Anxiety and fear
Changes in mood
IMAGINE : You wake up in a room, which you don’t recognise. You see hands on the counterpane which are wrinkled and blotchy, not at all like your hands which are young and firm. But they are hands which seem to be attached to your arms. It’s very puzzling. Someone comes into the room with a cup of tea. She says, “Good morning mother. It’s Wednesday. Your day for the day centre.” You’ve only got one daughter and she is only 17 so who’s this woman of 50 plus calling you mother? And what’s a day centre?
People with dementia sometimes feel afraid or are anxious. There are many possible reasons for this. Some people with dementia become anxious as a result of mixing up things from the past with those from the present (e.g. worrying about the children coming home safely from school). Others may feel anxious or afraid as a result of hallucinations or delusions (please refer to the chapter on hallucinations and paranoid delusions) or as a response to the general mood in the household. It could just be the result of living in what seems to be a constantly changing world. There are also the worries and fears which many of us have, such as those concerning the future.
Unfortunately, it is not always possible to determine the exact cause of anxiety or fear. As a carer, you may feel distressed at seeing the person with dementia worried or afraid. You might feel helpless as a result of not knowing what to do. However, it is not absolutely necessary to understand the cause of the distress in order to be able to help. You can still offer reassurance, affection and express your concern. As you will see below, you can also take measures to reduce the likelihood of the person with dementia feeling anxious or afraid.
How to cope with anxiety and fear
If the person with dementia seems to be afraid or anxious, you may be able to reassure them by explaining that you understand how they must feel but that there is nothing to worry about. If the person does not seem to understand what you are saying, you could perhaps take their hand and just hold it or perhaps put your arm round their shoulder. In the case of frightening hallucinations, it is best not to pretend that you can see them too or try to convince the person that there is nothing there (please refer to chapter on hallucinations and paranoid delusions).
Try to respond to the feelings as well as the words
People with dementia may have difficulties expressing themselves. What they actually say might not be the real cause of anxiety or fear. For example, if the person looks afraid and keeps asking “How long?” you might take it to mean, “How long is it until dinner?” However, it might mean, “How long will you be gone?” or “How long will you be able to look after me for?” The better you know the person, the easier you will find it to understand what they are really trying to say. However, you can still respond to the emotion being expressed, by providing reassurance and showing that you care.
Create a distraction or remove the source of anxiety or fear (if known)
You may find that if you can distract the person with dementia, they will forget feeling afraid or anxious. It is often difficult to know what the cause is. But if you think you know what is causing the fear, you could first try to remove it (e.g. remove an ornament, poster or mirror, reduce the number of people in the room, improve lighting to eliminate shadows, etc.). Another possibility is to take the person away from the source of worry.
Consult a doctor
Medication for anxiety sometimes proves effective but should only be tried when the anxiety is severe and after all other options have been tried. There is always the problem of possible side effects such as increased confusion with medication for people with dementia.
How to prevent anxiety and fear
Explain regularly who people are and what is going on
Provide reassurance and explain what is going on and who people are to help the person with dementia feel less anxious. Even if the person does not understand what you are saying, he or she will probably feel reassured by your expression and tone of voice.
Try to maintain a stable environment and stick to routines
Creating and maintaining a stable environment and routines will probably give the person with dementia more chance of feeling secure in the world. They might still not recognise familiar places and people, but might at least have something to hold on to.
Remember that the person with dementia may be sensitive to mood
Even though people with dementia may have difficulty communicating, many remain very sensitive to the mood in the home. A tense atmosphere may make the person feel insecure or uneasy. You cannot guarantee a constant harmonious atmosphere in the home, nor is it realistic to pretend that everything is all right if it is not. But it is just worth bearing in mind that the person may sometimes be affected by the mood in the home and need reassurance.
Last Updated: Thursday 06 August 2009