This article will focus on how to deal with dementia patients who are aggressive and combative.

With so many challenging behaviours dementia patients can display, it’s important to have the right strategies and approaches to manage the behaviour.  

There may be moments when dementia patients display anger outbursts within the care home environment or towards you personally. Understanding the triggers of challenging behaviour in dementia will help equip you deal the with situation more effectively.

Agitation may be triggered by a variety of things, including environmental factors, fear, and fatigue. Most often, agitation is triggered when the person experiences “control” being taken from him or her.

10 Tips On How to Deal With Dementia Patients Who Are Aggressive

1. Be prepared with realistic expectations

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

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

Looking around, you might notice that the room is starting to get darker because it’s early evening. The dim light causes shadowing in the corners of the room, making it seem like there are people in the corner.

After identifying that potential trigger, turn on the lights to get rid of the shadowy corners. That will hopefully help your dementia patient calm down. And, in the future you’ll know to turn on the lights before the room gets too dim as this may trigger paranoia within the patient.

3. Rule out pain as the cause of the behaviour

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

Many elderly adults with dementia aren’t able to clearly 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 patient gets upset, take a deep breath and stay as calm as possible. If you’re upset, that unintentionally continues escalating 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.

If appropriate, use a gentle and calming touch on the arm or shoulder to provide comfort and reassurance.

5. Validate their feelings

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

Try to look for clues to their emotions in their behavior and speak in a calm and comforting way. Reassure them that it’s OK to feel that way and that you’re there to help.

6. Calm the environment

Another factor to consider on how to deal with dementia patients who are aggressive is the environment.

A noisy or busy environment can be a trigger for aggressive dementia behaviour and anger outbursts.

If your patient begins to behave aggressively, take notice of the environment to see if you can quickly calm the room. Turn down any music, TV,’s and ask other people to leave the room.

7. Play their favorite music

Music can have an amazing effect on mood. Sometimes, singing an old favourite song, humming a soothing tune, softly playing relaxing classical music, or playing their favorite sing-a-long 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 patient 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 patient down.

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 might even forget that they’re angry.

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

10. Make sure you and your patient are safe and call for help in emergencies

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

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

In an emergency, call 999 and emphasise to the operator that the person has dementia, which is causing them to act aggressively. This helps let the emergency services know that the person isn’t behaving criminally and needs help to safely calm down.

When the emergency services arrive, make sure you again clearly state that this behaviour is caused by dementia.. That knowledge helps the emergency services treat them more appropriately.

If your patient needs to be removed from the home, ask that they be taken to a hospital or psychiatric institution rather than to a police station.

Assuming that you don’t want to press charges, make it very clear that this behaviour 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.

The Wrap Up

Hopefully use of these tips will help you on how to deal with dementia patients who are aggressive, combative or highly agitated. 

To learn more on how to deal with dementia patients who are aggressive or other challenging forms of behaviour, enroll in our accredited online managing challenging behaviour in dementia training.

Our training is great for your continuing professional development and provides you with full certification upon completion.