Agitation and Aggression
Module 4 - Lesson 2 of 3
Introduction
Consider that a person is signaling the need for a change through their behavior. In this module you'll wonder about what might need to be changed? The environment? The person’s service, support or care plan? What else? Let's take a closer look.
Warm Up
- Imagine, for example, a person is calling out at night. Ask yourself, "What can I check?"
Common responses include the physical environment. Maybe the person is too cold or too hot.
Once these basic biological and environmental questions have been asked and answered, caregivers sometimes get stuck. We’re not used to paying attention to the core psychological, emotional and spiritual needs.
2. Now ask yourself, "What else can I check?"
Sometimes we need to look at the person’s service, support and care plan and ask,
- "Am I doing enough to prevent boredom and loneliness?"
- "Am I caring for but not truly engaging with the person?"
- "Do I need to change my behavior towards an individual at a particular point in time?"
It’s easier to change our behavior than the behavior of others.
Agitation and Aggression
Agitation and aggression are often lumped together. Agitation is a catch-all word that really doesn’t describe anything specific. It’s used to describe everything from crying to throwing a chair out of a window. The kinds of behaviors that we refer to as 'agitated' are meant to effect a very different change than behaviors we call 'aggression'.
Learn the difference between agitation and aggression. It helps sort out the communication and ways to effectively respond.
Agitation - Something is Wrong with Me
The behaviors usually referred to as agitation, such as clapping, yelling, slapping thighs, and screaming, are used to communicate: Help! Come closer!
For example, a person may be signaling for you to look at them when he/she claps or bangs on the table, and that’s what is wanted. This is what agitated individuals are trying to communicate: “Look at me.” So let’s use 'agitation' to describe those self-referred behaviors that attempt to communicate: “Look over here! Something is wrong. Do something!”
Aggression - Something is Wrong with You
Aggression is very different from agitation. Hitting, kicking, spitting, biting, swearing and throwing things are considered aggression. The communication is pretty clear: Stop! Leave me alone! Go away!
So aggression, in contrast to agitation, is a term reserved for those behaviors that are other-referred. They try to communicate you’re the problem, not me. The change the person wants to see is: you stop doing what you’re doing. As in, “Go away. Don’t come any closer”.
Avoiding Unnecessary Drugs
There are two basic questions you can ask to avoid unnecessary medication when dealing with challenging behaviors:
- What are some common triggers for this behavior? How might you anticipate these triggers and meet their needs before it becomes a problem?
- What is this person trying to tell me? What needs to change? What information is needed? Who do I need to share this information with?
Description of Agitation and Aggression in Documentation
The best way to describe behaviors is to use words that describe the action, such as “Mrs. Jones threw a pillow” or “Mr. Smith called out all night” or “Mrs. Alvarez swears at me.” If you do use the word agitated, then make sure you use it to describe a behavior the person used to call attention to him or herself. If you use the word aggressive, then make sure you use it to describe a behavior the person used to call attention to someone else.
Wrap Up: Lesson 2
Communication by the kinds of behaviors we’ve been describing might be used by people who have had a stroke, have dementia or have any other condition that makes it hard for them to state their needs in words.
Take a moment to pause and reflect on how you can begin to anticipate their needs. In response to challenging behaviors, there are a number of non-pharmacologic interventions you can take. What needs can you help meet to prevent agitation? How might you adjust your behaviors to prevent aggression?