A small field guide

Aggression and striking out

Hitting, biting, yelling

The person's language: "I am terrified." "I am in pain and can't tell you." "I feel threatened and need to protect myself." "You are invading my personal space and I don't understand why."

Respectful response:

• Do NOT take it personally. It is a symptom, not a personal attack.
• Look for the trigger. Are they constipated? In pain? Are you approaching them too quickly or from behind? Are they overstimulated?
• Defuse, don't confront. Lower your voice, step back, and give them space. Use a calm, reassuring tone.
• Check for pain. A urinary tract infection, which is common and makes people very confused, can often be the culprit for sudden aggression.
• Validate, don't argue. "I can see you're very upset. I'm sorry. Let's sit down for a minute."

Wandering and pacing

The person's language: "I am restless and need to move." "I'm looking for something but I don't know what." "I am uncomfortable and need a change of scenery." "I'm looking for my home/my mother/my husband."

Respectful response:

• Exercise: Is the person getting enough movement during the day?
• Design a safe route. Make a clear path in the garden or house for them to wander in.
• Avoid restraint. Restraining a wanderer is dangerous and traumatic. Try to redirect them instead. "Let's go to the kitchen and get a snack" or "Will you help me fold this laundry?"
• Address unmet needs. Are they hungry, thirsty, or needing the toilet?
• Wander with them. Sometimes, the most loving thing you can do is simply to walk alongside them, validating their need to move.

Repetitive questioning and speech

The person's language: "I need reassurance." "I am anxious about something but can't articulate it." "My short-term memory is broken and every minute is a new moment."

Respectful response:

• Look for the emotion behind the question. They aren't asking "What time is dinner?" to be annoying. They are asking because the anxiety of not knowing is overwhelming. Answer the emotion, not the fact. "You don't need to worry, I'll take care of dinner."
• Use "therapeutic fibbing" (or reality validation). If they ask for their mother (who has been dead for 40 years), do not correct them. This can cause profound distress and re-traumatize them with the grief of their loss. Instead, validate the need behind it: "She sounds like a wonderful woman. Tell me about her." Or, "We'll see her soon."
• Use a "wonder wall" or response cards. Sometimes, writing the answer to a repeated question ("Dinner is at 6pm") on a whiteboard can help, but for many, the issue is the inability to hold information, not the lack of an answer.
• Validate the concern. "I can see you're worried about that. It's okay, I'm here to look after you."

Screaming or vocalizations (in later stages)

The person's language: "I am in pain." "I am lonely and need human connection." "I am bored out of my mind." "I am hungry/thirsty/tired."

Respectful response:

• This is a medical priority. Rule out pain and discomfort immediately.
• Provide sensory stimulation. A gentle massage, soothing music, holding a hand, giving them a soft doll or stuffed animal to cuddle.
• Identify and avoid triggers. Is it too quiet? Too loud? Are they near a window where they can't see the outside?
• Remember that this is not a choice. They are not "trying to annoy you."

Hiding, or accusing others of theft

The person's language: "I am trying to keep my valuables safe." "I don't remember where I put my wallet." "I feel vulnerable and my memory is failing me, so someone must have taken it."

Respectful response:

• Don't argue. "You're right, we'll find it." Acknowledge their distress.
• Search with them. Look in "safe" places (under the mattress, in a favorite drawer, inside a book). You'll often find the "stolen" item.
• Always have duplicates. Have copies of their keys, glasses, and favorite items. Keep spares in a drawer to produce when needed.