3 Stages of Dementia: What to Expect as the Disease Progresses – DailyCaring
Managing Behavioral Issues in Dementia Patients
Behavioral and psychological symptoms of dementia (BPSD) — such as agitation, aggression, wandering, hallucinations, and sundowning — are common, often triggered by unmet needs, environmental stressors, or disease progression Supportive Care+1. Effective management requires a person‑centered, non‑pharmacological approach that addresses both the person and their environment.
1. Identify Triggers and Causes
- Medical causes: pain, infections, constipation, hunger, thirst, fatigue, or sensory impairments Supportive Care+1.
- Environmental factors: noise, glare, clutter, sudden changes in routine, unfamiliar surroundings Alzheimer’s Association+1.
- Psychosocial factors: fear, loneliness, misperceived threats, or loss of independence Supportive Care+1.
A thorough medical checkup is essential, especially if symptoms are new or severe Alzheimer’s Association.
2. Create a Calm, Safe Environment
- Reduce overstimulation: limit background noise, clutter, and distracting visuals Alzheimer’s Association.
- Maintain a familiar, consistent routine to reduce confusion helpdementia.com.
- Ensure comfort: regulate temperature, provide privacy, and use security objects if needed Alzheimer’s Association.
3. Respond with Calm, Positive Communication
- Use calm, clear, and simple language; avoid confrontation Alzheimer’s Association.
- Offer choices (“Would you like tea or water?”) to give a sense of control Alzheimer’s Association.
- Reassure frequently: “You’re safe here,” “I’m sorry you’re upset,” “I’ll stay with you until you feel better” Alzheimer’s Association.
- Listen to expressed frustration and validate feelings Alzheimer’s Association.
4. Address Unmet Needs Promptly
- Check for pain, hunger, thirst, bladder/bowel needs, and skin irritation Alzheimer’s Association+1.
- Provide gentle physical comfort if needed.
5. Use Structured Activities and Sensory Stimulation
- Gentle exercise (walking, gardening) to reduce restlessness Alzheimer’s Association.
- Music, familiar voices, or guided reminiscence to engage and comfort Alzheimer’s Association.
- Simple, repetitive tasks to provide structure and reduce anxiety helpdementia.com.
6. For Agitation and Sundowning
- Avoid sudden changes in environment or routine Supportive Care.
- Use dim lighting in the evening and maintain a consistent sleep schedule Supportive Care.
- Offer calming activities or guided choices to redirect focus Alzheimer’s Association.
7. Caregiver Self‑Care
- Behavioral issues can be exhausting; caregivers need breaks, support, and respite helpdementia.com.
- Training in dementia‑specific communication and de‑escalation techniques can improve outcomes Supportive Care.
8. When to Consider Medication
- Only after non‑pharmacological strategies are in place and under medical supervision Alzheimer’s Association.
- Options may include low‑dose antipsychotics for severe, persistent symptoms, but with careful risk‑benefit assessment.
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- Sleep Issues & Sundowning occurs in late afternoon through the night, causing confusion and …
- Anxiety &Agitation may be caused by a number of different medical conditions, …
- Accepting The Diagnosis Coming to terms with a diagnosis of Alzheimer’s or other dementia requires …
- Wandering among people with Alzheimer’s and other dementias is dangerous – find …
- Early-Stage Caregiving for people with Alzheimer’s and other dementias — get …
- Late-Stage Caregiving for people with Alzheimer’s and other dementias – learn …
- Hallucinations may occur in people with Alzheimer’s or other dementias – learn …
- Memory Loss & Confusion behavior may occur in people with Alzheimer’s or other …
- Caregiver Depression: Symptoms & How to Cope | alz.org
Key takeaway: Understand that behaviors often signal unmet needs or distress, not just “bad behavior.” By combining environmental adjustments, empathetic communication, and proactive care, you can reduce agitation, improve safety, and preserve dignity. Supportive Care+2.
Coping With Agitation, Aggression, and Sundowning in Alzheimer’s Disease
People with Alzheimer’s disease may become agitated or aggressive as the disease gets worse. Agitation means that a person is restless and worried, and they aren’t able to settle down. Agitated people may pace a lot, not be able to sleep, or act aggressively toward others.
They may verbally lash out or try to hit or hurt someone. When these problems start to happen or worsen in the late afternoon or early evening, it’s called sundowning. On this page, learn about the causes of agitation, aggression, and sundowning and how to manage them.
