Dementia – disruptive behaviour

Information for carers on managing disruptive behaviour

Key points about dementia and disruptive behaviour 

  • It's common for people with dementia to have disruptive behaviours. 
  • Examples of disruptive behaviours in people with dementia include restlessness, confusion, aggressiveness, wandering, sleep disturbance, repetitive behaviours, shadowing and hoarding. 
  • Sometimes they can be due to frustration at not being understood and being confused with their environment. 
  • Disruptive behaviours that happen suddenly can also be caused by medicines or another health condition.
  • Treatment of disruptive behaviours is usually non-medicine behavioural strategies
  • There are also things you can do as a carer to help cope with disruptive behaviours.
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People with dementia may behave differently in the later stages of dementia. Often these behaviour changes can be disruptive and more distressing than the loss of memory for both the person with dementia and family/whānau or carers looking after them. 

Some examples of disruptive behaviours in dementia include:

  • restlessness, confusion and being aggressive – these behaviours tend to get worse in the late afternoon when daylight fades, which is also known as sundowning
  • wandering up and down
  • sleep disturbance and night-time waking
  • repetitive behaviours such as asking the same question or doing an activity over and over again
  • shadowing – following their partner or carer constantly
  • hoarding – keeping things excessively to save them. 

Sometimes these symptoms or behaviours are not caused by dementia. They can be due to frustration at not being understood and being confused with their environment. 

In some cases, disruptive behaviours that happen suddenly can also be caused by medicines or a health condition. Bring the person you are caring for to your GP to get checked. Your GP can assess and rule out any underlying problems and give advice on treating disruptive behaviours. 

If disruptive behaviours are caused by a health problem or medicines, treating the health problem and reviewing their medicines can help. Your GP or doctor can help check and rule out any underlying problems. 

Otherwise, the treatment of disruptive behaviours can include: 

  • keeping a diary to help identify when these disruptive behaviours happen or are worse
  • tips to cope with disruptive behaviours - see below. 
  • medicines such as antidepressants or antipsychotics

While geriatricians are the specialists primarily involved in the long-term care and oversight of people with dementia, when disruptive behaviours become an issue, psychogeriatricians (psychiatrists who specialise in mental health issues for older adults) may also help in their care.

In rare cases, there are secure dementia units for people with dementia who have disruptive behaviours and wandering. It is very uncommon but sometimes needed for safety.

Although it's not always easy to cope with disruptive behaviours in people with dementia, there are things that you can do to help with these.

Have a daily routine

Establish a basic daily routine in the household and try to stick to it. Try to keep things as normal as possible and not treat the person with dementia like an invalid. Support them to be independent for as long as possible, doing tasks they can still carry out. This helps them retain some sense of dignity and usefulness.

Because people with dementia experience sundowning, where they get more confused and agitated later in the afternoon, plan to do activities that use more energy, such as bathing, earlier in the day or having the biggest meal at midday.

In the evening, set a quiet mood with lower lights, less noise and soothing music. Also, try to keep the bedroom dark and comfortable to encourage sleeping. 

Exercise

You can help the person do simple exercises such as taking one or two walks each day. Physical activity can help use nervous energy and improves mood. Exercise can also make them feel tired so they sleep better at night. 

Don't argue

Don't argue or raise your voice when the person you are caring for is distressed or agitated. Instead, try to explain things to them in a calm and reassuring voice. If an explanation doesn't help, you can try distracting them with music, singing, dancing, going for a walk or asking them to help with a simple task such as folding clothes or setting the table.  

Offer general reassurance

People with dementia can feel insecure and unsafe at times as they can't remember things and are confused in their environment. They may follow and shadow their carers around wherever they go. They need constant reassurance that they are safe and not alone. As a carer, you can always reassure them that they are safe and let them stay with you if you are doing household chores. 

Plan simple activities and social time

Planning simple activities that the person you are caring for has enjoyed or keeping an active social life can help reduce disruptive behaviours.

