How to Manage Agitation and Aggression in Dementia: Real Advice From Real Families
Caring for someone living with dementia can bring moments that are difficult to prepare for.
Agitation, shouting, anger or aggression can sometimes seem to appear without warning. For families and carers, these moments can be frightening, exhausting and upsetting.
But behaviour can also be a form of communication.
A person living with dementia may be experiencing pain, confusion, fear, frustration, overstimulation or another unmet need that they are finding difficult to communicate.
For this guide, we asked people in dementia support groups to share strategies they had learned through their own experiences caring for someone with dementia.
We have combined those practical experiences with guidance from trusted Australian dementia and health organisations.
Important: Every person living with dementia is different. A strategy that works well for one person may not work for another. This guide provides general information and does not replace advice from your doctor or other healthcare professionals.
1. Look for What Might Be Behind the Behaviour
One of the most useful things a carer can do is stop and ask:
What might this person be trying to communicate?
Agitation and aggression can have an underlying cause or trigger, even when it is not immediately obvious.
Possible contributors include:
Pain or discomfort
Hunger or thirst
Constipation or needing the toilet
Tiredness
Feeling too hot or cold
Fear or confusion
Changes in routine
Too much noise or activity
Difficulty seeing or hearing
Medication side effects
Illness or infection
Frustration with a task
Feeling rushed or overwhelmed
Dementia can make it harder for someone to explain what is wrong, so distress may sometimes appear through changes in their behaviour instead.
2. Stay Calm and Avoid Arguing
When someone becomes distressed, arguing about facts is unlikely to help.
Try to keep your voice calm and reassuring.
Use short, simple sentences and give the person time to process what you are saying.
Rather than repeatedly correcting something that is not accurate, try to respond to the emotion behind what they are saying.
For example, if someone is distressed because they believe they need to go home, repeatedly telling them that they already are home may increase their frustration.
Instead, you might acknowledge how they are feeling and gently redirect the conversation or activity.
Healthdirect similarly recommends calm communication, short sentences and avoiding unnecessary arguing or correcting.
3. Reduce Noise and Stimulation
Sometimes the environment itself is contributing to distress.
Televisions, several people talking at once, unfamiliar visitors, bright or busy surroundings and crowded spaces can become overwhelming.
If agitation begins, consider whether you can make the environment calmer.
Turn down the television.
Reduce unnecessary noise.
Move to a quieter area if appropriate.
Avoid several people giving instructions at once.
Give the person some physical space.
Dementia Australia identifies noisy and crowded environments as possible triggers and recommends creating a safe, calm and comfortable environment.
4. Keep a Familiar Routine
Routine can provide predictability when other parts of life have become confusing.
Try to keep everyday activities such as waking, meals, medications, bathing and bedtime reasonably consistent.
That does not mean every minute needs to be scheduled.
It simply means reducing unnecessary surprises and giving the person familiar patterns throughout their day.
Dementia Australia recommends maintaining a consistent daily routine and minimising unnecessary changes in the home environment.
5. Try Gentle Redirection
Sometimes the best response is not to continue discussing whatever is causing distress.
Instead, gently shift attention toward something familiar or enjoyable.
Depending on the person, that might include:
Listening to familiar music
Looking through old photographs
Having a cup of tea
Going for a short walk
Folding washing together
Talking about family
Gardening
Spending time with a familiar pet
Watching something they enjoy
The important part is knowing the individual.
Something one person finds relaxing could irritate somebody else. Responding to changed behaviour often involves trial and error rather than finding one technique that works every time.
6. Do Not Rush Personal Care
Bathing, dressing, toileting and other personal care tasks can sometimes trigger distress.
Imagine someone approaching you, removing your clothes or trying to move you when you do not completely understand who they are or what is happening.
Even when the carer is trying to help, the experience may feel frightening or humiliating.
Approach slowly.
Explain what you are going to do.
Use simple instructions.
Give the person time to respond.
Where possible, offer choices that allow them to maintain some control.
Dementia Australia notes that needing assistance with personal tasks can sometimes cause embarrassment or defensiveness, while breaking larger tasks into smaller steps may help.
