For caregivers, the days feel longer and more challenging when a loved one with Alzheimer’s disease is agitated. They may spend hours restless, worried, or unable to settle down. Changes in their communication abilities make it difficult to express their feelings and needs verbally. This can feel frustrating and overstimulating, potentially leading to angry — sometimes violent — outbursts. Then begins the cycle of trying to de-escalate the situation and soothe them.
Agitation and aggression are often related to communication, orientation, and memory deficits as their brain changes with the progression of the disease. These experiences can be exhausting, disheartening, and at times, scary. But it’s important to understand that these behaviors usually aren’t a choice for someone with Alzheimer’s disease; they are not trying to be difficult or give their caregivers and family members a hard time.
In honor of National Brain Awareness week, the Alzheimer’s Caregivers Network asked the caregiving community to share their best tips for coping with agitated and aggressive behaviors.
Read personal experiences and advice directly from caregivers and experts themselves:
Caregiving Advice founder Michelle Seitzer says checking and adjusting the environment is one of the most immediate ways to ease a loved one’s agitation:
“Remove any potential sources of overstimulation, like loud music, TV programs that have stressful overtones (news, crime shows, movies with violence, tragedy, or trauma), bright lights, and clutter. Put on softer lights and soothing music. Or, change your location entirely; go outside or to a place in the house that seems to settle the person. Have a cup of tea or coffee and a cookie, something that’s filling, comforting, and requires slowing down and savoring.”
Michala Gibson, co-founder at Prairie Elder Care and Connectivities, says coping with aggression and agitation begins with checking in on unmet needs:
“When someone living with dementia is experiencing agitation or aggression, it can be a challenge to find out what’s causing it. The first thing I always recommend is asking yourself if basic needs are being met. Is the person hungry, thirsty, tired, in pain, or needs to use the restroom? Is something in the environment overstimulating them, such as loud music or TV, or is someone else in the room visibly upset? Also, check in with yourself – how are YOU doing as the care partner? Do you have an unmet need?”
Gibson suggests caregivers take a proactive approach when dealing with aggression or agitation:
“Often there are certain activities, times of day, or stimuli that you know may trigger these issues with your loved one, so it’s good to have a plan in place to deal with these events rather than waiting until they happen and reacting. For instance, if your loved one tends to get more agitated later in the day, plan a short rest early afternoon followed by an activity they enjoy. Music, movement (walking, exercising, dancing), baking, puzzles, or doing something hands-on with a loved one are great things to initiate proactively.”
She offers this advice for scenarios where aggression becomes a safety concern:
“There are cases where the aggression or agitation gets to the point that it is unsafe for the person living with dementia and/or the care partner. It is good to have a team in place before the situation gets to this stage. Care partners often avoid sharing this information to protect their loved one. This is when it becomes essential to make decisions based on what is best for everyone becomes essential. It may be time to consider whether non-pharmaceutical interventions are no longer sufficient, medications are introduced, or alternate living situations are explored.”
Bre’anna Wilson, Dementia Care Consultant for Bambu Care, encourages caregivers to support a loved one through episodes of agitation and aggression using de-escalation tactics:
“If your partner is ever upset and becoming increasingly agitated or aggressive, here are some quick tips to de-escalate a situation where a loved one with Alzheimer’s disease is upset:
- Give your partner space by standing away and off to the side.
- Make sure you know where the exit is, but do not block it.
- Relax your body and transition into an open stance.
- Talk in a calm, empathetic tone of voice.
- Validate your partner’s emotions and feelings.
If appropriate, apologize in a non-patronizing manner — you want the apology to be genuine. As tempting as it may be, do not touch your partner in an attempt to console them. It could make them more agitated, and they may even hit you.
She adds this advice for situations that escalate into a safety concern:
“If you ever feel unsafe, excuse yourself from the room. If you are fearful that your partner may harm you or themselves and they cannot be calmed, call 911 (or your country’s emergency #) and clearly explain — please always mention that your partner has dementia.”
Lauren documents her journey as a caregiver for her mother with dementia on her Instagram account. She shares some fun ways she engages her mom to redirect her agitation:
“My mom has recently been pacing inside and outside when she’s agitated. We started ‘coaching’ her to make small accomplishments using things she’s already doing. We say things like ‘take one lap around the chair,’ ‘two laps around the picnic table,’ ‘walk to the gate, the garage door, the fence,’ etc. She follows the directions and eventually calms down, and for whatever reason, it makes my husband and I laugh a little. Maybe because she marches with such pride — I’m not sure, but it’s a win-win, and we like those solutions. She also likes to throw things, so we got a bean bag toss game and basket pop & catch games to play outside for when she’s in those moods.”
