How Prevalent is Aggressive Behaviour Between People with Dementia and their Carers?

Oct 29, 2025 5 min read •

Dementia Care healthcare caregiving

Studies suggest that aggressive behavior is a common challenge, with over one-third of caregivers reporting at least one aggressive incident, such as verbal threats or destroying property, within a week. This prevalence highlights the significant and complex issue of how prevalent is aggressive behaviour between people with dementia and their carers, requiring a deeper understanding of its causes and impacts.

Quick Summary

Reports indicate that aggressive behaviors, including verbal and physical acts, are prevalent among individuals with dementia, often resulting from unmet needs or confusion. The high frequency of these incidents significantly impacts caregiver well-being and can lead to increased stress and burnout.

Key Points

Prevalence is high: Over one-third of caregivers report experiencing aggressive behaviors, including verbal and physical aggression, from people with dementia.
Common triggers exist: Aggression can be caused by unmet physical needs (pain, hunger), confusion, frustration, environmental factors, and misinterpretation of events.
Verbal aggression is particularly frequent: It is reported to be the most common form of aggression and is highly disruptive to caregivers.
Non-drug therapies are first-line treatment: Studies indicate that strategies like music therapy, massage, and routine adjustments are more effective and safer than medication for managing agitation.
Caregivers face significant consequences: Exposure to aggression increases caregiver stress, burnout, depression, and can result in physical injury.
Safe de-escalation is vital: Techniques such as staying calm, redirecting attention, and avoiding confrontation are crucial for responding during an aggressive incident.
Seeking professional and peer support is essential: Connecting with healthcare providers and support groups is necessary for managing behavior and coping with the emotional toll of caregiving.

Prevalence and Types of Aggressive Behavior

Aggressive behavior is a distressing and frequently encountered aspect of dementia caregiving, with prevalence rates that vary depending on the type of aggression and the study population. Research from the Resources for Enhancing Alzheimer's Caregiver Health (REACH II) initiative showed that over a third of caregivers reported experiencing one or more aggressive behaviors in a single week. Another study on Veterans with dementia observed that 40.9% of a non-aggressive cohort developed aggressive behaviors over a 24-month period, with verbal aggression being the most common.

The types of aggressive behavior can range from relatively subtle to overtly dangerous, creating significant challenges for carers. Verbal aggression, which can include yelling or verbal abuse, is frequently cited. Physical aggression, such as hitting, kicking, or biting, and threatening others are also reported, sometimes with physical consequences for the caregiver. More severe cases may involve property destruction or sexual aggression, adding to the complexity and trauma of the caregiving experience.

Factors Influencing Aggression in Dementia

Aggression in people with dementia is not a random occurrence but is often triggered by underlying physical, psychological, and environmental factors. Understanding these triggers is critical for prevention and management.

Physical Factors

Unmet physical needs: A person with dementia may exhibit aggression when they are in pain, hungry, thirsty, or constipated but cannot effectively communicate their needs.
Infections and illness: Conditions like urinary tract infections can cause confusion and discomfort, leading to behavioral changes.
Medication side effects: Some medications or drug interactions can increase confusion, agitation, and aggression.
Sleep disturbances: A lack of adequate rest can increase irritability and agitation, sometimes tied to the phenomenon known as 'sundowning,' where confusion worsens in the evening.

Psychological and Emotional Factors

Fear and confusion: A person with dementia may feel threatened by unfamiliar people or surroundings due to memory loss and confusion, prompting a defensive, aggressive response.
Misinterpretation: They may misunderstand a caregiver's intentions, viewing personal care tasks like bathing as an invasion of privacy or a threat.
Frustration: The inability to complete simple tasks or communicate effectively can lead to intense frustration and outbursts.
Delusions or paranoia: A person might experience irrational thoughts or beliefs that others are trying to harm them, leading to an aggressive reaction.

Environmental and Social Factors

Overstimulation: A noisy, crowded, or cluttered environment can overwhelm a person with dementia, causing agitation.
Changes in routine: A consistent routine provides security. Disruptions can cause anxiety and stress, leading to aggressive behavior.
Caregiver behavior: A caregiver's impatience, frustration, or anger, even if unexpressed verbally, can be mirrored by the person with dementia.

Managing Aggressive Behavior: Prevention vs. Reaction

Managing aggression effectively involves a dual approach: preventing potential triggers and knowing how to respond safely during an incident. Non-pharmacological interventions are recommended as the first line of treatment.

