Your loved one with dementia may go into a state of agitation, a high level of anxiety, seemingly triggered by the simplest of things, like taking a bath or a shower. But the cause of anxiety in someone with dementia is typically not rooted in one single event, it is often brought on by one or more of the five most common causes.

Studies indicate that anxiety is prevalent in individuals with dementia, with anxiety symptoms showing in about 40% of people diagnosed with the most common type of dementia, Alzheimer’s. There is hope! By having strategies in place, you can lower your loved one’s overall anxiety and may prevent any worsening of cognitive shortfalls produced by higher levels of anxiety.

Signs of Anxiety with Dementia

Most adults who experience bouts of anxiety describe their symptoms as a menagerie – a headache, stomach ache, fatigue, restlessness, and disturbed sleep. People with dementia feel these same effects of anxiety, but they may not be able to articulate how they are feeling.

You may notice anxiety in your loved one with dementia through these signs:

• Agitation and irritability (verbal and physical signs of agitation)
• Restlessness (pacing around, repeated behaviors, unable to sit still)
• Avoiding social situations (especially activities that were once enjoyed)
• Complaining or showing signs of muscle tension or pain
• Poor sleeping pattern (difficulty falling asleep and staying asleep)
• Inability to concentrate (difficulty focusing and easily distracted)
• Fatigue (easily tired, wanting more sleep)

Five Common Causes of Anxiety with Dementia

Even though the reasons for anxiety in people with dementia vary individually, there are some common threads. Caregivers most often manage anxiety with a focus on these five common causes:

1. Changes in routine
2. Perceived threats
3. Discomfort or pain
4. Fear and fatigue
5. Change in environment

If your loved one had anxiety before they were diagnosed with dementia, consider what might have caused it. They may have been worried about money, housing, clothing, food, etc., and they may still be anxious about it, even if they are in a different environment.

What You Can Do to Help

Medications for most adults with prolonged anxiety are helpful, but medications do not always help seniors or dementia patients with anxiety. Try to find alternative methods, such as apps, music, and exercise to reduce anxiety. Ask their physician about supplements, vitamins, diet, and other holistic measures that may help reduce anxiety but do not interfere with any prescribed medications.

1. Changes in Routine

Structure and routine are crucial to living with dementia. Unpredictability can lead to agitation and fear, which can grow into fatigue and a higher level of anxiety.

Could your loved one be troubled by a change in routine?

• Has their care, meal, bathing, or medication schedule changed?
• Is someone new taking care of them?
• What other changes in daily routine might have taken place?

Consider creating a caregiver’s schedule. Doing so will also help you as a caregiver, especially if you include ‘downtime’ for a much-needed rest. Routine helps to build a sense of security and safety in your loved one with dementia. It diminishes stress.

3. Perceived Threats

What we see as normal in adult life can be perceived as a threat to your loved one with dementia. Perceived threats can lead to sensory overload and hallucinations in people with memory loss. Sensory changes and side effects of medications can also ‘up the level’ of perceived threats and lead to agitation.

Could your loved one be experiencing perceived threats?

• Has anything in their environment changed (i.e., lighting, sound, colors, furniture, medication, caregiver, etc.)?
• Has anything changed that could affect their sense of safety?

Remember that a perceived threat is very real to a person with dementia. Do not invalidate their thoughts and feelings. Provide reassurance and speak softly as you do so. Ensure your loved one’s environment is calm and as stress-free as possible. Ensure it is a place where they feel comfortable. Decrease the noise level, if applicable, and adjust the lighting appropriately.

3. Discomfort or Pain

Always reach out to your loved one’s medical team to review possible medication changes, interactions, and side effects, and to rule out hidden problems that can cause discomfort and pain and increase anxiety.

Could your loved one be experiencing discomfort or pain?

• Are they pulling or tugging at their clothing?
• Are they making noise when using the toilet? (Could indicate a urinary tract infection or problems with bowel movements.)
• Are they suddenly talking about being too hot or cold?
• Does their facial expression reflect discomfort (i.e., grimacing when they move or walk)?
• Is your loved one hungry or thirsty?

Look for areas of discomfort or irritation on your loved one’s skin or body (i.e., rashes, redness, bruises, swelling), but always bring in the medical team to examine what you cannot see.

4. Fear and Fatigue

What is the link between fear and fatigue? The challenges that your loved one with dementia faces, such as confusion, perceived threats, and the anxiety itself, can add to fear – fear that leads them to always want someone around, and it can be exhausting.

Could your loved one be experiencing fear and fatigue?

• Does your loved one not want you to leave their side, or have they chosen someone else that they always want around?
• Does your loved one show fear or anxiety when a particular person walks into the room? (Warning: This may not be a perceived fear. So, please take precautionary measures.)
• Is your loved one fearful that she or he will be abandoned?

Separation anxiety is a normal response that a person with dementia can have when separated from a primary caregiver. It mostly stems from fear, but it can be triggered by loneliness and boredom.

Help your loved one engage in meaningful activities. This will provide a healthy outlet that not only eases boredom but can help with separation anxiety and loneliness when activities are shared with other like-minded people.

5. Change in Environment

Change in the environment can lead to fear, confusion, perceived threats, separation anxiety, and overall agitation in a person with dementia. It all ties in. A change in environment is often the most difficult adjustment for a senior with dementia to make.

We have an entire blog library dedicated to Moving to Memory Care, but here are some tips that can help you avoid and reduce the anxiety that comes with moving to a new environment:

Preparation is king!

• Reduce the surprise factor. Visit the facility, or the new environment, and include your loved one in the upcoming process as much as possible.
• After the change in environment – make frequent visits.
• Little things matter! Make things look and feel familiar in the new environment. Less change = more calm (less agitation and anxiety).

Your loved one may need time to adjust to a change in environment. They may need to adjust at their own pace. Your role is to provide reassurance, comfort, and enjoyable distractions – healthy holistic options that deter confusion and stress.

We Are Here to Help

We know that it can feel overwhelming and daunting when someone that we love becomes anxious or agitated. If you have questions, we can help! If you are in the Round Rock or North Austin, Texas area, reach out to us online and request an appointment or call 512-399-5080.