Anxiety in Dementia

Anxiety and worry will show up differently for our family, patients and clients who have dementia. It would be great if they could just say, “I’m feeling really anxious right now.” To recognize and then verbalize it is something we might expect but won’t get. If we continue to expect this to happen, then this in of itself leaves us as caregivers endlessly frustrated. I mean, many of us don’t recognize and verbalize it unless we have really good insight. How would we expect people with dementia to do this?

So why can’t they just tell us? Unfortunately, the skills needed to do just this simple task are dwindling, like insight, good judgement, problem-solving, anticipating risks and language, because the parts of the brain that manage and control these skills are affected by the disease little by little. 

Therefore, instead of words, individuals with dementia are going to show us in other ways that they are anxious. For instance, they might wander or wander more than usual. They may yell out repeatedly or repeat other sounds or behaviors over and over. Possibly they could isolate or they may collect items repeatedly - some people refer to this as hoarding. They may have false sensory perceptions - speaking about people who have passed as if they are alive, needing to get somewhere they don’t need to be, etc. They could even become aggressive.

 This way of showing rather than telling is very similar to how children communicate when they are anxious. Children won’t outwardly say they are anxious and don’t necessarily yet have the ability to have insight into their feelings. They typically will show their anxiety by cutting school or getting into fights, picking arguments at home with siblings or parents, having mood swings or temper tantrums, isolating, experience changes in sleep or eating patterns, not completing assignments or chores, using drugs or alcohol, or talking about death. Parents should look for these changes in behavior and proceed with next steps to get them help. We use this same observation and intervention techniques with those of have dementia then.

Anxiety can easily be managed in those who have dementia. It’s always best to start with a non-pharmacological stance, meaning don’t use medication first. My go-to intervention is anything tactile. Research has indicated that when using tactile stimulation this increases focus and attention and decreases anxiety, worry, and fear. This is the best recipe for individuals with dementia! For tactile stimulation, you can have them hold on to or fidget items. You can offer a life-like animal or baby. You can also encourage them to cook, bake, draw, or color something with you. Another go-to intervention is music. Playing calming music has shown much success because music influences the limbic system, responsible for mood and memory. Also, another great intervention in managing anxiety is using essential oils. Lavender, cedarwood, and roman chamomile have all been studied oils that have shown effectiveness in lowering anxiety. Essential oils can be diffused in the air or worn topically with a carrier oil, like jojoba, coconut, or argan oil.

The other great reward of using non-pharmacological techniques, other than your loved ones or patients not experiencing side effects from medication use, is that you benefit too! Because you are ridding the individual of their anxiety or at least minimizing it, that feels good. Then your anxiety of trying to relieve their anxiety is lowered too! It’s a “Win, Win!”, I like to say.

In the event that non-pharmacological techniques are not successful, then consult with the individual’s physician about next steps. A low dose of an antidepressant or anti-anxiety medication, short-term, may be effective.

So when you observe your loved one, patient or client with new or increase in maladaptive behaviors, remember this is a way they are communicating that something is not right. They could have anxiety.

                                                                                            -- Dr. Jennifer Stelter


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