When dementia causes agitation, aggression, or other challenging behaviors, antipsychotic medications may seem like the only solution, but these powerful drugs come with serious risks for older adults. Before turning to pharmaceuticals, caregivers should explore safer, more compassionate approaches that address the root causes of distress.
From simple environmental tweaks to personalized calming techniques, these six evidence-based strategies can often reduce challenging behaviors without medication. Here’s how to help your loved one feel more comfortable and secure while protecting their health and quality of life.
Medication Can’t Always Solve Challenging Dementia Behaviors
When someone with Alzheimer’s or dementia has challenging behaviors like aggression, anxiety, or agitation, it can be exhausting and frustrating for caregivers.
The first solution that comes to mind might be behavioral medication, usually antipsychotics.
Unfortunately, these medications are typically not helpful.
We found a handy tip sheet created by the American Geriatrics Society (AGS) and Choosing Wisely that explains why antipsychotic medications for dementia aren’t recommended as the first choice for treatment – the risks often outweigh the benefits.
We explain why the AGS doesn’t generally recommend antipsychotic medications for dementia, share six non-drug ways to handle dementia behaviors, and explain when antipsychotics should be considered.
Why Antipsychotic Medications Aren't Recommended For Dementia?
1. Antipsychotic drugs don’t help much
According to the AGS, studies have found that antipsychotic drugs usually don’t reduce challenging behavior in older adults with dementia.
2. Antipsychotic drugs can cause serious side effects
Doctors may prescribe antipsychotic medicines “off-label” for use in treating dementia behaviors, but the FDA has not approved them for this purpose.
The side effects can be severe, and the FDA now requires the strongest warning labels on these drugs.
Side effects include:
- Drowsiness and confusion
- Increased falls
- Weight gain
- Diabetes
- Shaking or tremors (which can be permanent)
- Pneumonia
- Stroke
- Sudden death
VIDEO: Antipsychotics in Dementia Care with Dr. Liz
How to Handle Challenging Dementia Behaviors
In most cases, it’s best to try other approaches before using antipsychotic medications to manage challenging dementia behaviors.
1. Get a thorough physical exam and medication review
Having their doctor give a comprehensive exam and full medication review is a good first step to determining the cause of complex behavior.
Because people with dementia can’t communicate discomfort or needs, these behaviors may have a physical cause like constipation, infection, chronic pain, vision or hearing problems, or sleep problems.
Plus, many common medication side effects and combinations of medicines (due to drug interactions) can cause added confusion and agitation in older adults. That could lead to challenging behaviors.
2. Stick to a regular daily routine
If older adults lose their cognitive abilities, their world becomes filled with more unknowns.
Life can become even more stressful for those whose days aren’t structured because they may not know what to expect next.
A regular daily routine can reduce challenging behaviors, improve sleep, and reduce sundowning symptoms.
3. Help them exercise regularly
Regular exercise has many physical and mental benefits for all people, but can be especially helpful for older adults with dementia.
Exercise can slow cognitive decline, boost mood, burn off nervous energy, and improve sleep.
There’s even a home exercise routine that improves dementia symptoms. Get more exercise suggestions here.
4. Learn new communication skills
Something less obvious is that we need to learn new ways to communicate with someone with dementia.
Their cognitive abilities are declining, so our “normal” methods may not work well anymore and could cause conflicts.
For example, specific natural actions may unintentionally cause your older adult to resist help.
Try these tips to make sure they’re not startled by your attempt to help.
Additional dementia communication tips:
- Agree and use therapeutic fibs to go along with their reality rather than correcting them
- Respond in ways that reduce repetitive questions before you get too frustrated
- Use short, direct sentences to make understanding easier
- Increase your ability to handle false accusations
5. Keep them entertained with engaging, no-fail activities
Boredom can also contribute to challenging behaviors. Everyone needs something to do and a way to have fun and feel successful.
Helping older adults find activities that suit their current abilities and interests is a great way to boost their mood and self-esteem while reducing anxiety and agitation.
Some ideas:
- 10 Fun, No-Fail Activities for People with Dementia
- 6 Calming Ways to Help Seniors with Alzheimer’s Keep Hands Busy
- 6 Alzheimer’s Sensory Activities Reduce Anxiety without Medication
- Get more dementia activity ideas
6. Consider other types of medications
- Try FDA-approved medications for Alzheimer’s (that may also work for other dementias) to slow cognitive decline and reduce symptoms.
- If an older adult is depressed, treat with antidepressants.
When Antipsychotic Medications May Be Necessary
There may be situations where antipsychotic medications may be necessary.
