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How to Handle Aggression in Dementia with the 6 R’s

How to Handle Aggression in Dementia with the 6 R’s

Of the many challenging behaviors common in dementia, perhaps the most difficult to manage is aggression. A senior who has always been mild-mannered can suddenly lash out in outbursts that are truly frightening: hitting, yelling, cursing, kicking, biting, or throwing objects. How can you, as a family caregiver, safely help restore a sense of calm?

First of all, remind yourself that aggression in dementia is caused by the disease. It’s not something the person can control, and it is not intentional. That being 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, can be an effective way to help. Read through and refer back to them so you’re prepared for the next burst of aggression.

The 6 R’s:

  • Restrict. Maintain a calm demeanor and tone of voice as you work to help the person disengage from the behavior.
  • Reassess. Think through what may have provoked the incident. Triggers could include physical pain, too much noise or other distractions in the room, hunger, thirst, fatigue, etc. Keeping a journal of what was happening before and during each incident can help provide clues.
  • Reconsider. Empathize with the senior by imagining yourself battling a disease that inhibits your ability to clearly communicate your needs and wishes, to complete tasks independently that were once so easy, to feel confused and disoriented, etc.
  • Rechannel. Redirect the person to an activity the senior enjoys, or move to a different environment, such as stepping out onto the front porch or going into the dining room together for a snack.
  • Reassure. Let the senior know that everything is ok and that you are there. If 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. Note in your journal what went well – or what didn’t – to aid in using the most effective response when the aggression arises again.

Understanding that aggression in dementia may arise at any time, it’s helpful to assess the home environment and take steps to ensure it is as calming and comfortable as possible, such as:

  • Playing quiet music the senior enjoys in the background.
  • Placing familiar, comforting objects within easy access.
  • Avoiding TV shows that may display violence or other disturbing images.
  • Opening the blinds during the day to allow plenty of natural light to stream in.

Amy’s Helping Hands, award-winning experts in caregiving in Windsor, Ontario and nearby areas, is here for you as well with specially trained dementia caregivers who understand the nuances of the disease and how to best manage the associated challenges. Contact us for more information on our in-home dementia care services for seniors.


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