How to Manage Challenging Dementia Behaviors

Dementia can change how your loved one reacts to the world. You may see anger, pacing, fear, or withdrawal, and you may feel shocked by how “different” they seem.

You can learn about these symptoms in our guide to dementia.

It’s important to remember that, most of the time, a challenging behavior is their way of communicating a need or a stressor.

Alicia Seaver, Vice President of Memory Care Operations

Your job is not to fix the disease in the moment (an impossible task).

Instead, your job is to meet your loved one where they are in the moment. In doing so, you hope to ease stress, keep everybody safe, and become a detective as you look for the underlying cause of the behavior.

This takes patience.

And here’s what’s important: this ability to remain present and improvise in the moment is a learned skill. Our Wellness Director at Bridges Westford, Gretchen Bramanti, is a nurse with over 30 years of experience in senior living. She sees caregiver burnout all the time and empathizes with those feeling exhausted.

Her advice: take a breath. There is help available and ways to lighten the load.

Gretchen spoke about how to manage challenging dementia behaviors in an episode of the EPOCH Exchange, our podcast covering dementia care. In it, the team discuss various approaches that can lead to better outcomes for dementia caregivers. Watch or listen below:

What Should You Keep in Mind as Dementia Progresses?

Dementia changes over time. What works today may not work later. Early-stage care often allows more conversation and shared decisions as you plan for the future. Later stages often require more structure and more hands-on support, eventually leading to help with activities of daily living (ADLs).

The challenging behaviors associated with dementia can occur at any stage, and each individual is different. So, even if your loved one is not showing signs of aggression right now, it’s still good to be prepared. The more informed you are as a caregiver, the better equipped you are to de-escalate troubling situations.

Why Is My Loved One Acting So Differently?

Dementia affects memory, judgment, and impulse control because of the way the disease affects the brain’s nerve cells.

It can also change how your loved one handles stress. The same noise or request may feel overwhelming now. Once again, this is all thanks to the brain’s changing chemistry.

You may also see fear under the behavior. Your loved one may not understand what is happening to them. Consider how scary this is from their perspective. That fear often shows up as anger or some form of resistance (aggression, refusals, rummaging, wandering, etc.).

What Does “Behavior Is Communication” Mean?

Dementia can take away the individual’s ability to express their needs clearly or coherently, but those needs don’t vanish. When your loved one cannot explain the need, the behavior often carries the message instead. So, you need to ‘listen’ to the behavior. That’s what we mean when we say behavior is communication.

Common messages sound like this:

• “I’m in pain.”
• “I feel rushed.”
• “I feel lost.”
• “I need the bathroom.”
• “This is too loud.”
• “I do not understand what you want.”

Examples of this model in action:

• Your loved one refuses a shower = They may feel cold or exposed.
• Your loved one paces near the door = They may feel bored or anxious.
• Your loved one yells during dinner = They may feel overstimulated or tired.

When we see behavior as communication, it helps us to pivot away from the idea of wanting to change the ‘bad’ behavior. We start to see that we can change our approach, the environment, and other things before getting frustrated by what we perceive as ‘bad behaviors’. We look for the unmet need instead.

When you try to understand or guess the underlying feeling that is causing the behavior, you can choose a better response to the situation.

Alicia Seaver, Vice President of Memory Care Operations

What Should You Check First When Behavior Changes?

Start with the body and the basics before you assume “this is dementia.”

Check for:

• Pain or discomfort
• Constipation
• Hunger or thirst
• Fatigue or poor sleep
• Too much noise or activity
• A room that feels hot, cold, or confusing

This is where you begin your ‘detective work’ we referred to earlier. Checking for these factors leads to a trial-and-error approach as you try to work out a solution that calms the behavior.

Also, review recent changes:

• New medications or dose changes
• Missed doses or double doses
• Recent illness or fever
• New vision or hearing problems
• Major stress, grief, or depression

As you check these things, consider the gravity of the behavior; a sudden, drastic behavior change needs a medical check. Trust your gut when something feels off.

9 times out of 10, we find that a sudden change in behavior is down to a UTI.

Gretchen Bramanti, Wellness Director, Bridges Westford

How Can You Calm Agitation Safely Right Now?

Agitation can escalate fast. You can try to slow it down with a simple sequence, aiming for safety and calm, and avoiding logic or debate.

If you feel unsafe, don’t be afraid to call 911. Tell dispatch your loved one has dementia. Health professionals are trained to deal with these situations.

What Should You Say in Tough Moments?

You will not be able to use logic to explain away their fear or confusion. However, you can help them feel safer. That is why your tone and manner matter even more than the actual words you use.

Use short sentences and calm repetition. Avoid resorting to a hard “No” or confrontational phrases like “You already told me.” These will only serve to escalate frustrations.

Don’t argue with them. Trust me, you’re not going to win. It is much easier to take some blame to de-escalate the situation. This is your gift to them.

Gretchen Bramanti, Wellness Director, Bridges Westford

When Can Fiblets Help?

Sometimes facts increase distress, so a small, harmless fiblet can prevent escalation. Use a fiblet to reduce fear, then redirect to something more comforting.

Take a deeper dive into ethical fibbing and the need to “embrace their reality”.

This is the basic rule: if truth creates panic or agitation, then a fiblet, sometimes called a therapeutic lie, is the more empathetic choice.

Alicia Seaver, Vice President of Memory Care Operations

How Do You Handle Anger and Aggression?

Anger often comes from fear, frustration, or pain. Your loved one may feel trapped or embarrassed. They may also misread your intent.

Do this:

• Keep space until the episode cools down.
• Remove the audience and lower noise.
• Avoid physical contact unless safety requires it.
• Use validation and redirection, not correction.
• Call a clinician if aggression becomes frequent.

