Dementia & Aggressive Behavior: What to Do at Home

First: Keep Everyone Safe

• Create space. Step back, keep an exit path, and avoid cornering.

• Protect—not punish. Use a calm voice; open hands; neutral facial expression.

• Remove hazards. Move sharp objects; turn off stove; secure pets.

• If you’ve been hit or feel unsafe: leave the room, call for help, and re-approach later with support.

✨Call 911 if there’s immediate danger, serious injury, loss of consciousness, chest pain, signs of stroke, or a head strike (especially if on blood thinners).

De-escalation: What to Do in the Moment (90-Second Playbook)

1. Breathe & lower your voice. Speak slowly, one short sentence at a time.

2. Validate the feeling: “I see this is upsetting.”

3. Offer two simple choices (both acceptable): “Would you like tea or water?”

4. Change the environment: reduce noise, lower lights, turn off TV news, give personal space.

5. Redirect with purpose: “Could you help me fold these towels?”

6. Use the senses: favorite music, hand massage, familiar scent, soft blanket.

7. If needed, pause and reset. Try again in 5–10 minutes.

✨Avoid: arguing facts, “You’re wrong,” long explanations, sudden touch, blocking the exit, or more than two choices.

Find the Cause (Most Aggression Has a Trigger)

Run through this quick checklist after things are calm:

Medical & physical

• Pain (arthritis, dental pain, pressure area)

• Infection (UTI, pneumonia), fever, constipation, dehydration

• Vision/hearing problems amplifying confusion

• Medication effects (new meds, missed doses, sedatives, anticholinergics)

Daily needs & environment

• Hungry, thirsty, overtired, too hot/cold

• Overstimulation (noise, clutter, visitors) or under-stimulation (boredom)

• Privacy concerns during bathing/toileting; embarrassment

• Sundowning—symptoms rise late afternoon/evening

Emotional

• Fear, misunderstanding, shame, grief; feeling rushed or “bossed around”

Action: Fix what you can (snack, drink, bathroom, change room/lighting), then message the clinician about possible pain, infection, constipation, or medication review.

Gentle Communication That Works

• One step at a time. “Let’s stand up.” (Pause.) “Now we’ll walk to the chair.”

• Use names & roles. “Mary, it’s John—your son. I’m here to help you feel safe.”

• Explain while you do it. “The water is warm. I’ll wash your hair next.”

• Frame it as help for you. “Could you help me dry these dishes?”

• Scripts for hot spots

  • Bathing refusal: “Shower or warm washcloth? I’ll warm the bathroom. We’ll be quick.”

  • Wanting to “go home”: “You’re safe here with me. Let’s have tea, then we’ll call after lunch.”

  • Accusations (“You stole this!”): “That sounds frustrating. Let’s look together—maybe it’s in this drawer.”

Safety Setup at Home (Fast Wins)

• Clear pathways; remove throw rugs; add nightlights on bathroom routes.

• High-arm chair for safer sit-to-stand; table for glasses/ID bracelet.

• Lock or relocate knives/cleaners; use auto-shutoff appliances.

• Labels (large text + icons) for rooms/drawers; whiteboard with today’s plan.

• For sundowning: lights on before dusk, close curtains, soft music, simple task.

Build a Behavior Plan (So Everyone Responds the Same Way)

Track a few incidents using ABC notes (Antecedent–Behavior–Consequence):

• A (What happened before?) Noise? Bath time? Hungry?

• B (What did they do?) Shout, hit, kick, push?

• C (What helped?) Space, music, snack, validation, choice?

Then set a standard response the whole family/team will use:

• Trigger prevention: snack + hydration at 3 pm, quiet room before bath, lights on at 4 pm.

• De-escalation script: validation → two choices → redirect task → calming music.

• Call tree & roles: who steps back, who leads, who calls the nurse if it continues.

When to Call the Clinician or Home-Health Team

• New or worsening aggression, sudden confusion, fever, pain, constipation, poor intake, dehydration.

• Head strike, fall, or skin tears.

• Medication side effects (excess sedation, paradoxical agitation).

• Caregiver burnout—you need respite or in-home training.

Our nurses can check for medical issues, coordinate labs/MD visits, teach de-escalation, adjust routines, and work with your physician on safe treatment options. Medications for behavior are physician-directed; we avoid “chemical restraints” and monitor for side effects if meds are used.

Caregiver Safety & Self-Care (Non-Negotiable)

• If risk of scratching/biting, keep long sleeves available; remove necklaces/earrings.

• Position yourself at the person’s side, not face-to-face in tight spaces.

• Plan two 15–20 minute breaks daily; accept help (a neighbor sits in while you walk).

• After any incident, do a quick debrief: What worked? What will we change next time?

© 2025 MedPro USA Health Services. All rights reserved.

Our Support in Houston (Memorial & Greater Houston)

Caregivers (Private Pay): companionship, ADL support, calming routines, safety checks, evening/sundowning coverage, visit notes.
Nurses/Therapists: medical assessment (pain, infection, constipation, delirium), home safety plan, communication coaching, transfer training, care coordination with your physician.

Typical scheduling: morning start-ups, evening/sundowning, or overnights; 4–12-hour visits; short-term or ongoing.

Ready for a calmer plan at home?

Memorial & Greater Houston • 📞713-932-0017 ✉️Info@MPUHealthServices.com
🏠Address: 9219 Katy Freeway, Suite 207, Houston, TX 77024  🌐Web: mpuhealthservices.com