What is aggressive behaviour in dementia?

Caring for someone with dementia is emotionally demanding, and managing dementia aggression can be especially overwhelming. It’s normal to feel exhausted and frustrated when facing verbal or physical outbursts from a loved one.

This article explains the causes of aggression in dementia and provides practical tips to manage it with patience and care. You’ll also learn about care options that can support your loved one and your well-being throughout the process.

What does aggression in dementia mean?

Aggression in dementia refers to physical or verbal outbursts from the person suffering with the illness. It includes hitting, kicking, biting, yelling, saying insults, or making threats.

This challenging behaviour is distressing for both the person with dementia and their family.  An aggressive episode can result in serious consequences, including injury, hospitalisation, or the need for specialised care.

It also places a heavy emotional and physical burden on caregivers. It’s deeply painful and exhausting to be on the receiving end of anger or violence from someone you love — even when you understand it’s not their fault.

Many caregivers find the experience overwhelming, leading to stress, anxiety, exhaustion, and burnout. Caregivers also struggle with guilt, wondering if they’re doing enough or feeling like they’re failing when they can’t prevent aggression.

These feelings are understandable and don’t indicate failure on the caregiver’s part. Providing care, even under challenging circumstances, reflects deep commitment and compassion.

Aggression is also more common than most people realise, with one-third of patients experiencing it. Many families face similar challenges.

What are the causes of aggression in dementia?

Aggression in dementia is caused by factors like brain changes, frustration from communication difficulties, environmental stressors, and unmet needs such as hunger or pain. Medical issues like infections or medication side effects can also trigger aggression, especially in Alzheimer’s and other forms of cognitive decline.

Let’s explore these causes (and others) in more detail:

Developing symptoms of dementia

As dementia progresses, individuals become more vulnerable. They experience increasing confusion, memory loss, and difficulty with reasoning. These changes make it hard for them to understand what’s happening around them or why certain tasks are needed, like getting dressed or bathing.

When they can’t communicate their frustration or needs effectively, agitation, aggression and resistance may follow.

“We often observe distressed behaviours in patients who are experiencing significant confusion,” says Charlotte Jackson, Clinical Manager at Hometouch. “Waking in an unfamiliar environment, surrounded by unknown faces, can be deeply distressing. For some individuals, aggression is a response to that fear and confusion.”

“Waking in an unfamiliar environment, surrounded by unknown faces, can be deeply distressing. For some individuals, aggression is a response to that fear and confusion.”

Psychotic symptoms

Some forms of dementia (especially Lewy body dementia) are associated with psychotic symptoms like delusions, paranoia, or hallucinations. A person may believe someone is trying to harm them or may see and hear things that aren’t there.

This distorted reality can significantly increase agitation, lead to aggression, and compromise the safety of both the person with dementia and those around them.

For example, a person might think their caregiver is stealing from them or that strangers are breaking into the house. Feeling threatened, they may lash out physically or verbally to “protect” themselves.

Poor dietary intake

Malnutrition and dehydration can significantly worsen behaviour in people with dementia. When basic nutritional needs aren’t met, it can lead to low energy, irritability, and confusion, which increases the risk of aggression.

For example, if a person hasn’t eaten or had enough to drink, they may become restless, lash out, or refuse care without explaining why.

As Lucinda Ejiwunmi, Senior Clinical Manager (Nurse), at Hometouch explains:

“Even mild dehydration can have a huge impact on mood and cognition in people with dementia. We encourage families to keep a close eye on eating and drinking, as small adjustments here can make a meaningful difference.”

Research also shows that poor nutritional status can worsen behavioural symptoms in Alzheimer’s patients.

Other causes

Other common causes of aggression in someone with dementia include:

• Improper sleep. Lack of restful sleep or disrupted sleep cycles can contribute to confusion, irritability, and aggressive outbursts. People with dementia often experience changes in their sleep patterns, which can increase agitation and frustration.

• Fatigue. Excessive tiredness (whether due to poor sleep, overstimulation, or other factors) can make individuals more prone to outbursts and aggression. Fatigue reduces a person’s ability to cope with stress or confusion, leading to frustration.

• Pain. Unaddressed pain (whether from an underlying condition, an infection, or other illness) can cause significant discomfort and aggression in dementia patients. They may not be able to verbalise their pain, so aggression is a way of expressing distress. Discuss with a doctor or other healthcare professional if there’s any illness or pain that’s causing aggressive behaviour.

• Feeling unprotected. The involvement of a caregiver in daily tasks such as bathing, dressing-undressing, and helping with personal care makes the person feel insecure and helpless. The loss of independence may upset them and show in the form of aggression.

• Adverse effects of medication. Some medications used to treat symptoms of dementia or other health conditions can have side effects that worsen agitation or aggression. For example, certain antipsychotic medications or sedatives may lead to increased confusion or irritability.

• Impaired hearing or vision. When a person with dementia experiences changes in their hearing or vision, it can create confusion and make them feel unsafe, triggering aggression. Difficulty seeing or hearing can also contribute to heightened frustration when trying to communicate or interact with their environment.