If violence seems likely, prioritize safety. Leave the room if you can.

What Is Sundowning and What Helps?

Sundowning often shows up in the late afternoon and evening. You may see anxiety, confusion, pacing, or sleeplessness. Fatigue and low light often worsen these symptoms.

Try these actions:

• Keep a steady routine.
• Increase daytime activity and natural light.
• Reduce caffeine and sugar later in the day.
• Limit evening noise and busy visits.
• Keep hallways and bathrooms well-lit.
• Offer a simple calming routine before bed.

Sundowning can exhaust you as a caregiver – these behaviors are draining to have to deal with. Ask for evening support when you can.

How Do You Reduce Wandering Risk?

Wandering can happen at any stage of dementia. It can start with a search for routine. Your loved one may want to “go to work” or “pick up the kids.”

Think of different layers of safety:

• Add door alarms or chimes to alert you of attempted exits.
• Secure doors and gates.
• Try to remove visual cues to leave: Put keys, shoes, and coats out of sight.
• Build movement into the day to expend energy in a safe way.
• Offer purposeful tasks and simple activities at times when energy levels are high.
• Use an ID bracelet or ID tag for safety.

If wandering starts suddenly, check for pain, infection, or stress. These triggers can drive exit-seeking as a kind of search for a solution. It is sad to think about, but an individual who wanders is often trying to ‘escape’ a stressor.

What Should You Do About Hallucinations and Delusions?

Hallucinations and delusions can feel real to your loved one. Again, don’t argue your version of reality; this will only lead to more frustration and fear as they are forced to question their reality.

We follow the same guidelines: respond based on emotion and safety.

If your loved one seems calm, you may not need to do much. If your loved one feels scared, do this:

• Stay calm and keep your voice low.
• Offer reassurance and stay nearby.
• Reduce glare and shadows.
• Turn off the loud TV or radio.
• Redirect to another room or activity.

Tell a clinician if hallucinations start suddenly. Ask about illness and medication effects.

It is real to them, so don’t try to convince them otherwise. You have two options. You can ask them to explain what they see. This validates them, even if you say you don’t see the same thing; at least you are acknowledging their reality. The second option, if safe, is to go along with it. If they believe there are bugs on the floor, why not say you’ll get them cleaned up to reassure them? The distinction of when to fib is a learned skill.

-Gretchen Bramanti, Wellness Director, Bridges Westford

What Do You Do About Hiding, Hoarding, and Rummaging?

Hiding, hoarding, and rummaging often show up as repeated searching, collecting, and “putting things away.”

Your loved one may stash items in odd places, carry objects from room to room, or dig through drawers and bags.

These actions can reflect a need to feel safe or prepared for some obscure, unspecified event. They can also reflect confusion about what is important, worry about items getting stolen, or a habit from earlier life, like saving useful things.

In some cases, these behaviors are nothing more than a way to stay busy when the day feels slow or unfamiliar.

Use practical steps:

• Keep dangerous items out of reach.
• Give a “safe drawer” or “safe box.”
• Keep duplicates of essentials like keys and remotes.
• Check common hiding spots regularly, and without letting them see.
• Trade unsafe items for safe items.

Don’t turn this into a power struggle between you and your loved one. Instead, offer a safe outlet for these urges. This is why we suggest creating safe drawers and safe boxes for your loved one to interact with, satisfying their urge in a way that won’t cause any harm.

What Should You Do if They Won’t Eat?

Start by accommodating, not forcing. Pushing food often turns a meal into a fight. Dementia can change taste, smell, swallowing, attention, and routine. Your loved one may also feel rushed, distracted, or confused by what’s on the plate.

Try simple changes first:

• Offer finger foods that are easy to hold and recognize.
• Serve small portions more often instead of one large meal.
• Use high-contrast plates and cups so food stands out.
• Reduce noise and distractions during meals.
• Offer fluids and soft foods if chewing feels hard.
• Keep mealtimes predictable and calm.

Sometimes you also need a practical workaround that fits their habits. We see this often at Bridges.

One resident only wanted yogurt. We served yogurt consistently and boosted it with added protein and nutrients. Over time, trust grew, and she accepted a wider range of foods.

-Gretchen Bramanti, Wellness Director, Bridges Westford

Another resident refused meals, even when the food was familiar. A family member shared a key detail. He ate lunch from a thermos during his working years. The team served his meal in a thermos, and he started eating again.

Use these examples as the takeaway: you may not change the behavior quickly, but you can change the approach and the setup. If eating drops sharply or swallowing becomes difficult, call a clinician for guidance.

When Should You Seek Urgent Medical Care?

Some behavior changes require urgent evaluation. Call a clinician if you see these clear red flags:

• Sudden behavior or personality change
• New or rapidly worsening confusion over hours or days
• Refusal to eat or drink
• Signs of pain you cannot control or identify
• Repeated falls or new weakness

Call 911 if:

• Your loved one might harm themselves or others
• You cannot keep the environment safe
• Confusion or anger appears suddenly and severely

It is better to err on the safe side because acting early on your instincts can often prevent a crisis situation.

How Can Bridges by EPOCH Support You?

Bridges® by EPOCH offers caregiver education and support groups, so you can learn practical tools and talk with people who understand the day-to-day.

We also welcome caregivers and families at select activities and events led by our Life Enrichment teams. These moments can give you a break, reduce stress, and create positive time together.

If care at home feels unsafe or unmanageable, it might be time to consider memory care.

Bridges® by EPOCH is purpose-built for residents with Alzheimer’s disease and other dementias, with trained teams, structured routines, and a secure, purposefully-designed environment.

We support changing needs across stages, so you can step back from crisis mode and get consistent help.

Contact us to learn more or schedule a tour.