Attending day programmes in facilities can provide motivation and socialisation for people with dementia while providing respite for you as the carer. It may be difficult to introduce the idea of going to a day programme to a person with dementia as they may not see the need to go and may prefer to remain at home. It can take time for a person with dementia to get used to a new environment and new people. 

Ask other people, such as your doctor, family and friends to provide encouragement and to reinforce the positive benefits. Begin by trying day care one day a week and increase this as the person gains confidence to attend.


Enquire about suitable day programmes by contacting your Needs Assessment and Service Coordination (NASC)(external link)(external link) team or local Alzheimer’s organisation(external link)(external link).

Disruptive behaviours in dementia can create a lot of stress and be distressing for family/whānau or carers looking after them. As a carer, you can learn about the support available and make sure you look after your own health and wellbeing. Read more about dementia for carers

There are a wide range of support organisations and services that are there to help you if you are caring for someone with dementia. 

Phone support 0800 004 001 Alzheimers NZ(external link)(external link)

The following links provide further information about disruptive behaviours in dementia. Be aware that websites from other countries may have information that differs from New Zealand recommendations.   

Alzheimer's disease and other forms of dementia – disruptive behaviour(external link)(external link) Choosing Wisely, NZ
Understanding changed behaviour – a guide for people with dementia and their family/whānau(external link) Alzheimer's NZ
Dementia and behaviours(external link)(external link) Dementia Canterbury, NZ
Dementia – behaviour changes(external link)(external link) Better Health Channel, Australia
Behaviour changes(external link)(external link) Dementia Australia
Coping with dementia behaviour changes(external link)(external link) NHS, UK 

Resources

A guide for carers(external link)(external link) Ministry of Social Development, NZ, 2021
Resources and information on dementia for New Zealanders(external link)
Understanding changed behaviour(external link)(external link) Alzheimers NZ, 2016
Information for family and friends(external link) Dementia New Zealand, 2023
Communicating with people with dementia(external link)(external link) Dementia New Zealand, 2017
Disinhibited behaviour(external link) Dementia New Zealand

References

  1. Managing the behavioural and psychological symptoms of dementia(external link)(external link) BPAC, NZ, 2020
  2. Alzheimer's disease and other forms of dementia – disruptive behaviour(external link)(external link) Choosing Wisely, NZ, 2017
  3. Behavioural and psychological symptoms of dementia (BPSD)(external link)(external link) Auckland Regional HealthPathways, NZ, 2020

The following information on treating disruptive behaviour in people in dementia is taken from Choosing Wisely, NZ, accessed October 2020:

Antipsychotic drugs don’t help much. Studies have compared these drugs to sugar pills or placebos. These studies showed that antipsychotics usually don’t reduce disruptive behaviour in older dementia patients.

Antipsychotic drugs can cause serious side effects. Doctors can prescribe these drugs for dementia for behavioural symptoms, but they cause serious side effects.

Side effects include:

  • drowsiness and confusion – which can reduce social contact and mental skills, and increase falls
  • weight gain
  • diabetes
  • shaking or tremors (which can be permanent)
  • pneumonia
  • sudden death.

Other approaches often work better. It is almost always best to try other approaches first, such as the suggestions listed below.

Make sure the patient has a thorough exam and medicine review.

  • The cause of the behaviour may be a common condition, such as constipation, infection, vision or hearing problems, sleep problems, or pain.
  • Many drugs and drug combinations can cause confusion and agitation in older people.

Read more about treating disruptive behaviour in people in dementia(external link) Choosing Wisely, NZ

See our page Dementia for healthcare providers

Clinical resources and guidelines

Managing the behavioural and psychological symptoms of dementia(external link)(external link) BPAC, NZ, 2020
Behavioural and psychological symptoms of dementia (BPSD)(external link)(external link) Auckland Regional HealthPathways, NZ, 2020
Antipsychotics in dementia(external link)(external link) BPAC, NZ

Brochures

a guide for caeres

A guide for carers(external link)

Ministry of Social Development, NZ, 2021

Information for family and friends

Dementia New Zealand, 2023

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Helen Kenealy, geriatrician and general physician, Counties Manukau DHB

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