Managing Disruptive Behaviors
There are two types of treatments for disruptive behaviors: drug and non-drug approaches. You should ALWAYS use non-medication methods first. Steps to managing disruptive behaviors include using the ABC method to identify the behavior and understand its cause, and then adapting the environment/ situation to avoid/ fix the problem behavior.
Before reading the content on this page, it may be beneficial to review the following video(s) from the Office of Rural Health (ORH).
Dealing with Problem Behaviors
Length: 05:27 (Link opens new window)
Nurse explains problem behaviors common in moderate and severe stages of dementia. She offers tips to help with difficult behaviors.
How to Respond to Disruptive Behaviors Using Non-Medication Interventions
Some examples of how the caregiver should respond to disruptive behaviors include the following: 
Anger/ Aggression and Anxiety/ Agitation
- First, rule out pain as the trigger behind aggressive or combative behavior, then focus on the immediate cause, or trigger.
- Focus on your loved one’s feelings behind their actions or words. Try not to get upset, as hostile or aggressive communication can only make the behavior worse. Be positive, speak calmly and reassure your loved one. If he or she anxious/ agitated, listen to their frustrations and try to understand.
- Examine your loved one’s surroundings and adapt to avoid similar situations. Ie: limit noise/ distractions. Try relaxing activities that your loved one might enjoy, or perhaps engage him/her in exercise. Shift the focus to another calming activity.
- If disruptive behavior continues, it’s ok to take a break. If your loved one is in a safe environment, walk away and take a moment for yourself. If he/she is unable to calm down, seek help from others. It may be necessary to call 911, especially in an emergency situation. If this is the case, be sure to tell the responders the person has dementia, which causes them to act out.
Forgetfulness/Confusion
- Stay calm and do not take it personally if your loved one does not recognize you. This can be painful for the caregiver, and it may help to discuss this with a friend or family member.
- Respond to your loved one with simple explanations when asked. I.e.: ‘You use a spoon to put food in your mouth.’
- Use photos, memorabilia or music to serve as reminders to your loved one with dementia. Encourage the person with dementia to tell stories of the “good ole’ times,” you’d be surprised what stories he/she might remember to tell!
- Try not to scold your loved one for forgetting. Use responses like “I thought it was a fork,” or “I think he’s your grandson Peter.”
Repetitive Words/Actions
- Try to look for the specific trigger for the behavior. Is he or she looking for comfort or familiarity?
- Turn the action or behavior into an activity, such as folding clothes or dusting.
- Always stay calm and be patient with your loved one with dementia. If he/she is asking the same question repeatedly, give them the answer they are looking for, even if you have to repeat it several times.
- Consider that repetitive actions may be the result of boredom. Try to engage the person in an activity like taking a walk, or a puzzle.
Suspiciousness
- Try not to take offense at any accusations of theft, infidelity or other improper behaviors. Listen to what is troubling your loved one and try to be understanding. Arguing and trying to convince him/her will likely not help, so allow him/her to express their thoughts.
- Offer a simple answer to any accusations, and then switch the focus to a new, engaging activity. Perhaps a chore.
- Duplicating items may help if your loved one seems to constantly look for the same item, i.e., a wallet. Purchase multiples of the same kind.
Sleep Issues/Sundowning 
- Discussed at length in the Sleep Issues page
Wandering & Hoarding
- Discussed at length in the Wandering & Hoarding page
According to the examples listed above, you can see that a key intervention is redirecting your loved one’s attention, rather than arguing, disagreeing or being confrontational. Additional strategies may include the following:
- Simplify the environment
- Simplify routines/ chores
- Allowing rest between activities
- Use labels to remind your loved one
- Utilize safety locks on doors and gates
- Remove unsafe items, such as guns
- Use lighting to reduce confusion and restlessness at night
Additional Resources 
VA Resources 
US Department of Veterans Affairs
VA values your commitment as a partner in our pledge to care for those who have "borne the battle." We have several support and service options designed with you in mind. The programs are available both in and out of your home to help you care for yourself and the Veteran you love.
- Caregiver Support Network
- VA Caregiver Support Line: 1-855-260-3274
Geriatrics and Extended Care Services (GEC) is committed to optimizing the health and well-being of Veterans with multiple chronic conditions, life-limiting illness, frailty or disability associated with chronic disease, agining or injury. This VA site reviews information on delirium, dementia and Alzheimer's care, decision making, home and community based services, and advance care planning, among many other important topics that may be important for you as a caregiver.
Veteran's Crisis Line Phone: 1-800-273-8255 (Veterans Press 1)
References: Information adapted from Alzheimer’s Association and Office of Rural Health
If you have any questions or concerns, contact Dementia Caregiver Web Support.
