How to help when someone with dementia becomes agitated

10 minutes ago

5 min read

We all get agitated sometimes. But for someone living with dementia, it can happen far more often. Feeling confused, losing control over everyday life and struggling to find the right words are all frustrating – and that frustration often grows as dementia progresses.

If you’re caring for someone who becomes agitated, it can be upsetting and exhausting. Here are some things that might help.

Start by looking for patterns

Before trying to fix anything, step back and ask yourself a few questions.

When does it happen? Is it at a certain time of day? Around a particular person? Does it happen during personal care, like washing or dressing? Or after coming home from a day out?

Is it worse later in the day? Some people experience “sundowning” – becoming more restless, anxious or confused as it gets dark in the late afternoon and evening. This often gets worse in autumn and winter, when the evenings draw in.

Is it directed at you? Sadly, people with dementia often take their frustration out on the person closest to them, which is usually the main carer. It isn’t personal, but it can really hurt. Where you can, try to avoid arguing, correcting or giving instructions, as these can make things worse.

Do certain people or situations set it off? A relative with a loud voice, or someone who talks a lot, can be overwhelming. A gentle word with family about these triggers can make a real difference.

Is it after a busy day? Some people come home from a lively social event feeling wound up and unable to settle. Give them time, try something calming, or think about whether shorter or quieter outings would suit them better.

Has it come on suddenly?

This one’s important. If the agitation has built up slowly over months, it’s most likely part of the dementia progressing.

But if it has appeared or got worse quickly, over a few days, it could be delirium.

Delirium is a sudden change in someone’s mental state, often caused by an infection (such as a urine infection), dehydration or a change in medication. It needs medical attention, so contact the GP or NHS 111 straight away.

Agitation and sleep

Agitation and poor sleep often go hand in hand, and each can make the other worse.

Night-time restlessness can be caused by:

• side effects of medication

• pain or physical discomfort

• being thirsty, hungry or needing the toilet

• too much light, noise or activity in the evening

• sleeping too much during the day

• confusing dreams with real life

• anxiety, low mood, or worries that surface when things go quiet

• changes in the brain that affect the body clock

• conditions such as restless legs

• changes to routine

7 ways to help someone feel calmer at night

You won’t always be able to prevent night-time agitation, but a calm, familiar environment can make a big difference.

1. Soften the lighting. Dim the lights gradually through the evening and switch to warm lamps. Cut down on screen glare and dark shadows, which can be confusing or frightening.

2. Keep the bedroom calm and familiar. Soft colours like greens, blues and neutrals feel soothing. Clear away clutter but keep favourite and familiar things nearby. Mirrors, shiny surfaces and busy patterns can be misread in low light, so consider covering or moving them.

3. Build a bedtime routine. Doing the same calming things each evening – a warm bath, a cuppa (decaf!), reading together or gentle music – helps signal that it’s nearly time for bed.

4. Be a reassuring presence. If they wake up distressed, keep your voice calm and your words simple. Reassurance works far better than correcting or reasoning with them, even when what they’re saying doesn’t make sense.

5. Keep evenings quiet. Cut back on caffeine and alcohol from the afternoon, keep noise down around the house, and save busier activities for earlier in the day. A clock that clearly shows whether it’s day or night can help too.

6. Make the trip to the toilet easy. Plug-in night lights, a clear path, and a sign or picture on the bathroom door can help them find their way if they wake up and you’re not there.

7. Check comfort before bed. Offer the evening meal a bit earlier, suggest a trip to the toilet before bed, and leave a glass of water within reach. If they find it hard to tell you when they’re in pain, a gentle hand massage or a quick check-in at bedtime can help you spot discomfort.

Keeping everyone safe

If agitation ever puts you or others at risk, it’s OK to take steps to protect yourself and your family. That might mean locking away sharp objects or hiding the car keys. There’s no shame in this.

When someone sees or believes things that aren’t real

Sometimes agitation is linked to psychosis. This can mean hallucinations, where someone sees things that aren’t there, such as children, animals or insects in the house.

It can also mean delusions, where someone firmly believes something that isn’t true – for example, that someone is stealing from them, or that they need to get to work or collect the children from school.

If these beliefs are very distressing, or are putting anyone at risk, speak to the GP.

What about medication?

Doctors will always try non-drug approaches first. But if agitation or aggression is severe and putting someone at risk, a doctor may consider a type of medicine called an antipsychotic.

These are usually prescribed at a low dose, for a short time, and with regular reviews, because they can have serious side effects. These include drowsiness, a higher risk of falls, and a higher risk of stroke. Risperidone is the one most often used for people with Alzheimer’s disease.

Extra care is needed for people with dementia with Lewy bodies or Parkinson’s disease dementia, as they can react very badly to many antipsychotics. If your relative has one of these diagnoses, make sure any doctor prescribing for them knows about it.

Never start, stop or change medication without talking to the GP or pharmacist first.

You don’t have to manage this alone

Living with agitation is hard – for the person with dementia, and for you. If things are getting worse or feel too much, please reach out sooner rather than later. You’re doing an incredibly tough job, and asking for help is a sign of strength, not failure.