How to Manage Agitation and Aggression in Dementia — Real Advice From Real Families
One of the most challenging and most frightening moments for any family caring for someone with dementia is the first time their loved one becomes agitated or aggressive. It can happen without warning. It can be directed at the people closest to them. And without any preparation or understanding of why it happens — it can feel overwhelming, heartbreaking, and completely impossible to manage.
This guide was written with the help of real families and carers who have lived through this experience — people who know what actually works day to day, not just what the textbooks say. If you are navigating this for the first time — this guide is for you.
Understanding Why Agitation Happens
The single most important thing to understand about agitation and aggression in dementia is this:
There is almost always a reason.
Agitation and aggression in dementia are rarely random — they are almost always a response to an unmet need, an overwhelming situation, or a frightening experience that the person with dementia cannot communicate in any other way.
Common triggers include:
Physical discomfort and unmet needs Hunger, thirst, pain, needing to use the bathroom, being too hot or too cold — these are among the most common triggers for agitation in dementia. A person who can no longer communicate their needs reliably may express discomfort through agitation or aggression. Always check the basics first.
Fear and paranoia As dementia progresses — particularly in the later stages — many people experience fear, paranoia, and sometimes hallucinations. Agitation in these cases is often a response to a genuinely frightening experience that feels completely real to the person experiencing it.
Overstimulation and overwhelm Too much noise, too many people, too much activity — environments that feel overwhelming to someone with dementia can trigger agitation even when nothing appears obviously wrong. The brain’s reduced capacity to process sensory information means that what feels normal to us can feel genuinely unbearable to someone with dementia.
Disrupted sleep and circadian rhythms Sleep disturbance is extremely common in dementia — and disrupted circadian rhythms can significantly increase agitation, particularly in the late afternoon and evening in what is sometimes called “sundowning.”
Unfamiliar environments or faces Unfamiliar surroundings, unfamiliar faces, or changes to routine can trigger significant anxiety and agitation in people with dementia — even when those changes feel minor or positive to the people around them.
What to Do in the Moment
Step 1 — Stay calm
Your emotional state directly affects the emotional state of the person with dementia. If you are anxious, frightened, or frustrated — they will feel it. Staying as calm as possible — speaking slowly, moving gently, keeping your voice low — is the most important thing you can do in the moment.
This is genuinely difficult. There will be times when you cannot stay calm — and in those moments, the right thing to do is to leave the room briefly if it is safe to do so. Step outside. Take a breath. Compose yourself. A short break is not abandonment — it is good care.
Step 2 — Find the trigger
Before trying any specific technique — ask yourself what might be driving the agitation. Are they hungry? Thirsty? In pain? Too hot? Overstimulated? Frightened by something they are seeing or experiencing? Tired?
Addressing the underlying trigger — where possible — is always more effective than any management technique applied without understanding the cause.
Step 3 — Get to their level
Physical positioning matters more than most people realise. Standing over someone who is frightened or agitated can feel threatening — even when no threat is intended. Getting down to the same level as the person — sitting if they are sitting — allows them to see your face clearly and makes the interaction feel safer and less confrontational.
Step 4 — Use touch carefully
Gentle physical touch — a hand on the arm, holding hands — can be extraordinarily grounding and calming for many people with dementia. However touch can also feel threatening to someone who is frightened or paranoid.
If you are going to touch someone who is agitated — warn them first. Tell them what you are going to do before you do it. Use your voice to prepare them rather than reaching out without warning.
Step 5 — Don’t argue or correct
Arguing with or correcting someone with dementia when they are agitated or expressing something that isn’t true almost always makes things worse.
If they believe something that isn’t real — entering their reality rather than trying to correct it is far more effective. You do not need to agree with something that distresses you — but arguing against it rarely helps.
Step 6 — Use language thoughtfully
The words you use matter. Simple, calm, reassuring language — short sentences, a gentle tone — is far more effective than complex explanations or raised voices.
Small changes in language can make a remarkable difference. Calling a parent by a childhood name or term of endearment rather than their adult name can tap into deeper memories and a sense of safety that more familiar names no longer access.
Step 7 — Distraction and redirection
Once the immediate agitation has passed — distraction and redirection can be extraordinarily effective. Suggesting a walk, offering a drink, introducing a familiar object or activity — anything that gently shifts attention away from whatever triggered the agitation can prevent escalation and help the person settle.
