Allow behaviour that is not problematic.

Institute a patient-centred or relaxed schedule that allows flexibility for the preferential routines of each patient (eg, medication times, meals, bathing, sleep times, activities): assess daytime naps and limit or avoid in most patients (might be alright to allow aggressive patients to sleep while others are awake); make time for regular exercise to decrease restlessness and refer to daytime programs if available; and encourage daytime activities to minimize boredom and loneliness.

Create a positive environment that avoids triggering factors: make use of aromatherapy; play music suitable to the individual; reduce noise or the number of people in the room; remove keys from view if the patient is no longer driving; distract the patient with snacks or activities; ensure the house or room is safe if the patient is wandering (eg, put buzzers on doors, provide adequate light, take measures to reduce fall risk); provide a clock and calendar if the patient is confused about time and dates; and consider room placement changes if the patient is attempting inappropriate sexual behaviour, in order to minimize interactions of concern.

Minimize unnecessary and problem drugs. Difficulty swallowing can cause severe agitation; if medication is necessary, look for alternate formulations (eg, dissolvable tablets). As disease advances toward the end of life, transition to comfort care rather than curative or preventive care. -Review medications and consider stopping statins, vitamins, herbal remedies, and bisphosphonates. -Review blood pressure and blood sugar goals: levels that are too low can lead to falls.

Only do laboratory work when necessary.

Provide access to false teeth, hearing aids, and glasses to reduce agitation in some patients, although this can have the opposite effect if the patient is sound-sensitive or if these aids are considered bothersome by the patient (especially hearing aids).

Adapted from Regier and Bareham.³