Calm Compassion – Managing anxiety-related behaviors in dementia

Caring for someone with Alzheimer’s or another type of dementia can be challenging. One of the most difficult behaviors to manage is intense emotional outbursts—screaming, yelling, or crying. Your loved one might suddenly shout for help or cry for an extended period, leaving you uncertain about how to provide comfort. These episodes can be distressing for both of you, especially since they may not be able to articulate what’s wrong or stop the behavior on their own. Many older adults often struggle to describe or explain their feelings. People with Dementia may express themselves through angry outbursts, disinterest in activities, or reduced activity.

To alleviate the distress experienced by someone with dementia, we, as family members or caregivers, must remember to set aside logical reasoning. The individual with dementia cannot utilize their cognitive abilities effectively.

Dementia Can Alter a Person’s Behavior and Personality

Typical behavioral changes include becoming more agitated, restless, or not interacting with people or things around them. Sometimes, pain or infections can exacerbate these changes. While some medications can address specific behavior changes, others, such as wandering or pacing, may not respond well to medication. Non-drug approaches are often more effective in managing these behaviors. For example,

fear or confusion
physical pain or discomfort
bored
overwhelmed, frustrated, or overtired
sad or lonely
depressed
hallucinations or delusions
sundowning (increased agitation happens later in the day)
excessive noise or a chaotic environment

6 Ways to Address Sudden Screaming and Crying in Dementia

When dealing with agitation in seniors with dementia, it’s essential to approach the situation with compassion and understanding.

Stay Calm
Take a deep breath and try to remain relaxed. If you show distress, it will affect them. Speak slowly and gently, and offer a reassuring touch if they are comfortable.
Identify the Cause or Trigger
Consider what might have caused the outburst. Are they hungry, tired, or in pain? Keeping a journal can help you identify patterns over time.
Observe and Listen for Clues
Please pay close attention to their words and behaviors. If they tug at their clothes, they may be feeling uncomfortable. If they keep pointing at something, it might be distressing to them.
Address Physical Needs
Their distress can sometimes signal a need for assistance. Ensure they have enough food, water, bathroom breaks, or a more comfortable environment.
Utilize Calming Techniques
Use soothing methods, such as playing soft music, offering a gentle touch, or providing a comforting item like a blanket or stuffed animal.
Redirect Attention with Comforting Activities
Logic doesn’t always prevail with dementia, so redirecting their attention to something enjoyable can be helpful. To help them calm down, suggest a snack, music, or a favorite activity.

The “Gentle Redirection” Strategy

How it works: Instead of arguing or correcting the person, shift their attention to a different activity or topic. This reduces anxiety and keeps them engaged in something positive.

Scenario: Your loved one keeps following you, asking where their deceased spouse is. Or the person with dementia repeatedly asks the same question.

What to say: “Oh, you must miss Dad so much. He always loved [something they enjoy, like gardening or listening to music]. Let’s go outside for fresh air and see if the flowers bloom.”

Or “I see that you’re feeling worried. Everything is okay, and I’m right here. Why don’t we go sit together and listen to some music?” Use a calm voice to reassure them.

What to do:

Redirect their attention by providing an activity or a simple task that requires them to use their hands. Suggestions include folding towels, coloring, or sorting objects, such as organizing a box with various items.
Take them to a familiar and quieter environment. Choose a different room that is more spacious, has softer lighting, contains familiar objects, and plays gentle music.
Set up a personal station near their favorite spot. Include water, snacks, books, or activities to keep them engaged.

Distraction ideas:

Hand them a soft blanket and say, “Can you help me smooth this out?”
Ask about a favorite memory: “Tell me again about your favorite holiday meal!”
Engage them in an enjoyable activity, such as painting or puzzles.
Encourage movement, like walking, to release nervous energy. “I see some yellow flowers blooming. You love flowers, so let’s cut some and put them in this vase for the living room.”

