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


Dementia aggression is one of the more challenging behaviors to manage in a loved one with Alzheimer’s.

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

To start with, emphasize to yourself that the aggression is a consequence of the disease. It’s not something the older adult can control, and it is not intentional. Having said that, it needs to be diffused in order to keep both you and the older adult protected 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 ideal way to help. Go through and refer back to them so you’re prepared for the next burst of aggression.

The 6 R’s
  • Restrict. Maintain a calm tone of voice and demeanor as you work to help the person disengage from the behavior.
  • Reassess. Consider what may have provoked the incident. Triggers can include physical pain, too much noise or other distractions in the room, fatigue, hunger, thirst, etc. Keeping a journal of what was occurring before and during each occurrence often helps provide clues.
  • Reconsider. Empathize with the older adult by picturing yourself battling a disease that impedes your ability to clearly convey your wishes and needs, to accomplish tasks independently which were once very easy, to feel confused and disoriented, etc.
  • Rechannel. Redirect the older adult to a pursuit the individual enjoys, or relocate to another environment, such as moving out onto the front porch or going into the dining room together for a snack.
  • Reassure. Let the individual know that everything is alright 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 did not – to help in utilizing the most effective response as soon as the aggression arises again.

Knowing that aggression may occur at any time in an older adult with Alzheimer’s, it is helpful to evaluate the home environment and take measures to make sure it is as calming and comfortable as possible, for instance:

  • Playing quiet music the older adult enjoys in the background.
  • Placing comforting and familiar objects within easy access.
  • Staying clear of TV shows that may display violence or any other troubling images.
  • Opening the window shades during the day to allow an abundance of sunlight to stream in.

CareWorks Health Services is here for you as well with highly trained dementia caregivers who understand the nuances associated with the disease and how to most effectively manage the related challenges. Contact us at (949) 859-4700 to learn more about our Newport Beach memory care and home care services. For a full list of all of the communities where we provide care, please visit our Service Area page.