What is aggressive behaviour in dementia?

Caring for someone living with dementia can be emotionally challenging, especially when they display aggression. Outbursts, whether verbal or physical, can be distressing and difficult to understand. It’s important to remember that this behaviour isn’t personal. It’s a symptom of the condition, not a reflection of your loved one’s feelings toward you.

Aggression in dementia often stems from fear, confusion, or unmet needs. Understanding the causes behind these behaviours can help you respond with compassion and confidence.

Key insights:

• Aggression in dementia is a common symptom caused by fear, confusion, or unmet needs. It’s not intentional or personal.
• Identifying triggers such as pain, environment, or changes in routine can help reduce distress and prevent outbursts.
• Expert-led dementia care, guided by clinical specialists, provides calm, safety, and reassurance for families managing challenging behaviour at home.

Understanding aggression in dementia

Aggression in dementia refers to verbal or physical outbursts by someone living with the condition. These may appear suddenly or follow moments of frustration or confusion. Examples include:

• Verbal aggression: shouting, swearing, accusing, or threatening.
• Physical aggression: hitting, pushing, grabbing, or throwing objects.

Around 60% of hospital patients living with dementia have one or more BPSD symptoms (such as aggression, issues sleeping or eating and irritability). These behaviours are usually triggered by confusion, discomfort, or a sense of vulnerability – and they can occur at any point in the dementia journey.

What causes aggression in dementia?

Aggression in dementia often has several overlapping causes. Identifying and addressing these can make caring safer and less stressful for everyone involved.

Changes in the brain

As dementia progresses, memory loss and disorientation can lead to fear or frustration. A person might not understand why they’re being helped to dress or may no longer recognise their own home.

“When someone wakes up in an unfamiliar environment surrounded by faces they don’t recognise, it can be frightening. Aggression is often a fear-based response rather than an attempt to cause harm.”

Charlotte Jackson, Clinical Manager at Hometouch

Hallucinations or delusions

In some forms of dementia, such as Lewy body dementia, people may see or believe things that aren’t real. They might think their carer is a stranger or feel threatened, which can lead to defensive reactions.

Hunger or dehydration

Low food or fluid intake can quickly affect mood and cognition. Even mild dehydration can cause agitation or confusion.

“Small improvements in eating and drinking can make a big difference. Families should keep a close eye on hydration and nutrition.”

Lucinda Ejiwunmi, Senior Clinical Manager at Hometouch

Pain or physical discomfort

Pain from arthritis, infection, or other illnesses can lead to agitation, especially when the person struggles to express how they feel. If your loved one becomes more aggressive, speak with a healthcare professional to rule out physical causes.

Environmental or emotional triggers

Loud noises, clutter, bright lighting, or changes in routine can cause distress. Fatigue, lack of sleep, or feeling unprotected during personal care can also trigger aggressive behaviour.

Medication effects

Some medicines prescribed for dementia or other conditions can increase confusion or restlessness. Always speak to a GP or pharmacist before changing any medication.

When does aggression start in dementia?

Aggression can appear at any stage, depending on the type of dementia. For example, frontotemporal dementia can cause early personality changes, while aggression in Alzheimer’s disease often appears in later stages alongside confusion or delusions.

“The areas of the brain affected determine how emotions are expressed. Dementia doesn’t just impact memory – it alters how a person experiences and controls emotion.”

Adebola Adeyemi, Clinical Manager (Nurse) at Hometouch

If aggression increases, it can indicate that communication or environmental changes are becoming harder to manage.

Safety planning for caregivers

Your safety and your loved one’s well-being are equally important. During an episode of aggression:

• Stay calm. Keep your tone gentle and your body language relaxed.
• Give space. Step back and allow time for emotions to settle.
• Remove hazards. Move sharp or heavy objects out of reach.
• Plan an exit. Know where to go if the situation escalates.

If you ever feel unsafe, leave the room and seek help. In an emergency, call 999 or contact your local crisis service.

Treatment and support options

Doctors may sometimes recommend short-term medication to help manage severe agitation or psychosis, but non-medical approaches come first. Treatment usually focuses on understanding triggers and creating a calm, consistent routine.

Always discuss any treatment with a qualified healthcare professional before making changes.

Practical ways to manage aggression

Managing aggressive behaviour takes time and patience. These approaches can help prevent escalation and support calm communication:

• Stay composed. Deep breaths and a soft tone can diffuse tension.
• Use simple language. Short, clear sentences work best.
• Acknowledge emotions. Phrases like “I can see you’re upset” can help the person feel understood.
• Reduce noise and light. A calm environment promotes reassurance.
• Track patterns. Note when or where aggression happens most often.
• Use familiar comforts. Music or gentle activities can restore calm.

Caring for someone who shows aggression can be draining. Take breaks, reach out for help, and connect with organisations like the Alzheimer’s Society for guidance and emotional support.

Care options for people with dementia and aggression

When behaviour becomes difficult to manage alone, professional care can provide structure and reassurance for both you and your loved one.

Live-in dementia care

Live-in care places a trained professional in the home, providing one-to-one support and continuous reassurance. Staying in familiar surroundings helps reduce confusion and distress – two key triggers of aggression.

At Hometouch, our doctor-founded dementia care service is led by clinical experts. Every carer receives specialist dementia training and is supported by a Clinical Manager to ensure safety, consistency, and comfort.

Specialist care homes

Some families choose specialist dementia or EMI nursing homes when safety becomes difficult to maintain at home or when complex medical needs arise.

“For many, home care provides the security of a familiar setting. But for others, a structured environment with round-the-clock clinical oversight may be essential.”

Tracey Chapman, Clinical Manager at Hometouch

The right choice depends on your loved one’s needs, home environment, and family circumstances. Learn more about changes in behaviour in our article on rapidly progressive dementia.

Finding Confidence in Care

Aggression in dementia is challenging, but it can be managed with the right understanding, structure, and professional support. Recognising the causes and responding with empathy can transform how families experience care.

At Hometouch, we provide expert-led dementia care at home, combining clinical knowledge with compassionate support. Our carers are specially trained to manage challenging behaviours while maintaining comfort, dignity, and safety in familiar surroundings.

Talk to one of our care experts to learn how we can help your family feel confident and supported every step of the way.