The “Embrace Their Reality” Strategy

How it works: Instead of dismissing their concerns, acknowledge their feelings, follow up with a calming activity, or shift their focus to help them feel secure.

Scenario: Your loved one insists they see someone outside the window when no one is there.

What to say: “That sounds a little scary. Let’s take a look together to make sure everything is okay.” (Look outside with them calmly.) Then, add, “Everything seems peaceful. Let’s go to the kitchen and have some tea.”

If they think their long-passed spouse is coming home, instead of saying, “He passed away,” try:
“He must have been a wonderful husband. What do you miss most about him?”

What to do: Avoid arguing or telling them they’re wrong. Shift their focus: Resuming familiar routines or hobbies, such as sipping tea, brushing their hair, or doing puzzles, can help ease their minds. If they feel scared, hold their hand and guide them to another spot. Play soothing music and say, “Let’s listen to something nice together.” Offer a comforting object, like a stuffed animal or a warm drink.

Listening and Speaking Techniques and Tips

Keep your responses short and simple. If they’re worried about something, say, “Let’s check and make sure everything’s okay.”
Use eye contact and a gentle tone to prevent frustration.
Try humor if it helps lighten the mood. “Uh-oh, looks like we have a chair-loving acrobat!”
Create set responses for repetitive questions.
Stay calm. Take deep breaths and keep yourself calm first. They’re more likely to calm down if you remain relaxed.
Avoid using open-ended questions.

Struggling to Keep Things Calm? Long-Term Management and Seek Support

Make Daily Tasks Easier. Help them with frustrating activities like getting dressed or eating. Keeping things simple can reduce stress.
Identify Triggers and Make Adjustments. Look for patterns in their behavior and try avoiding known triggers. Their condition may change over time, so tracking changes is also helpful for sharing with a health professional for evaluation.
Stick to a Routine. A predictable schedule can ease stress and prevent outbursts.
Create a Peaceful Environment. Reduce clutter, noise, and bright lights to create a calm space.
Review Medications. Some medicines may cause fatigue, confusion, or distress. Ask the doctor to review all prescriptions, over-the-counter medications, and supplements.
Offer physical comfort by holding hands or a gentle hug.
Avoid restraining or arguing with them. Please do not shout at them, as this can increase their fear and confusion.
If they pose an immediate danger to themselves or others, call 911.
Schedule a doctor’s appointment to check for any medical problems.
Contact the Alzheimer’s Association Helpline at 1-800-272-3900 for additional support.

2 Tips to Minimize Emotional Distress During Friends ‘ Visits

Tip 1: Prepare and Set the Scene in Advance

Sudden surprises or too many people at once can cause anxiety and confusion.

Let the person with dementia know ahead of time in a calm, reassuring way:
“Mary is coming to visit today. She’s excited to see you, and we’ll chat nicely.”
Keep visits short (30–45 minutes) and in a quiet, familiar space.
Have only one or two visitors at a time to avoid overstimulation.
Ask visitors to approach slowly and greet them warmly without quizzing their memory (“It’s so good to see you!” instead of “Do you remember me?”).

Tip 2: Guide the Conversation and Provide Engagement

Open-ended questions or confusing topics can cause distress.

- Encourage visitors to discuss familiar and positive topics, such as past hobbies, pets, or family.
- To keep the visit structured, offer a simple activity, like looking through a photo album or listening to familiar music.
- If the person with dementia seems anxious or disengaged, step in to redirect:
- “Mom, remember how you loved baking? Susan was saying she still makes your famous cookies!”
- If distress increases, gently transition: “Let’s take a little break. Mom, maybe we can get some tea. Susan is thirsty. It will help us all relax.”

These small adjustments help make visits more enjoyable while preventing agitation and confusion. Remember, they are not acting this way intentionally. Their short attention span and memory loss affect how they respond to situations. They are doing their best in a world that no longer makes sense.