This page is part of PrimeCarers' guide to dementia care. It answers one question: why a person with dementia becomes agitated or aggressive, and what to do about it.
The short answer
- Rule out pain and illness before anything elseNICE tells clinicians to look for a clinical or environmental cause of distress before any treatment starts. At home that means pain, constipation, infection and the toilet.
- A change over a day or two is not the dementia moving onThe NHS advises going to A&E or calling 999 if someone suddenly becomes confused, and names urinary infections as a common cause in people with dementia.
- In the moment, do less rather than moreStep back, give them room, lower your voice, and agree with the feeling rather than correcting the facts.
- None of it is aimed at you, and you should not absorb it aloneYour own safety comes first, and a carer booked for the hardest hour of the day is a reasonable answer.
Checked against NICE guideline NG97, the NHS, the Alzheimer's Society and Dementia UK, September 2026. Prices are what carers on PrimeCarers charge, with our fee included.
What to rule out first
Look for pain, infection or the toilet before anything else
NICE guideline NG97 says that before any treatment for distress is started, a structured assessment should explore the possible reasons for it and check for and address clinical or environmental causes, giving pain and delirium as its examples. Somebody who can no longer say that their hip hurts has very few ways left to tell you.
Work through this before deciding it is the dementia
0 of 9 ticked
Pain and the body
Medicines and the senses
What changed recently
Pain is worth taking seriously on its own. In a trial published in the BMJ in 2011, 352 care home residents with moderate to severe dementia and significant behavioural disturbance were randomly assigned either to a stepwise pain treatment programme for eight weeks or to their usual treatment. Agitation scores in the treated group fell by an average of 17 per cent against the control group, and aggression improved as well. That says nothing about your own relative, but it does make treating pain properly a sensible first move.
What sets it off
What the behaviour is asking for
The Alzheimer's Society puts it plainly: aggressive behaviour can be a symptom of dementia itself, but it is more likely that there is another cause, and that the person is trying to stop feeling distressed. Read that way, shouting and hitting out are a form of communication left to somebody who has run out of words.
Something in the body
The group to work through first, because it is the one with a treatment.
What you see
Lashing out when being helped to move, stand or wash
What it can be asking for
Pain somewhere they cannot name or point to, such as a hip, a tooth, a pressure sore or a swollen joint
The first thing to try
Ask the GP about pain relief taken regularly for a fortnight rather than only when someone asks for it
What you see
Pacing, pulling at clothes, unable to sit for more than a minute
What it can be asking for
Needing the toilet, or constipation that has been building for days
The first thing to try
Offer the toilet at set times rather than waiting to be asked, and tell the GP how many days it has been
What you see
Confusion and anger that came on over a day or two, unlike them
What it can be asking for
A urine or chest infection, dehydration, or a reaction to a new medicine
The first thing to try
Ring the GP the same day, and follow the NHS advice below if the confusion came on suddenly
What you see
Short temper late in the morning or before a meal
What it can be asking for
Hunger, thirst or tiredness that they can feel but cannot put into words
The first thing to try
Bring the meal or the drink forward, and keep something easy to eat within reach
Something in the room
Changes here cost nothing and can be made this afternoon.
What you see
Getting worse as the light goes, wanting to leave or go home
What it can be asking for
Shadows and half-light making a familiar room look unfamiliar
The first thing to try
Put the lamps on and close the curtains before dusk rather than after it
What you see
Shouting or covering their ears when the house is busy
What it can be asking for
Too much happening at once: the television, a conversation and two visitors
The first thing to try
Turn one thing off, and keep visitors to one or two people at a time
What you see
Distress in a place they do not know, such as a waiting room
What it can be asking for
Nothing in sight they recognise, and no way to work out why they are there
The first thing to try
Bring something familiar, book appointments for their better time of day, and say where you are going as you arrive
Something about the task
Washing, dressing and using the toilet are the flashpoints families describe most.
What you see
Hitting out or refusing at the bathroom door
What it can be asking for
Being undressed by somebody feels exposing, and they may not have understood what is about to happen
The first thing to try
Say each step before you do it, keep the room warm, and stop at the point they agree to rather than finishing the whole wash
What you see
Anger when asked a direct question about today or yesterday
What it can be asking for
Being asked to produce a memory that is no longer there
The first thing to try
Take the question away. Talk about what is in front of you both instead
What you see
Refusing help with something they used to do themselves
What it can be asking for
Losing a job that was theirs, in front of their own family
The first thing to try
Hand back the part they can still do, even if that is one button or one plate
Something they are feeling
The hardest group to see from the outside, and the one that rarely responds to being corrected.