- If other approaches haven’t worked
- Your older adult is severely distressed
- They could hurt themselves, you, or others
If an antipsychotic medication is used, use these tips for best results:
- Start at the lowest possible dose and increase a little bit at a time – the goal is to find the minimum necessary dose to keep behavior manageable
- Observe to see if your older adult improves
- Observe for side effects
If the medication isn’t working or causes side effects, let the doctor know right away so they can devise an alternate plan. Don’t stop or change doses without doctor approval.
Summary: When to Consider & When to Avoid Antipsychotics
- ✅ Consider antipsychotics if:
- Behaviors pose immediate danger
- Non-drug methods failed after 2+ weeks
- ❌ Avoid antipsychotics if:
- First-line solution (most cases)
- Side effects outweigh benefits (stroke risk ↑ 50% in dementia patients)
Have YOU ever pushed back against a doctor’s antipsychotic recommendation?
💬 Comment below on what worked—your story could help another family!”
Recommended for you:
- How to Talk to Someone With Dementia: Calm, Positive Body Language
- How to Talk to Someone with Alzheimer’s: Short, Direct Sentences
- 9 Must-Read Alzheimer’s Books for Caregivers
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.
I have always found that it is individualized care that works best. There is no one answer for everyone. Yet careful observation and analysis of the situation will let you know what works for that individual. Even people who have the same condition and are roughly at the same level will still react in their own way. When caring for someone like this you just have to go with the flow. One day I would be able to provide the care the next I would be like Hitler and totally repulsive to the individual.
I have a older friend that has this she loves doll are anything l make her she gets so excited when I can go see her
It’s wonderful that you’re able to bring your friend so much joy!
Antipsychotics are a good source to control symptoms with Parkinson’s plus history of Bi-Polar 1 with psychotic and hallucinating manic episodes. I was sure Parkinson’s had stopped any possibility of manic episodes due to the depression. A low dose stopped all ruminating psychosis and I agree low dose but don’t be afraid to control these behaviors. I still hide certain objects that tended to prompt these episodes I.e, Angel throw pillow that was my deceased mothers, war pictures he has PTSD as well so not good.
It’s great that you’re aware of his triggers and able to remove them from his environment. That’s a great way to reduce symptoms. It’s wonderful that doctors have found medications that work well to control symptoms from his health conditions.
Hi I work in a retirement home as a PSW in Canada. I am on an assisted living floor with a few residents with varying levels of dementia. One particular lady who is probably 99 pounds fights like a tiger when we shower her. It takes two PSW’s. She is given a medication about an hour before the shower but seems to help little. Is there any advice you can give?
Overcoming a fear or reluctance to bathe can be challenging. It often takes a bit of trial and error to find strategies that help someone feel safe and be more cooperative.
Here are some articles with techniques that may help:
– 7 Tips to Get Someone with Dementia to Shower https://dailycaring.com/7-tips-to-get-someone-with-alzheimers-to-take-a-bath/
– How to Approach Someone with Dementia: 6 Tips for a Positive Care Experience [Video] https://dailycaring.com/how-to-approach-someone-with-dementia-6-tips-for-a-positive-care-experience-video/
– 4 Ways to Get Someone with Dementia to Change Clothes https://dailycaring.com/4-ways-to-get-someone-with-dementia-to-change-clothes/
9-23-19 We have appt. for the 25th with Neurologist and I planned to speak to him about removing my husband from Quetiapine which he has been on for about 6 mos. He uses a walker and did not have good balance, and it is worse and with one of the detriments to this med being “falling” among those listed, I am considering
the removal of my husband from this drug. He sometimes falls 3x a day. He normally has sleep problems and that has become aggravated as well slurred speech. Thank you for this edition of Caring as it has answered a lot of questions one can’t get answers to unless they see their physician all the time. The drug has helped with his nasty outbursts at night, sometimes they last all night.
So glad you’ll be able to speak with the doctor about your husbands frequent falls, that can be dangerous. In the future, you can always call the doctor’s office as soon as a side effect starts happening. Hopefully the doctor will be able to find a solution that won’t cause falls, but will help with his symptoms.
These tips would work for someone with ALZ, but for someone with frontotemporal dementia, behaviors often become more bizarre and aggressive, though memories may still be fairly intact. I suggest that you deal with at least frontotemporal dementia separately, instead of bunching it together under the umbrella of “ALZ and dementia”. There is a significant difference – I speak from experience.
That’s true, each type of dementia is different and each person and situation will also be different. These suggestions may not work for every person or every situation. They’re intended to give people ideas for how they can manage challenging behaviors. When situations become too difficult or dangerous for families to handle on their own, it’s always helpful to engage professionals who have the expertise to help.