You've laid out your mum's clothes, run the bath and made her favourite tea. She looks at you, arms folded, and says she's not getting in, you're not her daughter, and she wants to go home. She is home.
Changes in behaviour are often the hardest part of dementia for families. Agitation, suspicion, shouting, refusing care and repeated questions can be exhausting and hurtful. They can also feel very personal.
They usually aren't. This guide explains why behaviour changes happen, how to find what's behind them, and practical ways to respond that keep everyone calmer and safer.
Why Behaviour Changes Happen
Dementia affects how the brain makes sense of the world. Memory, reasoning, perception and the ability to manage emotions can all change.
The NHS notes that some people, particularly in the later stages, develop what are known as behavioural and psychological symptoms of dementia, which can include agitation, aggression, delusions and hallucinations.
A helpful way to think about it: behaviour is often communication. The Alzheimer Society of Canada puts it simply, noting that changes in behaviour usually have meaning and are a way of expressing needs and concerns.
When someone can't find the words for "I'm in pain", "I'm scared" or "I need the toilet", the message may come out as pacing, shouting or pushing you away.
Common behaviours include:
repeating questions or stories
restlessness, pacing or fidgeting
shouting, swearing or crying
suspicion or accusations, such as "someone's stolen my purse"
resisting help with washing, dressing or medication
wanting to "go home" even when at home
withdrawal and apathy
Step 1: Look for the Cause
Before trying to change the behaviour, ask: what might be behind this?
Physical causes. Pain, needing the toilet, hunger, thirst, constipation, tiredness, feeling too hot or cold. The NHS advises asking the doctor to rule out or treat underlying causes like pain, depression, infection (such as a urinary tract infection) and medication side effects. A sudden change in behaviour always needs checking. Our guide to sudden confusion in seniors explains why.
Environmental causes. Dementia Australia notes people can become overwhelmed in crowded or noisy places, or frustrated during complex tasks. Poor lighting, shadows, clutter and unfamiliar places can all add confusion.
Emotional causes. Fear, boredom, loneliness, feeling rushed or talked down to, or grief as the world becomes less familiar.
Care approach. Being hurried through a shower or corrected in front of others can trigger strong reactions.
Keeping a simple note of when behaviours happen, what came before and what helped can reveal patterns. Maybe the agitation always starts late afternoon, or after a certain visitor, or when the TV is loud.
Step 2: Stay Calm and Reassure
How you respond can make a big difference to whether things escalate or settle. It's easier said than done when you're tired, so be kind to yourself here too.
Keep your voice low and slow, and use short, simple sentences.
Don't argue or try to reason them out of it. The NHS advises staying calm and avoiding confrontation.
Get down to their eye level and give them space.
Acknowledge the feeling: "You seem worried" or "That sounds frightening."
Offer reassurance: "You're safe. I'm here."
Our guide to communicating more effectively with someone living with dementia has more on this.
Step 3: Validate, Then Redirect
When someone insists on something that isn't true, correcting them rarely helps. It can feel like being told they're wrong, again, by people who don't believe them.
Instead, respond to the emotion and then gently shift the focus.
"Someone's stolen my purse."
"That's awful, losing your purse is so stressful. Let's look together." Then help search. Knowing where it's often left, or keeping a spare, can help.
"I want to go home."
"Tell me about home." Often "home" means a feeling of safety or a time in their life. Talking about it, looking at photos, or making a cup of tea together can settle things.
"I'm not having a shower."
Leave it for now and try again later, or change the approach: a wash at the sink, a different time of day, warmer room, music playing.
Redirection ideas include favourite music, a snack or drink, a short walk, looking at photos, or a simple task like folding towels. Our guide to meaningful activities for people with dementia has more ideas.
Step 4: Adjust the Environment and Routine
Prevention is often easier than de-escalation.
Keep routines consistent. Predictable days reduce anxiety. See our guide to daily routines for people with early dementia.
Reduce noise and clutter. Turn off background TV and radio when you're doing care tasks.
Improve lighting, especially in the late afternoon and evening, to cut down on shadows.
Use signs and labels on doors and cupboards to help with orientation.
Plan harder tasks for the person's best time of day.
Allow extra time. Rushing is one of the most common triggers.
Consistent routines and fewer missed needs can prevent some difficult moments before they start. Elli Cares sends reminders for medications, meals, drinks and daily tasks, including short video reminders in a familiar family voice. Family in the care circle can add observational notes about hard days and what helped, which builds a picture you can share with the doctor through a downloadable report.
Step 5: Know When to Step Away
If things escalate and you or your loved one aren't safe, it's okay to leave the room. The Alzheimer Society of Canada advises moving to a safer place if your personal safety is at risk, making sure you can always get out of the room, and getting help straight away.
Take a few breaths, and go back when you're calmer. Often the moment has passed.
If aggression is frequent, severe or new, talk to the person's doctor. There may be a medical cause, and they can review medications and suggest other support. Be cautious about any medication for behaviour, especially if the person has Lewy body dementia, where some antipsychotics can cause serious reactions.
Specific Situations
Wandering. Walking about often has a purpose, like looking for something or someone, or needing to move. Our guide to understanding wandering in dementia covers how to reduce the risks.
Sundowning. Many people become more confused or restless in the late afternoon and evening. Good lighting, a calm evening routine and daytime activity can help.
Refusing medication. Our guide to encouraging medication adherence without conflict has specific tips.
Hallucinations. If they aren't upsetting, they may not need challenging. If they are, reassure and change the setting, and tell the doctor.
Look After Yourself
Behaviour changes are one of the biggest sources of stress for dementia caregivers. It's normal to feel hurt, angry or worn down. Talk to others who understand. Our guides to caregiver support groups and recovering from caregiver burnout can help. In the US, the Alzheimer's Association 24/7 Helpline (800.272.3900) can talk through a difficult situation any time.
Frequently Asked Questions
Why is my parent with dementia so angry?
Anger often reflects an unmet need or feeling: pain, fear, frustration, tiredness or feeling rushed. It can also come from changes in the brain that make emotions harder to control. A sudden change should be checked by a doctor.
How do I respond when someone with dementia accuses me of stealing?
Don't argue. Acknowledge how upsetting it is, offer to help look, and gently redirect. Keeping spares of commonly lost items can help.
What should I do if someone with dementia becomes aggressive?
Stay calm, give them space, and leave the room if you're not safe. Talk to their doctor about possible causes and support.
Can behaviour changes in dementia be prevented?
Not always, but consistent routines, a calm environment, meeting physical needs promptly and avoiding rushing can reduce how often they happen.
You're Doing Better Than You Think
There's no perfect way to handle difficult behaviours. There's trial, error and a lot of patience, for them and for yourself. To see how Elli helps families keep routines steady, visit our Seniors and Families page.
