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How to calm distress in dementia

“One of the most effective ways to overcome anxiety is to try to shift the focus of attention away from self and toward others.”
Dalai Lama

IMG_7350 “I’m so lonely here.” That is how one individual living with dementia described their distress. In a recent review of 121 studies in the Geriatric Psychiatry journal, people living with dementia were able to accurately and comprehensively describe what is going on for them.* Feeling fearful and lonely were the primary feelings behind their emotional distress.

Emotional distress and anxiety can come from different causes—including medical conditions and medications, a change of their environment, fear and fatigue, or mis-perceived threats. It can also come from too much stimulation and noise or feeling cold. However, according to the review, distress is mostly due to feelings of fear and loneliness.

When I think about it, this shouldn’t be a surprise—why would it be otherwise? If I was compelled to live in a large group setting surrounded by people who were mostly strangers to me, I would feel emotional distress too. It is difficult for me to truly imagine what it would be like to wake up every morning and think: “I don’t belong here”.

What can we do to support someone who is emotionally anxious—how can we help calm distress in the moment?2

081402927--by KOZOROG-two-cats-hide-under-blanket-ouHow to calm distress

  1. Create a calmer environment. Turn off the TV, reduce any background noise possible. If that isn’t possible, invite them to walk with you to find a quieter place. Provide reassurances in a calm voice: “You are safe here.” or “I’m sorry you are upset. I’ll stay here until you feel better.
  2. Monitor comfort. Ask the person if they are thirsty, hungry, in pain, uncomfortable or need the bathroom. If they are in pain, get help (find a nurse). Ask if the room is not too hot or cold.
  1. Encourage slow breathing. If it feels appropriate, invite them to participate in some slow breathing with you. Use your arms to demonstrate – e.g. Take a deep but gentle breath, and…breath out. Repeat.
  2. Find out what is calming. If you can, learn what is calming from someone who is anxious or in distress. Ask what brings calm. If they are not able to share that, ask family or friends for suggestions.
  3. Try matching and slowing. If the individual is agitated and walking quickly up and down the hallway, consider matching their pace. Chat a little. Then if it feels comfortable, link arms and then slow the pace down little by little using calming words. Or try singing a song using a slower and slower tempo.
  4. Offer a hug. Be very cautious about doing this too early. Wait until it feels comfortable and always ask first.
  5. And finally, and perhaps most importantly, ask for help with an activity. Giving is a calming activity. Invite the individual to help you help another resident (especially a fellow resident) with something. Bring someone a poem, an uplifting saying, a little music, chocolates, some flowers or a cup of tea to share. Or perhaps offer to take them for a walk.

The Dali Lama goes on to say:
One of the most effective ways to overcome anxiety is to try to shift the focus of attention away from self and toward others. When we succeed in this, we find that the scale of our own problems diminishes. This is not to say we should ignore our own needs altogether, but rather that we should try to remember others’ needs alongside our own, no matter how pressing ours may be.

Kristine Theurer, MA (Gerontology)
PhD Candidate, University of British Columbia

References

*Petty, S., Harvey, K., Griffiths, A., & Coleston, D. M. (2018). Emotional distress with dementia: A systematic review using corpus-based analysis and meta-ethnography. Geriatric Psychiatry, 33(5), 679-687. doi:10.1002/gps.4870

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