If the patient is not feeling well, has pain, is coming down with a cold, has a medication reaction, or an infection, you will probably see a sudden onset of problem behaviors and confusion that do not go away with rest.

If this happens and the patient does not improve in an hour, complains of pain, shortness of breath, is bleeding, or vomiting you need to see the doctor as soon as possible.

Think about the following common problems:

Has the person been drinking at least one and a half quarts of liquid each day?
Are they urinating frequently?
Does their urine smell strong? Urinary tract infections are very common causes of agitation.
Does the person have arthritis or another painful condition?
Is the patient on his/her feet all day?
Does the patient "hold" or protect a part of his body?

Even though the patient may not complain of pain, we need to think about it. Ask the doctor for a medication you can use to relieve pain and use it regularly for mild pain. If the pain is allowed to become severe, the pain medication will be ineffective. If the person begins to moan, yell, or scream, suspect he might be in pain.

Worry about constipation. Make sure the patient receives adequate fiber in their diet, but avoid laxatives and enemas. Have the person's prescriptions, over-the-counter medications, vitamins, and herbal preparations checked regularly by your doctor or pharmacist.

Avoid alcohol intake as it can worsen memory permanently. Many people with memory loss over-react to alcohol. Try alcohol-free beers, wines, and mixed drinks as a substitute. If the patient becomes upset, try mixing more and more dilute drinks. Some caregivers add water to liquor bottles after their loved one goes to bed.

Ask your physician to tell your patient not to drink alcohol. Talk with your physician about health and preventing illness. You may want to ask about flu shots or the vaccination for pneumonia. Diet and nutrition may become a problem. Have your patient take a simple multiple vitamin daily -- especially if they are not eating a balanced diet.

Become concerned if the patient begins to lose more weight than 6 pounds in 6 months. Unless the person is on a weight reduction diet, weight loss greater than 6 pounds in 6 months is cause for alarm -- no matter how heavy they were before. See your doctor. Consult with a dietitian.

If the person refuses to eat, try different foods that are high in calories, and contact a helping professional. Instant breakfast drink in whole milk can be used as an inexpensive, tasty, and fully effective nutritional supplement.

Supported by: Iowa Scottish Rite Masonic Foundation,
National Caregiving Training Project,
University of Iowa College of Nursing,
Gerontology Nursing Intervention Center
Research Development and intervention Core

Developed by: Geri R. Hall, Ph.D., ARNP, CNS
Gerontology Clinical Nurse Specialist
Mayo Clinic Scottsdale
13400 E. Shea Boulvard
Scottsdale, Arizona 85259
Phone: 602-301-8111
E-Mail: Hall.Geri@mayo.edu