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How to Respond Safely to Dementia Aggression Using the 6 R’s

Dementia aggression is one of many challenging changes that can occur in people with dementia, and it is undoubtedly one of the most difficult to respond to. A loved one who has always been mild-mannered can randomly experience outbursts that can be genuinely terrifying: hitting, kicking, cursing, yelling, throwing things, or biting. So how can you, as a family caregiver, safely help restore a sense of calm?

First, remind yourself that aggression is an effect of the disease. It’s not something the person can control, and it is not intentional. It needs to be diffused to keep both you and the senior safe.

The 6 R’s of Managing Difficult Behavior,” developed by Dr. Peter Rabins and Nancy Mace in their book The 36-Hour Day, can be an excellent way to help. So go through and refer to these suggestions to equip you for the next burst of aggression.


The 6 R’s

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

  • Reconsider. Empathize with the senior by imagining yourself fighting a disease that suppresses your ability to convey your needs and wishes, accomplish tasks that were once so easy, feel confused and disoriented, etc.

  • Reassess. Think through what may have provoked the incident. Triggers can include physical pain, too much noise or other distractions in the room, hunger, thirst, fatigue, etc. Keeping a journal of what was occurring before and during each incident might help provide clues.

  • Reassure. Let the individual know that everything is ok and that you are there. If the person responds positively to touch, place your hand on their shoulder, offer a pat on the back or hug, or take their hand in yours.

  • Rechannel. Redirect the person to an activity the individual enjoys, or relocate to another type of environment, such as stepping out onto the front porch or going to the dining room together for a snack.

  • Review. Make a note in your journal of what went ok – or didn’t – to aid in utilizing the most reliable response as soon as the aggression arises again.

Understanding that aggression may occur at any time in an older adult with dementia, it’s helpful to look at the home environment and take measures to ensure it is as comfortable and calming as possible, for instance:

  • Placing comforting and familiar objects within quick access.

  • Playing quiet music, the senior enjoys in the background.

  • Opening the window blinds during the day allows an abundance of daylight.

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


Modern Health Home Care, providers of expert home care in Philadelphia, PA and the surrounding counties, is here to help with specially trained dementia caregivers who understand the intricacies associated with the disease and manage the related challenges most effectively. Reach out to us online or at 215.995.2012 for more information on our in-home dementia care for seniors.

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