What you see
Accusing you of stealing, or of being somebody else
What it can be asking for
Fear and a gap in the story they are trying to fill
The first thing to try
Agree with how frightening that would be, help them look, and let the accusation go without defending yourself
What you see
Distress when you put your coat on or a visitor leaves
What it can be asking for
Not being able to hold on to the fact that you are coming back
The first thing to try
Say when you are back in terms of the day rather than the clock, and leave while somebody else is with them
What you see
Restless, irritable, nothing to do all afternoon
What it can be asking for
Boredom and the loss of anything that felt like their own job
The first thing to try
Offer one familiar activity at the same time each day rather than something new each time
These are the causes named by the Alzheimer’s Society, Dementia UK and NICE, grouped by where the distress comes from. One behaviour can have more than one cause at once, and the same behaviour can mean something different on a different day.
Three patterns have their own pages. If the agitation builds in the late afternoon, that is sundowning. If the restlessness takes the form of getting up to leave, wandering and leaving the house covers keeping someone safe without locking them in. Where personal care is the flashpoint, when someone with dementia refuses care goes into the washing and dressing battles in more detail.
Boredom belongs on the list too, and it is something a family can change the same week. NICE recommends that people with dementia who experience agitation or aggression are offered personalised activities to promote engagement, pleasure and interest. Activities for someone with dementia groups ideas by what they help with.
While it is happening
What to do while it is happening
Nothing you say to somebody who is frightened and angry is going to be taken in, so the aim is to take the pressure off until the feeling passes. The order below follows the advice the Alzheimer's Society and Dementia UK give to family carers.
- 1
Stop what you are doing and give them room
The first few secondsThe Alzheimer's Society advises taking a deep breath, stepping back to give the person space, and taking some time. Standing close and carrying on is what turns resistance into a struggle. - 2
Lower your voice and slow down
As you speakDementia UK suggests trying not to mirror the person's emotions or behaviour, and speaking in a low, steady tone. Short sentences, with a pause long enough for an answer. - 3
Agree with the feeling, not the facts
Instead of correctingIf your mother says her purse has been stolen, the useful reply is that it is horrible to think something has gone and you will help her look. Telling her nobody has been in the house asks her to accept that her own account is wrong. - 4
Change something in the room
Rather than argueTurn the television off, put a lamp on, or move somewhere quieter. Dementia UK suggests moving to a calmer place if the surroundings are causing the distress. - 5
Leave the task and come back to it
Later, or tomorrowA wash that is half done is not a failure, and very little has to happen at the hour you planned it. Coming back in twenty minutes is a decision, not giving in.
Keeping yourself safe
Keeping yourself safe, and what to do afterwards
The Alzheimer's Society tells family carers to make sure they are safe, and says that may mean speaking to the GP, social services or other family members, or calling the police if they are at immediate risk.
What keeps you safe
- Stand where you can reach the door, and leave the room when you need to
- Shut yourself in another room and phone somebody if you feel unsafe
- Ring 999 if you or anyone else is at immediate risk
- Write down what happened, what came before it, and the time of day
- Tell the GP or the memory service, even if it has only happened once
- Ring the council's adult social care team if you are being hurt
What tends to make it worse
- Holding on to someone, blocking a doorway, or taking something by force
- Raising your voice or arguing back, however unfair the accusation was
- Going over the incident afterwards, when they may have no memory of it
- Deciding it is your fault for handling it badly, or theirs for doing it
Being hurt by somebody you are caring for is not something to keep private because you feel it reflects on you. Afterwards, your relative may still be upset once they have forgotten what happened, so comfort matters more than explanation. Keep the note you made: two or three weeks of short entries showing the time of day and what came before is the most useful thing you can put in front of a GP.
Both the Alzheimer's Society and Dementia UK publish guidance for family carers in this position, and both charities offer support to families by telephone. Dementia UK's guidance also says plainly that these situations can tip into abuse, and that help should be sought when they do. If the strain has been building for months, the signs of carer burnout is worth reading for your own sake.
The GP and medication
What the GP can do, and where medication fits
Medication has a place, and it is a narrower place than families are sometimes led to expect. The NHS advises asking a GP for an assessment to rule out or treat any underlying cause when behaviour changes.
What a GP should look at first
When NICE says antipsychotics can be offered
What a prescription should come with
The warning about Lewy body dementia
The MHRA, the UK medicines regulator, states that in elderly patients with dementia these medicines are associated with an increased risk of stroke and a small increase in mortality, and that no antipsychotic other than risperidone, in limited circumstances, is licensed in the UK for these symptoms. None of that makes a prescription wrong. It does mean you are entitled to ask what else has been tried and when the review will happen.
NICE is equally clear about what should run alongside any prescription. Psychosocial and environmental interventions, the formal name for the routine, activity and lighting changes above, are its recommendation for initial and ongoing management, and people should keep access to them while taking an antipsychotic and after stopping. The different types of dementia explains why the diagnosis changes what is safe to prescribe.
