Hastie felt lonely and ignored. He did not want to be left out. He felt very angry at the fact that he could not do his normal everyday job which he carried out at past. In this case the patient had always had a busy life and wanted to be active and busy. He did not want to accept the fact that he had no job now, and nothing to do. He seemed to be living in his past, and seemed to think he was at work (as a bar staff) in the home.
