When Mom Says “No!”: Managing Agitation in a Loved One with Dementia

One of the most challenging situations for families caring for a loved one with dementia is managing episodes of agitation and aggressive behavior. Caregivers are somehow expected to not only comfort and calm their loved one, but also to steady their own emotions. It is a task that can feel overwhelming, especially when stress and worry are running high.

What can help is to first recognize that agitation is a common and expected symptom of dementia. It often shows up as restlessness, pacing, irritability, or sudden bursts of anger or aggression. If you’re caring for a loved one who becomes agitated, you already know how deeply these moments can affect the quality of day-to-day life for both of you. Understanding the nature of agitation is the first step toward finding practical ways to ease it and protect your own well-being as a caregiver.

What factors might be driving heightened agitation in an individual with dementia?

The answer is often complex because a range of influences can play a role. Research shows that agitation in individuals with dementia or other cognitive conditions often arises from a combination of biological, psychological, and environmental factors. Key factors include:

• Neurochemical changes: Imbalances or disruptions in neurotransmitters, such as dopamine, serotonin, and norepinephrine can heighten irritability and emotional reactivity.
• Cognitive decline: Damage to brain areas that manage decision-making, impulse control, and emotional regulation may lead to impulsive or inappropriate behaviors.
• Environmental triggers: Sudden noises, unfamiliar surroundings, crowded spaces, or even subtle changes in daily routine can provoke stress and agitation.
• Unmet needs: Physical discomfort (like pain, hunger, or fatigue) or emotional needs (such as loneliness, anxiety, or boredom) often manifest as restlessness or agitation.
• Health-related factors: Infections, side effects of medications, dehydration, or other untreated medical issues can also contribute.

Understanding these overlapping causes can help caregivers identify potential triggers and respond with empathy and appropriate interventions.

The National Institutes of Health (NIH) has published some tips for family caregivers to help mitigate the negative impact of the above factors and keep their loved one more relaxed and secure. We’ve paraphrased and summarized five tips below:

1. Remain composed. Try to be patient and keep your voice calm. Listen carefully to your loved one’s concerns and avoid arguing. Offer reassurance that they are safe and that you are there to help. A gentle touch or other nonverbal cues can often be more soothing than words.
2. Manage your own stress. If you feel yourself getting upset, pause, take slow deep breaths, and count to ten before responding.
3. Create a peaceful environment. Maintain a consistent daily routine for bathing, dressing, and meals. Reduce noise and clutter, play soft music, and display familiar objects and favorite photos. Let in natural daylight whenever possible and be mindful that your own tension can increase their anxiety, so move at a relaxed pace.
4. Offer positive distractions. Redirect attention to a pleasant activity or object. Share a snack or drink, watch a favorite TV show, listen to music, take a short walk, read together, or involve them in a simple task such as folding laundry.
5. Ensure safety. Secure or hide car keys and any potentially dangerous items, including firearms and sharp kitchen tools. If aggression occurs, keep a safe distance until the behavior passes. If aggressive episodes worsen, consult a doctor about possible treatments. In an emergency, call 911 and let responders know your loved one has dementia.

We also encourage you to watch a recent Anthem Memory Care webinar focusing on managing behavioral challenges, conducted by dementia expert, Dr. Tam Cummings. You can watch the video here.

Caring for someone you love during moments of agitation and aggression is never easy. We know how exhausting and overwhelming it can feel to comfort and reassure them when you’re carrying your own stress, fatigue, or worry. It’s natural to feel stretched thin, and those feelings don’t mean you care any less. They simply mean you’re human. Remember to give yourself permission to pause, take a breath, and seek support when you need it. Caring for yourself is an essential part of caring for your loved one.

Bringing these approaches together creates a calm, supportive atmosphere where both you and your loved one can feel more secure. By staying patient, reducing stressors, offering gentle reassurance, and keeping safety a priority, you not only help ease moments of agitation but also nurture a sense of trust and comfort. Remember, small, consistent actions, your steady presence, a soothing environment, and compassionate communication can make a meaningful difference in your loved one’s well-being and in your own peace of mind. And, remember, we’re here to help! Many of our caregivers and administrators have experienced the challenges of family caregiving themselves and will be happy to share some insights and tips with you.