More help at home
Getting a second pair of hands, and a break for yourself
There is a point at which the problem is no longer a technique that can be improved. One person cannot cover a difficult hour every evening indefinitely. Paid help puts somebody in the house at the hour things go wrong, and hands the flashpoint tasks to a person your relative is not related to.
| What it covers | When it helps | On PrimeCarers | |
|---|---|---|---|
| A visit at the difficult hour | A carer in the house for the hour when things go wrong, doing the wash, the meal or the settling. | The distress has a time of day attached to it. | £18 to £25 an hour |
| Overnight cover | A carer who stays the night, sleeping and getting up when needed, or awake throughout. | The nights are broken and you are the one lying awake. | £130 to £145 a sleeping night, £150 to £160 awake |
| Live-in care | One carer in the house, so the routine holds and the same person does the personal care. | Agitation is spread across the day, or your relative cannot be left alone. | from £1,050 a week, from £1,260 where needs are more complex |
A visit at the difficult hour
- What it covers
- A carer in the house for the hour when things go wrong, doing the wash, the meal or the settling.
- When it helps
- The distress has a time of day attached to it.
- On PrimeCarers
- £18 to £25 an hour
Overnight cover
- What it covers
- A carer who stays the night, sleeping and getting up when needed, or awake throughout.
- When it helps
- The nights are broken and you are the one lying awake.
- On PrimeCarers
- £130 to £145 a sleeping night, £150 to £160 awake
Live-in care
- What it covers
- One carer in the house, so the routine holds and the same person does the personal care.
- When it helps
- Agitation is spread across the day, or your relative cannot be left alone.
- On PrimeCarers
- from £1,050 a week, from £1,260 where needs are more complex
Rates are what carers on PrimeCarers charge, with our fee included. An agency charges £28 to £35 an hour and usually sends a different person each time.
When you are ready to look, you can search for carers near you and compare their rates, dementia experience and reviews without paying anything or booking anybody. Every carer has an online interview before they appear, and their identity, right to work and enhanced DBS on the Update Service are checked. Carers are self-employed, and they are insured while they work. PrimeCarers introduces you and handles the payments; the arrangement is between you and the carer, so you choose who to interview and what to ask about their dementia experience, their training and the references on their profile.
Tell whoever you talk to what has been happening, in full, before they start. The client contract requires it: the client agrees to give full and accurate information in advance and on an ongoing basis about known risks, naming cognitive impairment and challenging behaviours among them. A carer who arrives knowing that washing is the flashpoint and four in the afternoon is the hard hour can plan around both. One who finds out on the day may reasonably decide the work is not safe, and either of you can end an hourly arrangement on 48 hours' notice.
Ask the council for a carer's assessment for yourself in the same week. Section 10 of the Care Act 2014 requires a local authority to assess a carer's own need for support regardless of the level of that need or of anybody's financial resources, so it is not means-tested. What is a carer's assessment explains what happens at one, and respite for dementia covers a planned break rather than an emergency one. If the answer is that home has stopped working, at what point should someone with dementia go into care sets out how to think it through, and the cost of care for dementia covers the money either way.
Questions
Questions families ask about aggression
The Alzheimer's Society says aggressive behaviour can be a symptom of dementia itself, but that it is more likely there is another cause, and that the person is trying to stop feeling distressed. Pain, an infection, needing the toilet, a noisy or dark room, being helped with something private, and being asked to remember something they cannot are all named as causes.
No. There is no stage everybody reaches, and no stage that guarantees it. Agitation and aggression are more commonly described in the middle and later stages, but some people never show them. The seven stages of dementia explains how symptoms tend to build without promising a timetable.
Stop what you are doing, step back and give her room, then lower your voice and slow down. Agree with the feeling behind what she is saying rather than correcting the facts, and come back to the task later. If you feel unsafe, leave the room, shut the door and phone somebody. Ring 999 if anyone is at immediate risk.
Call 999 or go to A&E if someone suddenly becomes confused, which is the NHS advice for sudden confusion, or if anyone is at immediate risk. Ring the GP the same day for a change that has come on over a few days, or where you suspect pain, constipation or an infection. Use 111 out of hours.
Possibly, though NICE sets limits on it. Antipsychotics are to be offered only where a person is at risk of harming themselves or others, or where agitation, hallucinations or delusions are causing severe distress, at the lowest effective dose, for the shortest possible time, and reassessed at least every six weeks. The MHRA states that in elderly people with dementia they carry an increased risk of stroke and a small increase in mortality.
Yes to both. Carers who list dementia experience will have worked with agitation and resistance before, and a paid carer is sometimes accepted for washing and dressing where a son or daughter is refused. You do have to tell them: the client contract requires full and accurate information in advance about known risks, naming cognitive impairment and challenging behaviours. Hourly visits are £18 to £25 an hour with our fee included.
A visit cancelled by the client is payable in full, apart from unplanned hospitalisation, illness, or another reason the carer agrees to. PrimeCarers charges nothing of its own to cancel, but the terms sit between you and the carer rather than with us, and a carer may choose to waive the fee.