Techniques That Families Have Found Most Helpful
Music and rhythm
Music is one of the most powerful tools available for managing agitation in dementia — and the research strongly supports what families have known for years. Music accesses parts of the brain that remain intact long after other cognitive functions have declined — familiar music in particular can reach people who have become largely unreachable through conversation.
Movement combined with music — even gentle swaying or dancing — can be extraordinarily calming. A personalised playlist of genuinely meaningful music — songs from a person’s youth, songs associated with happy memories — can be one of the most effective tools in a carer’s toolkit.
Music therapy is now available as a professional resource in Australia. The MATCH music therapy program has been used in research settings and is available as a therapeutic resource for families and care facilities.
Physical touch and grounding
Gentle physical touch — holding hands, a light head massage — can provide powerful grounding for someone who is frightened or agitated. The physical sensation of familiar touch can communicate safety and love in ways that words sometimes cannot.
Pets are particularly effective grounding tools for many people with dementia. The presence of a familiar animal can calm agitation that nothing else has been able to reach.
Nature and fresh air
Getting outside — even briefly — can have a remarkably calming effect on agitation. A short walk, sitting in the garden, time near the water — the combination of fresh air, natural light, and gentle physical movement addresses several potential triggers simultaneously and often provides relief when indoor strategies have been exhausted.
Visiting places with animals
Some families have found that visits to places with animals provide extraordinary distraction and calm. Something about the presence of animals seems to reach through the agitation in ways that human interaction sometimes cannot.
Familiar objects and activities
Familiar objects — a favourite blanket, a well-loved photograph, a familiar piece of clothing — can provide grounding and comfort during agitation. Familiar activities that the person has always enjoyed can redirect attention and provide a sense of comfort and safety.
Creating an Environment That Reduces Agitation
Reduce stimulation Quieter, calmer environments with familiar faces and predictable routines significantly reduce the frequency and intensity of agitation in most people with dementia. Where possible — reduce noise, reduce unfamiliar visitors, and maintain the routines that feel safe and familiar.
Maintain routine Predictable daily routines — mealtimes, activities, bedtime — provide a structure that can significantly reduce anxiety and agitation. When routines must change — introduce changes gradually and with as much gentle preparation as possible.
Address sleep Sleep disturbance significantly worsens agitation. Working with your GP to address sleep issues — including the circadian rhythm disruptions common in later stage dementia — can reduce daytime and evening agitation considerably.
What to Do When You Are Struggling
Caring for someone with dementia who is frequently agitated or aggressive is one of the most physically and emotionally demanding roles any person can take on.
It is not weakness to struggle. It is not failure to need help.
If you are finding it genuinely difficult to stay calm — leave the room when it is safe to do so. Step outside. Breathe. Return when you are ready.
If you are finding the caring role overwhelming — please reach out for support. Carer burnout is real, it is serious, and it is extraordinarily common among people caring for someone with dementia.
Carer Gateway: https://www.carergateway.gov.au Phone: 1800 422 737
Dementia Australia: https://www.dementia.org.au National Dementia Helpline: 1800 100 500 — available 24 hours a day, 7 days a week
What to Know Before It Happens
The families who navigate agitation and aggression in dementia most effectively are almost always those who prepared before it happened — who read, researched, watched videos, and talked to professionals and other carers before the first episode occurred.
Forewarned is forearmed.
If your loved one has been diagnosed with dementia — start learning about agitation and behavioural changes now, before they occur. Understanding why these behaviours happen, and having strategies ready to try, makes an enormous difference to how you respond in the moment.
For more information on understanding dementia — read our complete guide to the early warning signs of dementia.
For information on navigating the aged care system — read our complete guide to palliative care in Australia.
The Bottom Line
Agitation and aggression in dementia are among the most challenging aspects of caring for someone with this condition — but they are almost always manageable with the right understanding, the right techniques, and the right support.
You are not alone in this. Thousands of Australian families are navigating exactly what you are navigating right now — and the collective wisdom of those families, combined with the expertise of professionals who work in this field every day, is genuinely extraordinary.
Stay calm. Find the trigger. Enter their world. Use music. Get outside. Accept help when you need it.
And above all — be kind to yourself. You are doing one of the hardest things a person can do. That matters.
Are you caring for someone with dementia? Share your experience in The Good Years Club community — your story could help another family navigating this for the first time 💙
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