Dementia and Aggressive Behavior

Grabbing & Hitting: How To Respond

There are many reasons why people with dementia show aggressive behaviors like grabbing and hitting. Usually, they are not intentionally trying to hurt someone, but it’s their first instinct on how to communicate their feelings or protect themselves. The part of their brain that controls this reaction has been changed by dementia. Some reasons may include:

Caregiver helping with aggressive behavior
  • Feeling uncomfortable or in pain. For example, if they have become incontinent and need to change into clean clothes.
  • An unmet need, like hunger or fatigue.
  • Feeling surprised or overwhelmed by sudden movements or noises, moving too fast, or coming up behind them.
  • Feeling confused or frustrated. For example, if you say something in a way they don’t understand or they have to do an activity they don’t like.
  • Not wanting to do something, like taking medications.
  • Feeling sad or lonely.
  • Sudden changes in routine, place, or people.

Prevent It!

Regardless of the reason, aggression can be a big safety risk for caregivers. Experts
agree caregivers should try to prevent aggression as much as possible, like:

  • Help them feel as in control as possible. For example, letting them choose
    between two options.
  • Keep a consistent routine as much as possible. Consider small elements of the
    routine, like drinking from the same water cup for medications or sitting in the
    same place for meals.
  • Avoid overstimulation by building quiet times into the day. As much as
    possible, avoid loud sounds from music or appliances.
  • Use a gentle voice when speaking to them. Keep sentences short and simple
    and when possible, approach them from where they can see you.
  • Take a break and try again later when they refuse something.
  • Find ways to make activities enjoyable if they don’t like them. For example,
    playing their favorite song during shower time.

In The Moment

If you find your care recipient starts to become aggressive, try these techniques
in the moment:

Teepa Snow’s Technique: Offer A Trade

Teepa teaches that if your care recipient tries to grab you or something else,
offer them something they perceive as valuable or important to hold instead as
a distraction. Put the item close to their hand and say:

  • “Here, can I give you this? Let’s trade.”
  • “I need someone to hold my keys for me. Can you hold my keys for me?”
  • “I’m going to do some dishes soon. I don’t want my watch to get wet. Can you
    hold it?”

Move Into It & Don’t Resist

Our first instinct is to pull away when someone grabs our arms, hair, or clothing.
However, this makes them grab tighter. Try moving toward where they are
pulling to reduce the tension. If they grab your arm, try not to grab them back
and let your arm go limp. Speak softly, apologize, and do your best to reassure
them. As they calm down, ask them politely to release their grip on you and
offer to help.

The 4 R’s

  • Reassure. Use a calm voice to reassure them. You can say “It’s okay. I’m here.
    I’m not going to hurt you. I’m sorry. I’m going to take a few steps back, okay?”
  • Reorient. If they seem confused or very frustrated, orient them to where they
    are. You can say, “Look. We are in the bathroom brushing our teeth. Do you
    see the picture of the seahorse on the wall?”
  • Redirect their attention to a familiar object that may bring them comfort. You
    can say, “Let’s take the picture down from the wall so we can see it better.
    Seahorses are one of your favorite animals.”
  • Reminisce. If possible, try to connect the item to something they’ll remember
    from long ago. You can say “My favorite trip was when we went to the
    aquarium. We saw so many little orange seahorses.”

Once they’ve calmed down, ask yes or no questions to try to figure out the
cause of the behavior. You can ask, “Is it too hot in here?” or “Are you tired?”

Step Away, Come Back Later

If it’s safe, give them some space for a while to cool down. Needing to step
away doesn’t mean you’re a bad caregiver or you’ve done something wrong–it
happens to everyone, and can sometimes be the safest choice. Come back in
10-15 minutes and try again, considering where to adjust your approach.

Safety Tip

If you believe your care recipient is a danger to themselves or others, call 911. Explain that the person has dementia and is behaving aggressively.

Additional Resources

  • Elderly woman driving

    Care Chat: Dementia & Driving

  • Caregiver assisting senior man out of bed

    Dementia and Skills for Responding to Communication Changes

  • Two elderly men talking

    Dementia Caregiver Checklist

  • Link

    Dementia Companion Cards