November 11, 2021 by Dean Bellefeuille


Dementia aggression is one of the most difficult behaviors common in dementia, and it is also one of the most complex behaviors to manage as a caregiver. A senior who is usually level-headed can unexpectedly lash out in outbursts that are truly concerning: cursing, hitting, kicking, biting, yelling, or throwing things. How can you, as a family caregiver, safely help give them a sense of calm?

To start with, remind yourself that the aggression is a consequence of the disease. It’s not something the person can control, and it is not purposeful. That said, it needs to be diffused to keep both you and the older adult protected from harm.

The 6 R’s of Managing Difficult Behavior,” developed by Dr. Peter Rabins and Nancy Mace in their book The 36-Hour Day, can be a useful way to help. Go through and refer back to them so you are prepared for the next burst of dementia aggression.

The 6 R’s:

  • Restrict. Maintain a calm tone of voice and demeanor while you strive to help the senior disengage from the behavior.
  • Review. Take note in your journal what went well – or what did not – to aid in utilizing the most effective response as soon as the aggression arises again.
  • Reconsider. Empathize with the senior by imagining yourself struggling with a disease that impedes your ability to clearly communicate your wishes and needs, to accomplish tasks independently which were once so easy, to feel disoriented and confused, etc.
  • Reassure. Let the senior see that everything is ok and that you are there. In the event that the person responds positively to touch, place your hand on their shoulder, offer a hug or pat on the back, or take their hand in yours.
  • Redirect. Redirect the person to an activity the senior takes pleasure in, or relocate to a new environment, such as stepping out onto the front porch or going to the dining room together for a snack.
  • Reassess. Consider what could have provoked the incident. Triggers could include physical pain, an excessive amount of noise or other distractions in the room, hunger, thirst, fatigue, etc. Maintaining a journal of what was happening before and during each incident can help provide clues.

Understanding that aggression may spark up at any time in someone with Alzheimer’s, it’s helpful to evaluate the home space and take steps to ensure it really is as comfortable and calming as possible, for example:

  • Playing relaxing music the senior enjoys in the background.
  • Avoiding TV shows that may show violence or other unsettling images.
  • Placing familiar, comforting objects within quick access.
  • Opening the blinds during the day to allow plenty of day light to stream in.

At Home Independent Living is here for you as well with elder care in Memphis, NY and the nearby areas from specially trained providers who understand the complexities associated with dementia and how to best manage the related challenges. Contact us online or at 315-579-HOME (4663) for more information on our in-home dementia care for older adults.