How to Deal with Aggressive Dementia Behaviors: 14 Tips

Watching a loved one with dementia become suddenly angry, combative, or agitated can be heartbreaking and overwhelming. Aggressive behaviors like yelling, hitting, or refusing care often stem from fear, confusion, or an unmet need that they can no longer express.

While these outbursts are among the most challenging aspects of dementia care, there are proven ways to prevent, de-escalate, and respond with compassion.

This article shares 14 practical strategies dementia specialists use, from identifying hidden triggers to creating a calming environment. Remember, connection is possible, even in difficult moments.

10 Tips for Dealing With Aggressive Behaviors in Dementia

1. Be prepared with realistic expectations

Reminding yourself that challenging behavior and aggressive outbursts are typical symptoms of dementia helps you respond in a calm and supportive way.

Knowing that these episodes are a standard part of the disease reduces your shock and surprise when it does happen and may also make it a little easier not to take the behavior personally.

2. Try to identify the immediate cause or trigger

Think about what happened just before the aggressive outburst started. Something like fear, frustration, or pain might have triggered it.

For example, your older adult might start yelling at empty areas of the room and telling people to get out. You might notice the room getting darker because it’s early evening. The dim light causes shadowing in the room's corners, making it seem like people are in the corners.

After identifying that potential trigger, turn on the lights to eliminate the shadowy corners. That will hopefully help you, older adult, calm down. And, in the future, you’ll know to turn on the lights before the room gets too dim.

In another example, you could have unintentionally approached your older adult from behind and startled them. In a sensitive moment, that could make them feel attacked, so they lash out in what they perceive as self-defense.

3. Rule out pain as the cause of the behavior

Pain and physical discomfort can trigger aggressive behavior in someone with dementia.

Many older adults with dementia aren’t able to communicate when something is bothering them. Instead, being in pain or discomfort could cause them to act out.

Check to see if they need pain medication for existing conditions like arthritis or gout, if their seat is comfortable, or if they need to use the toilet.

4. Use a gentle tone and reassuring touch

When your older adult gets upset, take a deep breath and stay as calm as possible. If you’re upset, that unintentionally escalates the tense emotions in the situation.

Staying calm and breathing slowly helps to reduce everyone’s anger and agitation. Speak slowly and keep your voice soft, reassuring, and positive.

Use a gentle and calming touch on the arm or shoulder to provide comfort and reassurance.

5. Validate their feelings

If your older adult is aggressive and there isn’t an apparent cause, it could be because they’re having strong negative feelings like frustration, sadness, or loneliness, and don’t know how to express themselves adequately.

Look for clues to their emotions in their behavior and speak calmly and comfortingly. Reassure them that it’s okay to feel that way and that you’re there to help.

6. Calm the environment

A noisy or busy environment could also trigger aggressive dementia behavior.

If your older adult starts behaving aggressively, notice the environment to see if you can quickly calm the room. Turn the music volume down or off, and consider asking others to leave the room.

7. Play their favorite music

Music has an amazing effect on mood.

Sometimes, singing an old favorite song, humming a soothing tune, softly playing relaxing classical music, or playing their favorite sing-along tunes can quickly calm someone down.

8. Shift focus to a different activity

If the current or previous activity caused agitation or frustration, it could have provoked an aggressive response.

After giving your older adult a minute to vent their feelings, try to shift their attention to a different activity – something they typically enjoy.

9. Remove yourself from the room

In some cases, nothing works to calm the person.

If that happens, it may be best to leave the room to give them some space and to give yourself time to calm down and regain balance. They may be able to calm themselves or even forget they’re angry.

Before leaving, check to see that the environment is safe and the children are not likely to hurt themselves while you’re gone.

10. Make sure you and your loved one are safe, and call for help in emergencies

If your older adult can’t calm down and is becoming a danger to you or themselves, you’ll need help from others.

If the situation isn’t extreme and there’s a nearby family member or friend that your older adult usually responds well to, call and ask them to come over to help immediately.

In an emergency, call 911 and emphasize to the operator that the person has dementia, which is causing them to act aggressively. This helps first responders know that the person isn’t behaving criminally and needs help to calm down safely.

When first responders arrive, make sure you clearly state that this behavior is caused by dementia or even “a brain injury” (in case they’re not familiar with dementia). That knowledge helps first responders treat them more appropriately.

If an older adult needs to be removed from the home, ask them to be taken to a hospital or psychiatric institution rather than a police station.

Assuming that you don’t want to press charges, make it very clear that this behavior is caused by dementia (or “mental illness” – might be easier to understand) and not criminal behavior. That helps avoid formal charges or unwanted court proceedings.

Use Calming Techniques to De-Escalate Aggressive Dementia Behaviors

Some people with Alzheimer’s disease or dementia may enter a combative stage of dementia.

This is a regular part of the disease that's caused by the damage that’s happening in their brain.

It can happen even if your older adult’s typical personality has been kind and non-violent throughout their lives.

Because they’re not able to communicate their needs, people with dementia may lash out when they’re afraid, frustrated, angry, or in pain or discomfort.

These aggressive outbursts can be scary and difficult for caregivers to handle. Older adults could scream, curse, bite, grab, hit, kick, push, or throw things.

Since you feel attacked, your instincts might prompt you to argue and fight back, but that only worsens the situation.

We share 10 tips for dealing with aggressive behavior in dementia while it’s happening. We also explain four ways to learn from the situation to find ways to prevent or reduce future outbursts.

4 things to do After Dealing with Aggressive Behaviors

1. Learn from what happened

After giving yourself a chance to calm down and de-stress from the episode of aggressive dementia behavior, take a step back to see what you can learn from the situation.

Analyzing the situation also helps you take it a little less personally and makes it easier to think about what you could do differently next time to try to avoid an aggressive reaction.

Think about possible triggers, which responses helped calm things down, and which responses seemed to make the situation worse.

It often helps to take notes on your observations to see if you can spot patterns or figure out new ways to prevent a similar outburst in the future or cool things down if one does happen.

2. Find sources of support

It’s essential for your well-being to talk with people who understand and can help you cope with these tough situations and conflicting emotions.

Share your experiences with members of a caregiver support group, a counselor or therapist, or with supportive friends or family members.

Getting your feelings out is an important outlet for stress. Plus, you might get additional tips and ideas for managing aggressive dementia behavior from others who have dealt with it.

3. Consider medication

When non-drug techniques aren't working and challenging behaviors become too much to handle safely, it might be time to work with their doctor to experiment with behavioral medications carefully.

When used appropriately, medication can curb dangerous aggression and improve the quality of life for your older adult and yourself.

4. Consider moving your older adult to a memory care community

If the aggressive behavior in dementia continues to be dangerous and no interventions are working, it may be time to consider moving them to a memory care community.

A specialized care community can be helpful because multiple staff members are on duty 24/7, there is 24/7 supervision and care, and the staff is trained to handle these difficult situations.

Next Step  Get 7 ways to reduce and prepare for aggressive dementia behaviors

Recommended for you:

• Dementia and Anger: 9 Calming Strategies
• How to Understand and Manage Dementia Behaviors: A Comprehensive Guide
• 7 Ways to Reduce Aggressive Dementia Behaviors

About the Author

Connie Chow

Connie was a hands-on caregiver for her grandmother for 20 years. (Grandma made it to 101 years old!) She knows how challenging, overwhelming, and all-consuming caring for an older adult can be. She also knows how important support is — especially in the form of practical solutions, valuable resources, and self-care tips.