When Patti LaFleur was a caregiver for her mother, these coping mechanisms helped soothe her when she was agitated:
“Distraction was a helpful coping mechanism with my mom. I would distract her from whatever was causing agitation by getting her to laugh or doing a favorite activity. Caregivers can also check the environment for triggers, reach out to a physical therapist or occupational therapist for a safety inspection, get help from a caregiver, plan respite stays, or look into a memory care facility.”
Adria Thompson, a Certified Dementia Practitioner, Dementia Consultant, and owner of Be Light Care Consulting, offers more de-escalation tips and advice:
“Often, once someone with dementia is upset, it can be very difficult to de-escalate them. Because aggression or agitation may be caused by an uncommunicated need, it’s important for caregivers to observe nonverbal communication carefully. There are often ‘tells’ when a problem exists. For example, when someone with dementia needs to go to the bathroom, caregivers may see over time that their loved one will consistently tug at their pants before getting upset. Figuring out these ‘tells’ will help caregivers meet their needs before they get upset.
However, this is not always possible. To de-escalate someone with dementia who may be feeling fear, it is important to clearly communicate that they are safe. Although it feels natural, caregivers who defend themselves or argue with the ‘unreasonable’ feelings of someone with dementia often make things worse. Instead, it’s important to make the person with dementia feel heard by reflecting on their feelings and then providing reassurance. This might look like saying, ‘You are upset. I made you so angry! I am so sorry. I will not do that again. You are safe.’”
It’s important caregivers talk to doctors and communicate what they are observing and the possible triggers or antecedents of these moments. It is possible that medications can assist, especially if they are becoming dangerous to themselves or their caregivers.”
Ashley, founder of The Dementia Guru, suggests caregivers take a step back when situations become overwhelming to work through their own anger and agitation:
“One tip for carers is to work through their own anger and agitation. Care situations and events can be so overwhelming and taxing, they can cause the carer to burn out or experience compassion fatigue over time, which can then lead to outbursts and unreasonable reactions to their loved one’s behavioral expressions.
“I’d encourage carers to take a step back at times, recognize the disease and de-escalate their own anger or frustration.”
Joan DiPaola, senior dementia care specialist at CareOne’s Paramus Harmony Village says caregivers can help minimize agitation by asking for permission before touching their loved one:
“One best practice to help minimize agitation and aggression in someone with Alzheimer’s is to ask for permission before touching them. This is especially important before performing invasive tasks like bathing or assisting someone in the restroom. When we take this step, we can deescalate their anxiety and begin to assess unmet needs. Another best practice is to empower people with dementia or Alzheimer’s to take care of themselves as long as they still can use their hands. A caregiver should never take away the person’s independence or ability to let them function at their best, particularly because if they do not use their cognitive abilities while they still have them, they will lose them.
“A strong coping mechanism is to make a habit of apologizing if you feel frustration heightening. Authentic apologies help to strengthen relationships by validating the person’s feelings. When we become frustrated, we must remember that the caregiver has to adapt to the needs of the person with Alzheimer’s. As a caregiver, you must constantly assess triggers and adjust to their needs accordingly.”
Kathy, elder suicide specialist and founder of The Caregivers Revelation, understands no two caregivers will have the same response to an agitated or aggressive outburst from their loved one:
“Aggression and agitation are different for everyone. You can have a room with a dozen caregivers watching the same situation unfold and have a different response from each caregiver.
“Each situation is unique to each caregiver and their loved one at that moment in time. I suggest the 5, 4, 3, 2, 1 method. Count back from five and take that time to regroup before engaging. If you’re able, take more time to process the situation and come up with a different idea that will be less stressful for your loved one as well as you, the caregiver.”
Christopher Smith of The Harvest Field on Instagram reminds caregivers that they need to share their experiences and connect over the challenge of dealing with the agitation and aggression of a loved one with Alzheimer’s disease:
“We all need a space to breathe and share. It’s comforting to know that others are just starting, in the midst of, or finishing up with the experiences you are going through. Supporting those who are about to come into the same experience offers you the opportunity to make someone’s life better because of your knowledge. Sharing with someone in the same place as you offers you the opportunity for an emotional hug — it’s kind of like an OK to have a pity party. Then there’s the place of understanding what’s to come by learning from others coming from a similar experience. It’s all sharing — it’s synchronistic and good.”