• Feeling afraid. Dementia causes a person to feel disoriented and confused, which triggers fear. They may fail to recognise familiar places or people, leading them to react with aggression to defend themselves from perceived threats.

When does aggression start in dementia?

There’s no set timeline for dementia aggression stages. People with dementia can display aggression at any stage of the disease, meaning it can be unpredictable. However, the timing and type of aggression can vary depending on the type of dementia a person has.

For example, frontotemporal dementia targets the frontal and temporal lobes (areas responsible for personality, emotional regulation, and impulse control). This often leads to aggression early in the disease course.

By contrast, aggression from people with Alzheimer’s disease is more likely to appear in later stages. For Alzheimer’s patients, physical aggression is also associated with delusions and irritability.

“The specific region of the brain affected by dementia significantly influences how behaviour is expressed,” explains Adebola Adeyemi, Clinical Manager (Nurse) at Hometouch. “Dementia impacts more than memory; it alters how the brain regulates emotions, impulses, and basic functions.”

In most types of dementia, the aggressive symptoms occur when the patient becomes more dependent on daily activities. This can create a sense of helplessness; the inability to communicate and call for help can trigger anger and agitation.

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Coping with aggressive behaviour in dementia

Dealing with aggression in dementia can be challenging. It’s important to manage frustration and exhaustion, but there are effective strategies to help handle these challenging behaviours.

Here are some tips to help you deal with aggression in dementia:

• Give them space. Step back when your loved one is agitated to defuse the situation — sometimes they need privacy or a break from stimulation.

• Control your frustration. Stay calm, even if they lash out. Take a deep breath, lower your voice, and if necessary, step away briefly to regain composure.

• Keep the environment calm. Reduce noise and harsh lighting, which can overwhelm them. For example, switch off the TV, soften the lighting, or close curtains to create a peaceful space.

• Avoid raising your voice. Speak gently and steadily in your responses. Shouting often increases fear or confusion and can make aggression worse.

• Use soothing music. Play soft, familiar music to ease tension and calm agitation.

• Identify triggers. Pay attention to what causes aggression and remove or minimise those triggers. For example, if your loved ones struggle to remember where food items are in the kitchen, add labels to prevent frustration.

• Use calming communication techniques. Speak slowly and clearly with short sentences and give them time to respond. Try not to intervene to correct what they’re saying. Instead, acknowledge their feelings: “I can see you’re upset, I’m here to help.”

Supporting a loved one with dementia-induced aggression can be emotionally and physically draining. It’s just as important to care for yourself as it is to care for them. Caring for yourself helps you better support your loved one.

Find ways to care for yourself, like setting aside time to rest, reflecting on your own needs, or leaning on your support network. If caregiving is affecting your well-being, reach out to charities such as the Alzheimer’s Society.

Care options for people with dementia and aggression

When someone with dementia shows aggression, caregiving can become overwhelming. Choosing the right care option can ease this burden.

The right care setting can also reduce aggressiveness in dementia by providing trained staff, structured routines, and a calm environment tailored to the person’s needs.

“As someone who’s supported many families through this journey, I can’t stress enough how important it is to find the right care for a loved one with aggressive dementia. The right care doesn’t just help keep them safe and comfortable — it also gives families the breathing room and peace of mind they need to cope and stay strong.” — Dimple Chandarana, Head of Clinical Governance and Registered Manager at Hometouch.

The different care options for aggression in dementia are:

Live-in care for dementia aggression

Live-in care places a professional caregiver in the home, offering 24/7 support. Caregivers assist with daily tasks, offer companionship, and are trained to manage challenging behaviours like aggression with patience and understanding.

Live-in care works well for families wanting their loved one to stay at home but need professional support for handling aggression. This option also keeps the patient in a familiar environment, reducing confusion and anxiety (two contributors to aggression).

At Hometouch, our professional caregivers for dementia are experts in providing round-the-clock care.

They help patients with their daily tasks, provide companionship, and take them to social gatherings or doctor’s appointments. They are also trained to manage anger, agitation, and aggression in dementia.

Care homes for aggressive dementia patients

Dementia care homes and EMI (Elderly Medical Infirm) nursing homes are specialist nursing care homes that provide 24-hour care by specially trained professional staff. The carers are trained to manage and control different behaviours of dementia people including aggression.

However, many people with dementia may feel calmer and less agitated at home. Home-based carers provide tailored support to manage aggression, ensuring safety and comfort while reducing confusion.

“By staying in a familiar setting with a dedicated caregiver, many patients feel more at ease, reducing their anxiety and aggression.” — Tracey Chapman, Clinical Manager at Hometouch.

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Addressing dementia aggression with the right care options

Managing aggression in dementia is challenging, but understanding its causes and choosing the right care is key.

Hometouch offers professional live-in care for dementia patients, providing 24/7 support and tailored strategies to manage aggression. Our trained caregivers create a calm, familiar environment, ensuring the patient’s and family’s well-being. Contact us to learn how we can help you support your loved one.