7. Keep a Behaviour Diary
This is one of the most practical things families can try.
When agitation or aggression occurs, write down:
What happened
What time it happened
Who was there
What was happening immediately beforehand
What the person said or did
How you responded
What appeared to help
After several incidents, patterns may become easier to see.
Perhaps agitation regularly happens late in the afternoon.
Perhaps showering is a trigger.
Perhaps busy family gatherings are overwhelming.
Perhaps the person becomes distressed when they are hungry or tired.
A behaviour diary can also be useful information to take to a GP or specialist.
Dementia Australia specifically recommends keeping a diary or log to identify patterns, triggers and strategies that appear to help.
8. Consider Pain and Physical Discomfort
Pain can sometimes be difficult for a person with dementia to identify or communicate.
Instead of saying that something hurts, you may notice changes such as grimacing, moaning, withdrawing, becoming frustrated or behaving differently from usual.
If you think the person may be experiencing pain, speak with their doctor so the cause can be assessed appropriately.
Also consider simple possibilities such as:
Are they thirsty?
Are they hungry?
Do they need the toilet?
Are they constipated?
Are they tired?
Are their clothes uncomfortable?
Are they too hot or cold?
Are their glasses or hearing aids working properly?
Sometimes looking at the basics can reveal something important.
9. Know When a Behaviour Change Needs Medical Attention
This is particularly important.
Do not automatically assume that a sudden behavioural change is simply the dementia getting worse.
Dementia generally progresses over time, whereas a sudden change in confusion or behaviour can have another medical cause. Dementia Australia advises that sudden changes should prompt medical assessment, including consideration of pain, illness, infection, medication effects and delirium.
Speak with the person’s GP or healthcare team if you notice new, worsening or concerning changes.
Seek urgent medical care for a sudden change in behaviour, particularly if the person has injured themselves or you feel unsafe. Healthdirect specifically recommends urgent assessment in these circumstances.
10. Protect Your Own Safety
Supporting someone does not mean putting yourself in danger.
If aggression escalates, give the person space where possible and avoid unnecessarily crowding or restraining them.
Keep yourself near an exit if you feel unsafe.
Have access to a phone.
If necessary, move somewhere safe.
Dementia Australia recommends carers consider their own safety and prepare somewhere they can move to if aggression occurs.
If you or anyone else is in immediate danger, call 000.
11. Remember That the Behaviour Is Not Deliberate
This can be incredibly difficult to remember in the moment.
Being shouted at, sworn at or pushed away by somebody you love hurts.
But changes in behaviour associated with dementia are not necessarily deliberate attempts to upset the people around them.
Dementia can affect communication, perception, emotional regulation and the person’s ability to understand what is happening around them.
Understanding that does not make difficult behaviour easy.
But it can change how you respond to it.
12. Look After the Carer Too
Caring for someone living with dementia can be physically and emotionally exhausting.
You are allowed to need help.
Talk to family members.
Accept respite when it is available.
Speak with your GP if you are struggling.
Connect with other carers who understand what the experience is actually like.
Sometimes simply speaking with someone who understands dementia can make a difficult situation feel less isolating.
Where to Get Dementia Support in Australia
The National Dementia Helpline provides free and confidential information, advice and support.
National Dementia Helpline: 1800 100 500
It is available 24 hours a day, seven days a week.
Dementia Australia National Dementia Helpline
You can also speak with the person’s GP or healthcare team about behavioural changes and available support.
Final Thoughts
There is no perfect script for responding to agitation or aggression in dementia.
What works today may not work tomorrow.
The most useful approach is often to stay curious about what may be causing the distress, keep the environment calm, communicate simply and learn which strategies work for that individual.
And sometimes the most important thing is recognising that something has changed and asking for professional help.
The families and carers we spoke with had different experiences, but that itself is an important lesson:
There is no single approach that works for every person living with dementia.
Patience, observation, flexibility and support matter.
And carers deserve support too.
If you have cared for someone living with dementia, what is one thing you learned that you wish someone had told you earlier?
