Mood swings, anger, yelling & agitation in dementia: what helps

Dementia makes it harder to manage strong feelings. If the person believes they are in danger, the part of the brain that handles fear and anger can take over. Their reaction may look out of proportion, but to them the threat feels real.

This is why arguing or explaining rarely works in the moment. Calming the body and the room comes first.

• Feeling embarrassed about needing help with washing or the toilet
• Losing independence, like no longer driving or handling money
• Not being able to find the right words
• Not understanding what other people are saying or doing

Anger is often a cover for shame or fear. Protecting the person’s dignity prevents many outbursts.

Not recognising a person or place, or misreading what is happening, can be frightening. Some people also believe things that are not true, such as someone stealing from them, which can lead to angry accusations.

Because dementia makes it hard to say what is wrong, the behaviour itself becomes the message. Finding the need behind it is often the fastest way to calm things down.

Past experiences, including trauma such as having been hurt by someone, can shape what feels threatening now. Anniversaries of sad events, touchy topics or seeing someone they have a hard history with can also stir things up.

People with dementia may not be able to say they hurt, so pain can come out as aggression. The next section, “Is it pain? Spotting hidden hurt”, shows the signs to look for.

• Chest infections and urinary tract infections (UTIs)
• Constipation, which causes cramps and bloating
• Not drinking enough
• Wet or soiled underwear or pads

Poor sleep and being overtired make agitation more likely. Many people are calmest in the morning, so plan baths, outings and appointments then.

The Dementia: changes in behaviour guide has a full plan for sundowning and nights.

• A busy family gathering or a crowded shop
• Clutter and glare
• Loud TV, radio or several people talking at once
• Unfamiliar people, even at home

Too little going on can be a trigger too. Boredom and having nothing to do can build restlessness.

Being undressed or touched by someone, even a loved one, can feel frightening or shaming. Fear or distress during washing can also be a sign of pain.

What can help

• Explain each step before you touch them
• Keep them covered and warm with a towel
• Let them do what they still can
• Try again later if they refuse

Travel, a hospital stay, houseguests, a new caregiver or a move can all bring on agitation. Even a change in the order of the day can throw someone off.

Too many questions at once, rushing, or a sharp or irritated tone can set off a reaction. People with dementia often read our faces and voices more than our words.

• Keep your arms loose and your hand movements small
• Move slowly and stay where they can see you
• Sit down if they sit, so you aren’t standing over them
• Stand about an arm’s length away, turned slightly sideways

• Arguing, correcting or trying to reason
• Cornering, crowding or holding them back
• Criticising or showing alarm or offence
• Ignoring them, or making sudden moves
• Matching their volume or tone

• “I can see this is upsetting. I’m here.”
• “I’m sorry if I upset you. I’m here to help.”
• “I will stay until you feel better.”
• “Let’s take a break and have a cup of tea.”
• “You’re safe here.”

If the person is safe, leave the room and come back in 10 to 15 minutes to see how they are. A short break also gives you a moment to recover.

If they are upset because they don’t recognise someone, it may help for that “stranger” to leave the room for a while.

Insults often land on the closest person, which is usually the main caregiver. Try to hear the words as a sign of distress, the same way you would hear a cry.

Instead of… try…

• Instead of “Don’t talk to me like that!”, try “You sound really frustrated.”
• Instead of “You know that’s not true”, try “That sounds frightening. Let’s sort it out together.”
• Instead of “Calm down!”, try “I’m here. Let’s sit down a minute.”

Shouting or groaning that is new or getting worse can be a sign of pain. Calling out over and over can also come from boredom, loneliness or not knowing where you are.

Ideas to try

• Leave a note or say where you’ll be: “I’m in the kitchen”
• Offer company, a familiar voice or music
• Offer something for their hands to do

Busy places and big gatherings can overwhelm. If an outburst starts, help the person move to a calmer spot. A quiet word to others, such as “My dad has dementia”, is usually enough.

Music, gentle massage and exercise are among the relaxing activities experts suggest when someone is upset. Play songs from their younger years, quietly.

A walk, time in the garden or sitting outside can release tension. Regular walks during the day help prevent restlessness later.

• Folding towels or socks
• Sorting buttons, cards or photos
• Watering plants
• Wiping the table

Offering a favourite snack or a drink meets a possible need and gives a natural change of focus.

Reassuring touch, affection and a comfort object can ease distress, even when you can’t find the cause. Only offer touch if they are calm enough to welcome it.

A favourite TV show or a photo album can help. Avoid the news or anything violent or upsetting, since it may seem to be happening in the room.

• Cover or remove mirrors if they mistake their reflection for an intruder
• Keep exits and hallways clear of clutter
• Lock away car keys, guns, knives, scissors and tools

• Keep a clear path to the door, and stand nearest to it
• Put a table or bed between you if you need a barrier
• Stay an arm’s length away, turned slightly sideways
• Step back to a safe distance until it passes
• Don’t travel in the car with them until they are calm

• A code word for family and friends that means “I need help now”
• A “go bag” with a spare key, phone charger, snacks and important numbers
• A room you can go to and lock, such as the bathroom
• A charged phone you can reach

Use the “My safety plan” worksheet to write this down.

• Check whether anyone is hurt and get medical help if needed
• Keep the room calm and quiet, and your voice low
• Give the person time. Stress hormones can take 20 to 30 minutes or more to settle
• Expect them to be easily upset again for the next few hours
• Don’t remind them what happened or tell them off. It rarely helps
• Later, think about what set it off and what you can change

Normal noisy play can sometimes trigger distress. Make sure another adult is close by if there is any risk, and teach children to move away to a safe room if they feel worried or frightened.

Let children tell you what they find hard, and let their school know what is happening. The Sharing dementia care: family, kids & care staff guide has more.

• Count to 10 and take slow, deep breaths
• Say to yourself: “This is the illness, not them.”
• If they are safe, step out of the room for a few minutes

Every carer loses their temper sometimes. Once things are calm, a simple “I’m sorry, I love you” is enough. The person may not remember, but the warmth helps you both.

If you notice you are snapping more often, treat it as a sign you need more rest and help, not as a failure.

That was one carer’s advice in a study of families coping with agitation at home. Carers found that friends, family, support groups and breaks made them calmer and better able to care.

If you often feel frustrated or angry, talk with a doctor, counsellor or trusted friend.

Ask relatives to take regular shifts, look into adult day programs, or use respite care. The Eldercare Locator can connect you with local help.

The Caring for yourself as a dementia carer guide and the Managing anger day to day guide have more ideas.

Free and confidential, day or night, with help in more than 200 languages. Staff can help you understand and respond to behaviour changes, communication and safety. Callers who are deaf or hard of hearing can dial 711 for relay.

A free public service from the U.S. Administration for Community Living. It connects families with local agencies on aging for home care, respite, caregiver training and more. Phone lines are open weekdays, 8 a.m. to 9 p.m. Eastern.

The Alzheimer’s Association’s free online community, ALZConnected, lets caregivers share what has worked for them. Local support groups can help too.