When someone is pacing, shouting, trying to leave, or becoming increasingly distressed, long explanations rarely help. Your first work is to lower stimulation, check immediate safety, and make your own presence less threatening.

Agitation is a description, not a diagnosis. Pain, illness, medication effects, sensory overload, fear, fatigue, hunger, toileting needs, or an unfamiliar environment can all contribute.

Use fewer words and more space

Approach from the front, identify yourself if needed, keep your hands visible, and avoid crowding. Lower your voice. One person should speak at a time. Do not demand eye contact or block an exit unless immediate safety requires trained intervention.

Try: “You are upset. I am here with you. We can slow down. Would you like to sit here or walk with me to the kitchen?”

Validate without agreeing to an unsafe claim

You can acknowledge fear, anger, or the wish to leave without confirming something untrue. Skip memory tests, correction, and “I already told you.” If a simple need can be met safely, meet it.

Change the environment

  • Reduce noise, people, screens, and competing instructions.
  • Check temperature, lighting, hunger, thirst, pain, toileting, and fatigue.
  • Offer a familiar object, music, snack, or simple movement.
  • If one caregiver has become the focus of anger, use a calm handoff when possible.

Afterward, record the pattern

Note what happened before, what the person did, how long it lasted, what helped, recent illness or medication changes, and whether anyone was injured. This is more useful to a clinician than a broad description such as “very aggressive lately.”

Plan for recurrence

Decide which responses everyone will use, where other people or hazards should move, who can be called, and what threshold means the situation is no longer safe to manage at home. A written plan reduces improvisation during the next episode.

Sources and further reading

Nestoa links to these organizations for source context. A link does not imply endorsement of Nestoa.

Related guidance

Dementia and sundowning: a plan for difficult evenings and nights

Use a calmer evening routine, track what happens before the pattern begins, and know when a change should be medically assessed.

Dementia wandering at night: make the plan before someone goes missing

Reduce predictable risks, prepare a missing-person record, and decide exactly who will search, call, and stay with the household.

When a person with dementia says, “I want to go home”

Respond to the need beneath the words, avoid an argument about the address, and prepare for leaving or wandering risk.