Managing Behaviors That Challenge in Dementia: Activity-Based Solutions

For those living with dementia, the world can feel unpredictable—full of moments that don’t quite make sense, emotions that don’t seem to fit, and memories that slip through their fingers. When words fail or frustration builds, behaviors like agitation, restlessness, or even aggression can emerge. These moments aren’t random acts of defiance; they are often a desperate attempt to communicate something deeper—pain, fear, confusion, or an unmet need.

As activity coordinators, caregivers, and family members, we’ve all seen how dementia can shape behavior. But how we respond in these moments can make all the difference. While structured activities are essential, the way we approach them—adapting to emotions, body language, and environment—can transform frustration into connection. Let’s go beyond the basics and explore advanced ways to support individuals with dementia through meaningful engagement.

Why Challenging Behaviors Happen

If we want to address challenging behaviors, we first need to understand their roots. Dementia alters the way the brain processes information, meaning that even simple daily activities can become overwhelming. Here are some lesser-discussed reasons why behaviors escalate:

1. Sensory Overload or Deprivation

Loud televisions, multiple conversations, harsh lighting, or even strong cleaning product scents can overwhelm someone with dementia. On the flip side, too much silence or a lack of sensory stimulation can lead to frustration. Striking the right balance is key.

2. The Impact of the Body Clock

Sundowning—the increase in confusion, agitation, or restlessness in the late afternoon or evening—is often linked to disruptions in the body’s internal clock. Exposure to natural light during the day and minimizing artificial light in the evening can help regulate sleep and reduce agitation.

3. Unrecognized Pain or Discomfort

A person may lash out because their shoes are too tight, their chair is uncomfortable, or they have undiagnosed pain (like arthritis or a urinary tract infection). If someone is unusually distressed, a quiet check-in—gently rubbing their hands or adjusting their seat—can reveal discomfort they might not be able to articulate.

4. Emotional Echoes from the Past

People with dementia sometimes relive emotions from past experiences, even if they can’t remember the details. A resident who spent years raising children may become distressed at dinnertime because, subconsciously, they feel they should be preparing a meal. Someone who worked in a factory might grow anxious if they don’t have something to do with their hands. Recognizing these patterns allows us to redirect their energy into something meaningful.

Transforming Distress Into Connection: Thoughtful Activity Approaches

Challenging behaviors are often a call for connection. A well-chosen activity can shift the mood, providing comfort, stimulation, or a sense of purpose. Ideally, activities should:

- compensate for lost abilities

- promote self-esteem

- maintain residual skills and not involve new learning

- provide an opportunity for enjoyment, pleasure and social contact

- be sensitive to the person’s cultural background.

Here are a few approaches that go beyond traditional methods:

1. Repetitive, Rhythmic Activities to Restore Calm

The brain finds comfort in predictable, rhythmic motions. Activities like kneading dough, rolling fabric, or threading large beads can have a naturally soothing effect. A simple hand massage, tracing circles on the palm, or even gently drumming fingers on a table can redirect agitation into something repetitive and grounding.

2. Personalized ‘Busy Boxes’ for Restlessness

For those who become agitated or fidgety, having a personalized “busy box” can work wonders. These can include items that mimic familiar movements from their past—a small set of nuts and bolts for a former mechanic, fabric swatches for a retired seamstress, or smooth stones for someone who enjoyed the outdoors. When someone is feeling unsettled, offering a familiar item to interact with can bring an unexpected sense of calm.

3. Music as an Anchor for Emotions

Music isn’t just entertainment—it’s a powerful emotional tool. Instead of just playing background music, use it interactively. If someone is anxious, try humming softly before introducing a familiar tune. If a resident is withdrawn, hand them a simple percussion instrument like a tambourine or maracas to engage their hands and senses. Singing well-loved songs together can spark moments of clarity and joy.

4. ‘Mirroring’ to Ease Aggression

If someone becomes upset or aggressive, rather than contradicting them or trying to ‘calm them down,’ try mirroring their emotion at a gentler level. If they say, “I need to go home!” with urgency, respond with matching concern: “I understand, you need to get home. It’s important. Let’s figure that out together.” Then, gradually guide the conversation toward a grounding activity like folding towels or sharing a snack. Mirroring validates their feelings, easing tension rather than escalating it.

New and Unique Activity Ideas for Dementia Care

1. ‘Listening Walks’ With a Twist

Instead of a standard walk, try a guided “listening walk” where the focus is purely on sounds. Prompt residents to listen for birds, footsteps, rustling leaves, or distant voices. This encourages mindfulness and connection to the present moment, which can help ease anxiety and agitation. If mobility is an issue, this can be done from a garden bench or open window.

2. Sensory ‘Mystery Box’

For individuals struggling with verbal communication, sensory play can provide engagement without pressure. Fill a box with objects of varying textures, temperatures, and shapes—cold metal keys, soft wool, a wooden spoon, a smooth stone. Let them explore each object, describing it together through feeling rather than naming. This can be incredibly calming and help redirect restlessness.

3. ‘Time-Travel Picnics’

Set up a small picnic in the garden or lounge, but tailor it to a specific decade based on the resident’s younger years. Use vintage packaging, play music from that time, and serve familiar snacks from their past (like jam sandwiches wrapped in wax paper). This creates a rich sensory experience that can spark memories and conversation, particularly for those who struggle with short-term memory but recall distant past events vividly.

4. ‘Chore Therapy’ (That’s Not Really Chores)

Many people with dementia feel a loss of purpose, especially if they were once very independent. Instead of giving them generic tasks, frame simple activities as helpful “chores” that align with their past roles. A former teacher might be asked to “help sort papers” (magazines, newspapers). Someone who worked in a café might “set the table” for an imaginary guest. The task itself doesn’t matter—what matters is that they feel needed.

5. Themed ‘Hand Massage Conversations’

Hand massages are already a great way to provide comfort, but turning them into storytelling moments makes them even more engaging. As you massage their hands, ask open-ended questions based on a theme—like “Tell me about a time your hands were busy baking something” or “What’s something your hands were really good at doing?” This invites personal storytelling while providing a soothing experience.

A Final Thought

Challenging behaviors in dementia aren’t about being difficult—they’re about navigating a world that no longer makes sense in the way it once did. Every distressing moment is an opportunity to understand, connect, and offer comfort in a way that feels meaningful.

As activity coordinators, you already do so much more than plan sessions—you create safe spaces, moments of joy, and opportunities for self-expression when words fail. By fine-tuning our approaches and deepening our understanding, we can transform the way we support those with dementia, turning even the hardest moments into meaningful connections.