Causes of agitation and aggression
Most of the time, agitation and aggression happen for a reason. When they happen, try to find the cause, then talk with a health care provider about possible solutions.
Causes of agitation and aggression can include:
- Pain, depression, or stress
- Too little rest or sleep
- Constipation
- Sudden change in a well-known place, routine, or person
- A feeling of loss — for example, the person may miss the freedom to drive
- Too much noise or confusion, or too many people in the room
- Being pushed by others to do something — for example, to bathe or to remember events or people — when Alzheimer’s has made the activity very hard or impossible
- Feeling lonely and not having enough contact with other people
- Certain medications or interactions between two medications
A doctor can give the person with Alzheimer’s a medical exam to look for any physical problems that may cause agitation and aggression, and in certain cases, may prescribe medication to ease the symptoms.
Tips for coping with agitation or aggression
Here are some ways you can help minimize and cope with agitation or aggression:
Read and share this infographic about how to communicate with a person who has Alzheimer’s disease.
- Be patient and try not to show frustration. Speak calmly. Listen to the person’s concerns and avoid arguing. Reassure the person that they are safe, and that you are there to help. Use other communication methods besides speaking, such as gentle touching, to help them calm down. Take deep breaths and count to 10 if you get upset.
- Create a comforting home setting. Try to keep to a routine, such as bathing, dressing, and eating at the same times each day. Reduce noise and clutter. Play soothing music and keep well-loved objects and photos around the home. Let in natural light during the day. Slow down and try to relax if you think your own worries may be causing concern.
- Try focusing on an object or activity. Distract the person with a snack, beverage, or activity. You could watch a favorite TV show, listen to music, go for a walk, read a book, or do a household chore, such as folding laundry, together.
- Protect yourself and others if needed. Hide or lock up car keys and items that could be used in a harmful way, such as guns and kitchen knives. If your loved one becomes aggressive, stay at a safe distance until the behavior stops. Talk to a doctor if aggressive behaviors worsen and consider medications that may help. In an emergency, call 911 and explain that your loved one has dementia.
Sundowning: Avoiding Late-Day Confusion
When restlessness, agitation, irritability, and confusion happen as daylight begins to fade, it’s known as sundowning. Being overly tired can increase late-afternoon and early-evening restlessness. Try taking these steps with the person living with dementia to help prevent sundowning:
Stick to a schedule.
Arrange a time to go outside or sit by a window to get sunlight each day.
Aim to be physically active each day, but don’t plan too many activities.
Avoid alcoholic drinks and beverages with caffeine, such as coffee or cola, late in the day.
Discourage long naps and dozing late in the day.
You may also be interested in
- Reading more about managing behavior changes in Alzheimer’s
- Playlist for those with dementia behavioral issues – Search Videos
- Finding resources for help with Alzheimer’s caregiving
- Exploring ways to take care of yourself as a caregiver
For more information
NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center
800-438-4380
adear@nia.nih.gov
www.nia.nih.gov/alzheimers
The NIA ADEAR Center offers information and publications for download (PDF) about Alzheimer’s and related dementias for families, caregivers, and health professionals. ADEAR Center staff answer telephone, email, and written requests and make referrals to local and national resources.
Alzheimers.gov
www.alzheimers.gov
Explore the Alzheimers.gov website for information and resources on Alzheimer’s and related dementias from across the federal government.
Eldercare Locator
800-677-1116
eldercarelocator@USAging.org
https://eldercare.acl.gov
Alzheimer’s Association
800-272-3900
866-403-3073 (TTY)
info@alz.org
www.alz.org
Alzheimer’s Foundation of America
866-232-8484
info@alzfdn.org
https://alzfdn.org
Family Caregiver Alliance
800-445-8106
info@caregiver.org
www.caregiver.org
National Respite Locator Service
www.archrespite.org/respite locator
This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.
Bottom line: A combination of identifying triggers, creating a calm and familiar environment, meeting physical and emotional needs, and using compassionate communication is the most effective approach to managing behavioral issues in dementia patients. This not only improves the patient’s quality of life but also supports the caregiver’s well‑being.
Dealing With the Root Cause Aggressive Behavior in Dementia Patients – Search Videos
5 Dementia Behavior Strategies That Feel Wrong But Actually Work