A dementia care plan for agitation should track the behavior, check for reversible causes, start with calm non-drug responses, and define when to seek help. Build it around a behavior log, clinical review, personalized routine, safety steps, and cautious medication criteria. Agitation is behavior that signals distress or restlessness and disrupts care or safety. The care plan is a written guide that helps caregivers respond consistently, measure results, and share useful observations with clinicians.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Table of Contents
- Record the pattern and set a goal
- Check for reversible causes
- Plan the everyday response
- Write a safety escalation plan
- Decide when medication enters the plan
Record the pattern and set a goal
Avoid vague descriptions such as "uncooperative" or "aggressive." CMS guidance recommends documenting the behavior's timing, setting, frequency, triggers, responses, and safety impact so the care team can identify patterns and establish a measurable goal. For each episode, record: Turn the pattern into a specific goal. For example: "Reduce agitation that interrupts the evening meal from five episodes a week to two within four weeks." Review the log regularly instead of judging success from one unusually good or difficult day.
- What happened before the behavior
- The time, place, and people present
- What the person did and how often it occurred
- What the caregiver tried
- Whether that response helped or worsened the distress
Check for reversible causes
Before treating agitation itself, ask a clinician to conduct a structured assessment. NICE advises checking for clinical and environmental causes before starting treatment, while continuing to consider non-drug approaches throughout management.
The assessment should consider: The behavior log can help the clinician connect symptoms with meals, personal care, medication timing, sleep, or particular settings. Add any identified cause and agreed response to the plan, then reassess if the behavior changes.
- Pain
- Delirium
- Medication effects
- Constipation
- Infection
Plan the everyday response
When there is no immediate danger, respond calmly, listen, and reassure the person. Do not argue about whether their concern is reasonable. The National Institute on Aging explains that agitation often has an identifiable cause and may express distress rather than intentional misconduct by the person with dementia.
The daily plan should reduce avoidable stimulation and preserve familiar patterns: For late-day agitation, sometimes called sundowning, maintain a daily schedule and provide daylight exposure and daytime activity. Avoid late caffeine, alcohol, and long late-day naps. Record whether fatigue or a disrupted routine appears before the agitation.
- Limit excessive noise and clutter
- Keep familiar objects nearby
- Use natural daylight
- Schedule bathing, dressing, and meals consistently
- Offer personalized activities that support engagement, pleasure, or interest
Write a safety escalation plan
The plan should state what caregivers will do if agitation becomes aggression. Secure dangerous items and keep a safe distance rather than attempting to argue or force cooperation.
Use clear escalation levels: Keep the clinician's contact information and the emergency number with the plan. Identify who will speak with responders and who will protect other household members or residents.
- If aggression is worsening, contact the person's clinician.
- If danger is present, move other people away and maintain a safe distance.
- If the situation is an emergency, call emergency services and disclose that the person has dementia.
Decide when medication enters the plan
Psychosocial and environmental measures should remain part of care even if medication is considered. NICE recommends reserving antipsychotics for severe distress or a risk of harm to the person or others. Prescribers should use the lowest effective dose for the shortest possible time and reassess treatment at least every six weeks. For adults with agitation associated specifically with dementia due to Alzheimer's disease, FDA-approved options include brexpiprazole and dextromethorphan-bupropion, also called Auvelity. The latter became the first approved non-antipsychotic option on April 30, 2026, according to the FDA approval notice.
These approvals do not establish treatment for agitation caused by every dementia type. Medication monitoring belongs in the written plan. Brexpiprazole retains an antipsychotic boxed warning about increased death risk in elderly people with dementia-related psychosis. Auvelity can cause seizures, hypertension, and mania or hypomania in susceptible people. Record the target behavior, review date, observed benefit, and suspected harm for any prescribed drug.
