Facing the Storm: How to Respond to Aggression and Inappropriate Behaviors in Dementia

Practical strategies for care partners

Aggression, inappropriate remarks, or belligerent behavior can be among the most difficult challenges for families and care partners of people living with dementia. When these behaviors arise, it’s natural to feel shocked, hurt, or frustrated — especially if they seem completely out of character.

The first step in responding well is to understand that these behaviors are symptoms of the disease, not a deliberate choice to be difficult. Dementia changes how the brain processes information, interprets the world, and reacts to stress. What looks like hostility may actually be fear, confusion, pain, or overstimulation.

Why These Behaviors Happen

Several changes in the brain can contribute to aggression, inappropriate behavior, or belligerence:

• Confusion and fear — Misunderstanding a situation can make a person feel threatened.

• Loss of impulse control — Damage to the frontal lobes can make it harder to self-regulate.

• Physical discomfort — Pain, constipation, infection, or other health issues can be expressed through agitation rather than words.

• Environmental triggers — Overcrowded spaces, loud noises, or unfamiliar routines can overwhelm the senses.

• Misinterpretation — Something as simple as a helping hand can feel like a threat if it’s unexpected.

Principles for Responding

1. Stay Calm — Even When It’s Hard

Your tone, volume, and body language can either escalate or de-escalate the moment.

• Take a deep breath before responding.

• Maintain a relaxed posture and avoid sudden movements.

• Lower your voice and speak slowly.

2. Prioritize Safety

If a situation feels unsafe for you or the person with dementia:

• Give them physical space.

• Remove any objects that could be used to harm.

• Step away and return when they are calmer.

3. Look for the “Why”

Behavior is communication. Identifying the trigger helps you prevent future incidents. Ask yourself:

• Are they in pain?

• Are they tired, hungry, or overstimulated?

• Is something in the environment distressing?

4. Avoid Arguing or Confronting

Logic rarely works in moments of heightened emotion — and arguing can make things worse. Instead:

• Acknowledge their feelings: “I can see you’re upset.”

• Redirect to a calming activity: music, a snack, a walk, or a familiar task.

5. Use Gentle, Clear Language

Short, simple sentences work best. Avoid sarcasm or complex explanations. Pair your words with reassuring facial expressions and gestures.

6. Reduce Triggers Before They Start

• Maintain a predictable daily routine.

• Limit loud or chaotic environments.

• Introduce changes slowly.

Addressing Inappropriate Behaviors

Some people with dementia may make socially inappropriate comments or engage in actions that feel embarrassing for family members.

• Stay composed — Overreacting can escalate the behavior.

• Redirect — Offer another topic of conversation or a different activity.

• Provide privacy when needed, such as for disrobing or other personal behaviors.

• Educate others — Help friends or visitors understand that the behavior is disease-related.

When to Seek Professional Help

Contact a healthcare provider or dementia specialist if:

• Aggression is frequent or severe.

• The person’s safety or the safety of others is at risk.

• You notice sudden changes in behavior — especially if they may indicate pain, infection, or medication side effects.

The Takeaway

Aggressive or inappropriate behaviors in dementia are not about malice — they are signals of unmet needs, discomfort, or changes in the brain’s ability to cope. By responding with calmness, empathy, and practical strategies, you can defuse tense situations, preserve dignity, and maintain safety.

When in doubt, remember: You can’t control the disease, but you can control the environment and your response.