Caregiver guide
Dementia and being mean to family: coping with agitation and aggression
When a person living with dementia becomes mean, angry or aggressive toward family, it's usually the disease talking. Pain, fear, confusion or an unmet need is often behind it. Finding the cause and staying calm can stop many outbursts before they start.
Why is my person with dementia being mean to family?
It hurts when someone you love yells at you, calls you names or pushes you away. It hurts even more when they're sweet to visitors and save the hard moments for you.
Aggression and dementia often go together because the disease damages the parts of the brain that control mood, judgment and self-control. Your person may no longer be able to say "I'm scared" or "my back hurts," so the feeling comes out as anger.
Family caregivers often get the worst of it because you're the safest person in their world. That doesn't make it okay, and it doesn't make it your fault. It does mean there are things you can do.
What is agitation and aggression in dementia?
Agitation means your person is restless, worried or can't settle down. You might see pacing, fidgeting, trouble sleeping or repeating the same words.
Aggression is when the person lashes out. It can be verbal, like shouting, swearing or insults, or physical, like hitting, pushing, kicking or throwing things.
Agitation often comes first. If you learn the early signs, you can step in before it turns into aggression.
What causes aggression in dementia?
Most outbursts have a trigger. Look for:
- Physical discomfort: pain, constipation, a full bladder, wet or soiled briefs, hunger, thirst, or being too hot or cold.
- Health changes: an infection, poor sleep, depression or a new medicine, or medicines that don't mix well.
- Too much going on: noise, clutter, a crowded room or a busy day.
- Change: a new place, a new caregiver, or a change in routine.
- Feeling pushed: being rushed through a bath, or asked to remember things they can't.
- Loss: missing the freedom to drive, work or make their own choices.
- Loneliness or boredom: not enough contact with people or too little to do.
If aggression starts suddenly, call the doctor. A urinary tract infection, pain or a medicine side effect can cause a quick change in behavior.
At what stage of dementia does aggression occur?
Aggression is most common in the middle to later stages of dementia, when communication gets harder and confusion grows. But it can show up at any stage, and some people never become aggressive at all.
Late stage dementia aggression often happens during personal care, like bathing, dressing or changing briefs, when the person doesn't understand what's happening and feels threatened.
How to calm an aggressive Alzheimer's patient
Stay calm and lower your voice
Speak slowly and softly. Keep your face relaxed and your hands open. Your person will often mirror your tone.
Give space
Step back to arm's length or more. Don't block a doorway or stand over them.
Listen and name the feeling
Try "You're upset" or "That sounds frustrating." Don't argue, explain or correct. Showing you understand is more calming than being right.
Look for the cause
Check for pain, a wet brief, hunger, thirst, noise or too many people. Fix what you can.
Redirect
Offer a favorite snack or drink, a familiar object, music, a walk or a simple task. Learn how music can help in Remember My Song.
Try again later
If a task like bathing set things off, stop and come back in 15 minutes or another day. Most tasks can wait.
How to prevent agitation before it starts
- Keep a steady routine. Bathing, dressing and meals at about the same time each day.
- Build in quiet time. Balance activities with rest.
- Let your person keep control. Offer simple choices, such as "the blue shirt or the red one?"
- Keep comforting things nearby. Favorite photos, a blanket or a familiar chair can help them feel secure.
- Lower the noise. Turn off the TV, cut down on clutter and limit visitors.
- Cut back on caffeine and sugar, especially later in the day.
- Watch the clock. If outbursts happen in the late afternoon or evening, read our guide to sundowning.
- Check your own stress. Our worry and hurry can rub off. Slow down, and find ways to take a break.
What to do with a violent dementia patient
Your safety comes first. If your person becomes physically aggressive:
- Step back and keep a safe distance until they calm down.
- Don't try to restrain them or argue.
- Move other people, especially children, and pets out of the room.
- Remove or lock away anything that could be used to hurt someone, including firearms, knives and car keys.
- If you or anyone else is in danger, call 911. Tell the dispatcher your person has dementia.
After things settle, write down what happened, when, and what came before it. Share it with the doctor. Some behavior can be eased by treating pain, an infection or a sleep problem, and the doctor can talk with you about other options.
If aggression comes with seeing or hearing things that aren't there, see our guide to hallucinations and paranoia.
When others don't believe you
Many caregivers say their person "pulls it together" for short visits from relatives or the doctor, then falls apart at home. It can feel like no one believes you.
Keep a short log of outbursts, and if it's safe, take a quick video to show the doctor. Ask to speak with the doctor privately, or send a note before the visit.
And please get support for yourself. The Alzheimer's & Dementia Resource Center (ADRC) offers free caregiver support groups where people understand exactly what you're living with. Our free Care Navigation sessions can help you build a plan for the hardest moments. If you need in-home help, adult day care or a dementia care community, our Information & Referral service can point you to local options.
Need to talk now, day or night? Call the Alzheimer's Association 24/7 Helpline at 800-272-3900.
Dementia aggression: common questions
Why is dementia aggression aimed at the spouse?
The husband or wife is usually the one helping with the most personal care and spending the most time together, so they're there when frustration boils over. The person may also not always recognize their spouse. It isn't a sign that love is gone.
Why is dementia aggression worse at night?
Tiredness, low light, shadows and a mixed-up body clock can all make evenings harder. This is often part of sundowning. More daylight and activity during the day and a calm evening routine can help.
Which dementia causes aggression?
Any type of dementia can cause aggression. Frontotemporal dementia often changes behavior and self-control early on. In Lewy body dementia, frightening hallucinations can lead to fear-driven outbursts. Ask the doctor what to expect with your person's diagnosis.
Is there medication for dementia aggression?
Doctors usually try other approaches first, like treating pain, infection or sleep problems and changing routines. If those aren't enough, the doctor may consider medicine. Some medicines carry serious risks for older adults with dementia, so ask about side effects and how long it should be used. Never start or stop a medicine without the doctor.
Do natural remedies or CBD help dementia aggression?
There isn't strong evidence that natural remedies or CBD calm aggression in dementia, and some products can interact with prescription medicines. Talk to the doctor or pharmacist before trying anything. Non-drug approaches like music, walks, routines and fixing discomfort are safe places to start.
Is sudden aggression a sign that dementia is getting worse?
Not always. A sudden change is often caused by something treatable, such as an infection, pain, constipation, dehydration or a new medicine. Call the doctor whenever behavior changes quickly.
How do I cope when my person says hurtful things?
Try to remember it's the disease speaking, not the person you know. Don't argue or take the bait. Step away if you need to, and talk it out later with a friend or a support group. Feeling angry or hurt doesn't make you a bad caregiver.
What are the symptoms of dementia aggression?
Watch for early signs like pacing, clenched fists, a raised voice, fidgeting, refusing help or a tense face. Later signs include shouting, swearing, threats, grabbing, hitting or throwing things. Catching the early signs gives you a chance to calm things down.
Download the free guide to agitation and aggression
Keep this one-page tip sheet from the National Institute on Aging handy. This page is based in part on National Institute on Aging guidance.
Free help for dementia caregivers in Central Florida
The Alzheimer's & Dementia Resource Center (ADRC) in Winter Park, Florida, offers free help for caregivers in Orange and Seminole counties. Call (407) 436-7750, Monday to Friday, 8:30 AM to 4:30 PM.