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How to Handle Dementia Aggression with the Proven 6 R’s Strategy


senior man with adult male
A challenging, but common, behavior seen in people experiencing dementia is aggression.

Of the many challenging behaviors typical in dementia, perhaps the most difficult to manage is aggression. A family member who has always been mild-mannered can suddenly lash out in outbursts that are truly distressing: hitting, cursing, kicking, yelling, biting, or throwing things. Do you, as a family caregiver, know how to handle dementia aggression safely to help reestablish a feeling of calm?


To begin with, emphasize to yourself that the aggression is due to the disease. It’s not something the individual can control, and it is not deliberate. That said, it must be diffused in order to keep both you and the senior safe from harm.

"The 6 R’s of Managing Difficult Behavior," developed by Dr. Peter Rabins and Nancy Mace in their book The 36-Hour Day, could be an excellent way to help. Go through and refer back to them so you are equipped for the next burst of aggression.

The 6 R’s:

  • Restrict. Maintain a calm tone of voice and demeanor as you strive to help the individual withdraw from the behavior.

  • Reassess. Consider what might have provoked the incident. Triggers can include physical pain, an excessive amount of distractions or noise in the room, hunger, thirst, fatigue, etc. Maintaining a journal of what was occurring before and during each occurrence will help provide clues.

  • Reconsider. Empathize with the older adult by imagining yourself battling a disease that impedes your ability to clearly communicate your needs and wishes, to complete tasks independently which were once really easy, to feel disoriented and confused, etc.

  • Rechannel. Redirect the person to a pursuit the senior takes pleasure in, or relocate to a new environment, for example, moving out onto the front porch or going to the living room together for a snack.

  • Reassure. Let the senior see that everything is all right and that you are there. In the event that the person responds favorably to touch, place your hand on their shoulder, offer a hug or pat on the back, or take their hand in yours.

  • Review. Make note in your journal what went well – or what didn’t – to aid in utilizing the most effective response if the aggression arises again.

Knowing that aggression may develop at any time in a person with Alzheimer's, it’s beneficial to evaluate the home environment and take measures to ensure it really is as comfortable and calming as possible, for instance:

  • Playing relaxing music the senior enjoys in the background.

  • Placing familiar, comforting objects within quick access.

  • Avoiding movies that may show violence or other unsettling images.

  • Opening the curtains in the day to allow lots of natural light to stream in.

The Care Company, offering Toronto in-home care services for seniors throughout the area, is here for you with specially trained dementia caregivers who understand the intricacies of the disease and how to most effectively manage the corresponding challenges. Contact us for additional information on our in-home dementia care services for older adults.

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