Managing Agitation in Dementia
Agitation is one of the most common behavioral challenges that caregivers face when supporting someone with dementia. It can show up as verbal outbursts, restlessness, pacing, or even aggressive behavior. Understanding what causes agitation and learning practical strategies to manage it can make a real difference in the daily life of both the person with dementia and their caregivers.
What Causes Agitation in Dementia
Agitation rarely happens without a reason. Most of the time, it signals that something is wrong or that a need is not being met. Common triggers include physical discomfort like pain or constipation, hunger, not getting enough sleep, loneliness, or feeling overwhelmed by too much noise or too many people around. Changes to familiar routines, places, or people can also spark agitation. Sometimes frustration builds when someone with dementia can no longer do something they used to do, or when they are pushed to remember something or perform a task that is now beyond their abilities.[1][4]
Medication interactions and depression or stress can also play a role. The key is to recognize that agitation is a form of communication. When someone with dementia becomes agitated, they are trying to tell you something, even if their words do not make sense or seem disconnected from what you think the problem might be.[2]
Identifying Triggers
One of the most useful things you can do is keep track of when agitation happens and what was going on at the time. Look for patterns. Does your loved one get upset at a certain time of day? After specific activities? Around particular people? Once you spot these patterns, you can often prevent agitation before it starts.[4]
For example, if someone gets agitated because they can no longer drive, you might store car keys somewhere they will not see them. If they become upset when routines change, keeping a consistent schedule for bathing, dressing, and meals can help them feel more secure and less confused.[4]
Ruling Out Physical Problems
Before assuming the agitation is purely behavioral, it is important to have a doctor check for underlying physical issues. Pain is a common culprit that people often overlook. Someone with dementia may not be able to tell you they are in pain, so agitation might be their only way of expressing it. Constipation, urinary tract infections, medication side effects, and other health problems can all trigger behavioral changes.[1]
Creating a Calm Environment
The physical space where someone with dementia spends time matters more than many people realize. A calm environment can prevent agitation from starting in the first place. This means using soft lighting, choosing muted colors for walls and furnishings, and keeping noise levels low. Loud alarms, blaring televisions, and background chatter can all increase agitation.[3]
Comfortable furniture, a cool bedroom temperature, and a generally peaceful atmosphere help someone with dementia feel safer and less overwhelmed. Simplifying the environment by removing clutter and unnecessary items also reduces confusion and sensory overload.[1]
Establishing Consistent Routines
People with dementia feel less anxious and confused when their days follow a predictable pattern. Setting regular times for sleeping, eating, bathing, and other daily activities creates a sense of security and helps them understand what to expect. These routines should be basic but flexible enough to handle difficult days while still accomplishing essential tasks.[2]
Visual schedules that combine pictures with written instructions can help someone with dementia better understand their daily sequence and what comes next. Consistency is calming, and it reduces the number of decisions and surprises that might trigger agitation.
Using Calm Communication
How you speak to someone with dementia matters just as much as what you say. Speaking slowly and using simple words helps someone with cognitive impairment understand your message without feeling overwhelmed. Your tone of voice should be calm and soothing, not rushed or frustrated.[3]
Listen to what your loved one is concerned about and try to address it, even if their worry does not seem logical to you. Acknowledging their feelings by saying things like “I see you are upset” or “It sounds like you are feeling frustrated” shows empathy and helps de-escalate tension.[3] Validate their emotions even when their perceptions are not grounded in reality. This builds trust and makes them feel heard.
Offering Choices and Control
People with dementia often feel a loss of control over their lives, and this can fuel agitation. Giving them manageable choices helps restore some of that control. Instead of saying “It is time to take a bath,” you might ask “Would you like to bathe now or in ten minutes?” or “Do you want to wear the blue shirt or the red shirt?”[3]
These small choices make a big difference in how someone responds. They feel more involved in decisions about their own care, which reduces resistance and agitation.
Redirection and Distraction
When agitation starts, direct confrontation usually makes things worse. Instead, try redirecting your loved one’s attention to something else. This might mean listening to music together, watching television, going for a walk, or engaging in an activity they enjoy.[4]
Distraction works because it shifts their focus away from whatever triggered the agitation. It gives them time to calm down while you work to understand what upset them in the first place. The goal is not to ignore the problem but to create space for emotions to settle before trying to address the underlying issue.[2]
Managing Sundowning
Sundowning is a specific type of agitation that happens in the late afternoon or evening. People with dementia become increasingly confused, restless, and agitated as the day goes on. To prepare for sundowning, make sure all basic needs are met before evening arrives. Maintain consistent daily routines, maximize daytime light exposure, and minimize stimulation in the evening.[1]
Offer calming activities as the sun sets, monitor sleep patterns, and ensure your loved one is comfortable. Limit caffeine and sugar after lunchtime, avoid alcohol, and keep the bedroom cool, quiet, and comfortable. Reducing noise from televisions, phones, and nighttime activity helps promote better sleep.[7]
Handling Refusal of Care
Sometimes people with dementia refuse help with bathing, eating, or other daily activities. This often stems from a loss of control, fear, or confusion about what is happening. Approach these situations gently and offer limited choices. Break tasks down into smaller, more manageable steps rather than trying to do everything at once.[1]
Use distraction to encourage cooperation. If someone refuses to bathe, you might suggest a warm shower while playing their favorite music. Be flexible with timing. If they are resistant in the morning, try again later in the day. Identify any underlying reasons for resistance, such as pain or discomfort, and adjust your approach accordingly.[1]
Medication and Professional Support
While behavioral strategies