Comparison of Non-Pharmacological and Pharmacological Interventions


Feature	Non-Pharmacological Interventions	Pharmacological Interventions
Efficacy	Often more effective than medication for agitation and aggression when triggers are addressed.	Can be effective in managing severe symptoms, but often have serious side effects.
Approach	Focuses on identifying and addressing unmet needs, environmental triggers, and communication breakdowns.	Involves prescribing medications, such as antipsychotics, to manage symptoms.
Risks	Minimal risks, focused on safety and compassionate care.	Potential for serious side effects like falls, heart problems, stroke, and even death.
Caregiver Role	Active role in tracking behavior, adjusting routines, and using communication skills.	Can provide temporary relief, but may increase caregiver dependency.
Recommended Use	First-line treatment for most behavioral symptoms in dementia.	Reserved for situations where non-pharmacological methods fail and the aggression poses a significant danger.

Strategies for Caregivers to Respond and Cope

When a person with dementia becomes aggressive, caregivers must prioritize safety and de-escalation. Recommended strategies include:

Stay calm: Respond in a calm, steady voice. Raising your voice or showing frustration can escalate the situation.
Identify the cause: Look for immediate triggers like pain, hunger, or overstimulation.
Redirect attention: Gently shift the person's focus to a different, relaxing activity or a favorite object.
Create space: If it's safe to do so, step back and give the person room to calm down.
Avoid arguing: Do not try to correct their reality or argue facts, as this will increase their confusion and frustration.
Seek help: If the behavior poses an immediate danger, ensure safety for all involved and call for assistance.

Caregivers also need robust coping strategies to manage the significant emotional and physical toll. Aggressive behaviors can lead to injury, increased caregiver burden, depression, and burnout. It is vital for caregivers to:

Utilize respite care to take regular breaks.
Join support groups to connect with others facing similar challenges.
Practice self-care, including exercise, proper nutrition, and adequate sleep.

Conclusion

Aggressive behavior is a prevalent and challenging aspect of caring for someone with dementia, affecting a significant number of caregiver-patient dyads. It stems from a variety of complex factors, including unmet needs, psychological distress, and environmental triggers. Effective management relies heavily on non-pharmacological approaches that prioritize understanding the individual's needs and creating a safe, calm, and predictable environment. Caregivers play a crucial role in implementing these strategies and must also prioritize their own well-being to prevent burnout. While confronting aggression is difficult, understanding its roots and applying empathetic, de-escalating techniques can significantly improve the quality of life for both the person with dementia and their carer.

Key takeaways

Aggressive behavior is common: Over one-third of caregivers report experiencing aggressive behaviors in people with dementia.
Verbal aggression is frequent: Studies show verbal aggression is a highly reported and disruptive behavior.
Aggression has triggers: Common causes include unmet physical needs (pain, hunger), confusion, frustration, fear, and environmental overstimulation.
Non-drug therapies are effective: Non-pharmacological interventions like music therapy, massage, and outdoor activities can be more effective than medication for agitation.
Caregivers need support: Experiencing aggression can lead to caregiver burnout, depression, and anxiety, making support groups and respite care essential.
De-escalation is key: Caregivers should respond calmly, avoid arguing, and redirect attention during an aggressive episode to ensure safety.
It's not personal: Caregivers should remember that the aggression is a symptom of the disease, not a personal attack from their loved one.

Frequently Asked Questions

Physical aggression is a concerning but common aspect of dementia care, with some studies estimating a prevalence of physical violence between 44% and 72% within patient-caregiver relationships. Research has also shown that between 18% and 35% of people with dementia may exhibit physical aggression. It is often a result of confusion, pain, or fear rather than malicious intent.

Primary triggers include unmet physical needs (such as pain, hunger, or a need to use the toilet), environmental factors like overstimulation from noise or clutter, changes in routine, and psychological distress such as confusion, frustration, or fear. Sometimes, simple care tasks like bathing can be misinterpreted as a threat.

Caregivers should remain calm, speak in a gentle and reassuring tone, and try to identify the immediate cause of the outburst. Redirecting the person's attention to a new activity or a favorite object can be effective. If the caregiver feels unsafe, they should step away to a safe distance and seek help.

Yes, experiencing aggressive behavior from a loved one with dementia significantly increases the risk of caregiver burnout. Aggression is associated with higher levels of caregiver burden, anxiety, and depression, highlighting the need for robust support systems and self-care strategies for carers.

Yes, non-pharmacological approaches are often the first and most effective line of treatment for managing aggression. These strategies include music therapy, massage, aromatherapy, creating a calm environment, maintaining consistent routines, and engaging in appropriate physical and sensory activities.

No, caregivers should avoid arguing or correcting the person's reality during an aggressive episode. Doing so can increase their frustration and escalate the situation. Instead, it is more effective to focus on the feelings behind their actions and offer reassurance.

Caregivers can protect themselves by creating space between themselves and the person, always knowing the nearest exit, and removing potential hazards like sharp objects from the environment. If physical violence occurs, it is essential to prioritize one's safety by walking away and seeking assistance.

References

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.