Agitation in Dementia: Communication Strategies (Processing Time, Perceived Threat, Preserving Dignity)

In Part 1 of Town Square University Parkway’s Agitation in Dementia education series, Catherine McDermott, PMHNP, explains that agitation is not always physical.

It often shows up in everyday moments through a sharper tone of voice, a tense facial expression, pacing, arguing, refusing help, pulling away, or simply appearing unsettled. The most important takeaway is that these behaviors are typically a sign of anxiety, confusion, or feeling unsafe, not someone “being difficult on purpose.”

The video also highlights how personal care tasks like bathing, dressing, or changing clothes can be especially triggering. When someone living with Alzheimer’s disease or dementia does not understand what is happening, those moments can feel rushed, confusing, or invasive. The brain may respond defensively as a form of self-protection.

This session helps caregivers recognize early warning signs before agitation escalates, including constant movement, big reactions to small problems, repeated worries or nonstop talking, quick mood shifts, and becoming overwhelmed in loud or busy environments. It also reinforces an important point: agitation usually has a cause, even when the person cannot clearly explain it. Common triggers include pain, fatigue, hunger, dehydration, constipation, needing the bathroom, feeling too hot or too cold, and frustration when tasks suddenly feel too complicated.

A practical approach caregivers can apply right away is to slow everything down. Approach calmly, speak in short, simple sentences, allow extra processing time, and reduce stimulation. Instead of correcting or arguing, focus on comfort, reassurance, and keeping things simple. If agitation continues, do a quick basic needs check and consider pausing and trying again later, especially during personal care, using one step at a time with a gentle and steady tone.