Dementia and Aggression Explained: What the Behaviour Is Really Telling You

Listen now:

Stop fighting the behaviour - start listening for the need underneath it.

January 30, 2026 min

15 min

🎧 Listen now on:
Spotify,
Apple Podcasts,
or watch on
YouTube.

When “aggression” is actually distress – what dementia behaviour is really telling us

If you’re supporting somebody living with dementia, you may have been on the receiving end of shouting, swearing, hitting, pacing, or refusing care. And it’s easy – in the heat of the moment – to label it as “they’re being difficult”.

But dementia doesn’t just affect memory. It can change perception, communication, processing speed, and how safe the world feels. That means behaviour often becomes the fastest, loudest way a person can communicate pain, fear, confusion or overwhelm.

A key reframe: from “aggressive” to “distressed”

One of the most helpful mindset shifts in dementia care is this: behaviour that challenges us is often distress behaviour for them. It’s not badness – it’s a stress response. A survival mechanism. Communication with the volume turned up to ten.

Why this matters

If we only try to stop the behaviour, we miss the message. But when we listen for the need underneath it, everything changes – including how safe the person feels, and how safe you feel while supporting them.

Common hidden drivers of distressed behaviour in dementia

Pain or physical discomfort (including injuries they may struggle to explain)
Fear, confusion or misperception – not being oriented to the here and now
Overstimulation (noise, people, demands, rushed care tasks)
Understimulation (boredom, frustration, restlessness)
Trauma triggers linked to personal care, touch, or loss of control
Communication breakdown – the person can’t find the words, so the body speaks

A reality check: not all behaviour is “the dementia”

This is important – and it’s where people can get a bit of uncomfortable honesty. Not all distressed behaviour is caused by a diagnosis. Sometimes a person is agitated because of what’s happening around them.

They feel patronised, infantilised, dismissed or controlled
They’re being rushed, talked over, or commanded
They’re not being treated with dignity

You don’t need dementia to get angry when someone talks to you like you’re a problem to manage rather than a person to support.

A simple 3-step response framework for dementia distress

In the episode, I share a straightforward approach you can use in the moment – whether you’re a family caregiver or a professional.

Step 1: Pause and protect

Think safety first – yours and theirs
Give space where needed
Soften your body language and tone
Reduce demands – and yes, sometimes the best move is to stop talking for a moment

Step 2: Scan for what’s going on (the HELP check)

Use the HELP model to look for drivers of distress:

H – Human: who’s here, what’s the relationship dynamic?
E – Emotional: fear, frustration, shame, overwhelm?
L – Location: noise, lighting, layout, time of day, crowding?
P – Physical: pain, hunger, thirst, toileting, temperature, fatigue?

Step 3: Adjust and connect

Change the environment to reduce distress
Validate feelings – even if the facts are confused
Offer reassurance and collaboration before any redirection

The phrase that can change everything

Here’s a simple script from the episode that works beautifully in dementia care:

“I’m sorry – this feels really frightening, doesn’t it? Let’s slow down and figure it out together.”

It does three things quickly: it validates, it reduces threat, and it invites teamwork.

HEART: connection before correction

I also share the HEART approach as a practical way to de-escalate:

H – Hear: listen to words, tone, body language, behaviour
E – Empathise: communicate understanding
A – Align: join their world – be on their side
R – Reassure: reduce fear, increase felt safety
T – Transition: gently redirect or support a change

A gentle challenge for carers: your regulation matters too

Here’s the bit we can’t skip. If you’re running on empty, every shout starts to feel personal. You can’t offer calm you don’t have. And if you can’t regulate, how are they supposed to?

This episode isn’t about “being perfect”. It’s about having tools, support, and a way to make sense of what’s happening – so you can respond with more clarity, dignity and confidence.

The takeaway

In dementia care, what we label as aggression is often a terrified brain saying: “Please help me make sense of this.”

If we listen for the need, everything changes – and that’s dementia care at its absolute best.

Related training courses

Want to go deeper with practical tools and clear frameworks? Explore our related courses below: