Challenging Behaviour in Dementia Care

By Xeila Ferreira Dementia Homecare January 15, 2026

“Behaviour is often a form of communication. Understanding the cause behind distress is usually far more effective than simply responding to the behaviour itself.”

Xeila Ferreira
Care Coordinator at 1st Focus Homecare

Speak to Amy About Dementia Care

Changes in behaviour can be one of the more difficult aspects of supporting someone living with dementia. Agitation, confusion, resistance to care, changes in sleep or other behaviours may place additional pressure on everyday routines and can be challenging for both the person with dementia and the family members supporting them.

If you are finding it increasingly difficult to support a parent, partner or loved one with dementia at home, you can speak directly with Amy Shikuku at 1st Focus Homecare. Amy can listen to what is happening, discuss your family’s circumstances and help you understand how personalised care at home could provide additional support, continuity and reassurance.

Amy Shikuku

Business Development Manager

Helping Edinburgh families arrange the right care package.

Choose a convenient time to speak with Amy or call our Edinburgh team now on 0131 510 7878.

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Challenging Behaviour in Dementia

Changes in behaviour can be one of the most difficult aspects of dementia for families and carers to manage. A person who was previously calm and independent may become anxious, agitated, suspicious, repetitive or resistant to everyday activities such as washing, dressing or taking medication. In some circumstances, they may also become verbally or physically aggressive.

Although these behaviours can be distressing, it is important to remember that they are often a form of communication rather than deliberate actions. Someone living with dementia may no longer be able to explain that they are frightened, uncomfortable, confused, in pain or overwhelmed by their surroundings. Understanding what may be triggering the behaviour is therefore an important part of responding appropriately.

Familiarity and consistency can also become increasingly important as dementia progresses. Maintaining established routines, recognising individual preferences and understanding what causes anxiety or distress can help make everyday care more predictable. This is one reason why families often try to support a person with dementia in their own home for as long as it remains safe and appropriate to do so.

For some families, occasional visiting care or respite support may provide the additional help they need. Where dementia has progressed to the point that someone requires much more consistent assistance and supervision throughout the day, Live in Care in Edinburgh can provide personalised one-to-one support while allowing the individual to remain in familiar surroundings and continue with established routines.

The level of support required will depend on the individual and how their dementia affects everyday life. Behavioural changes can also have physical or medical causes, so sudden or significant changes should not automatically be attributed to dementia. Pain, infection, constipation, medication and other health problems can sometimes contribute to distress or confusion and may require professional assessment.

This guide looks at some of the reasons challenging behaviour can occur in dementia, practical strategies families and carers can use to respond, and the support available in Scotland. It also considers behaviours such as aggression, sundowning, repetitive questioning and pacing, with an emphasis on understanding the person behind the behaviour rather than simply trying to stop it.

Understanding the “why” behind the behaviour

When someone living with dementia appears to act out, it is rarely a conscious choice. Alzheimer’s disease and other forms of dementia physically change the brain, often reducing the ability to communicate needs using words or logic. As a result, behaviour becomes a way of expressing an unmet need.

Within a home environment, common triggers can include:

Physical discomfort: Undiagnosed urinary tract infections (very common among older people in Scotland), constipation, pain, or feeling too cold.
Environmental overstimulation: A television that is too loud, busy surroundings, or even patterned carpets that may appear confusing or frightening.
Loss of control: Feeling “done to” rather than “done with” during personal care tasks such as bathing.

Practical strategies for different behaviours

1. Physical and verbal aggression

This behaviour is often a fight-or-flight response. If your loved one feels cornered, frightened, or does not recognise you, they may lash out as a way of protecting themselves.

Your action plan:

Step back: Give them physical space. Do not attempt to restrain them unless there is immediate danger.
Check the ABC: Look at the antecedent (what happened just before), the behaviour itself, and the consequence. For example, did the aggression begin when you turned on the shower?
Lower your pitch: Speak slowly and calmly using a low, steady voice. Loud or high-pitched tones can increase panic.
Avoid saying “no”: Instead of “Don’t do that”, try “Let’s try this instead” or “I can see you’re upset — how can I help?”

2. Sundowning (evening confusion)

Many families notice increased restlessness, anxiety, or suspicion as daylight fades. This pattern is commonly known as sundowning.

Your action plan:

Manage the light: Close curtains before dusk to reduce shadows and reflections, which can be frightening.
Routine is key: Keep evenings calm and predictable. Avoid bathing or heavy meals late in the day.
Use an orientation clock: A dementia-friendly clock that displays “Wednesday evening” rather than just numbers can help reduce confusion.
Limit stimulants: Reduce caffeine and sugary foods after midday.

3. Repetitive behaviours (questioning or pacing)

Repeated questioning or pacing can be exhausting for carers. These behaviours often stem from short-term memory loss or a need for reassurance rather than intentional disruption.

Your action plan:

Answer the emotion, not the question: If they ask, “When is my mother coming?” (even if she passed away years ago), respond to the feeling behind it. For example: “You’re thinking about your mum — she meant a lot to you. Tell me about her.”
Use visual prompts: If the repeated question is “What time is tea?”, a visible daily schedule on a whiteboard can reduce repeated anxiety.
Productive pacing: If they are pacing, they may have excess energy. Try giving them a simple task, such as helping carry a light item to another room.

Practical Strategies for Different Behaviours

Navigating support in Scotland

You do not have to do this alone. Scotland has a robust support system designed to help people remain safe and supported at home for as long as possible.

1. Alzheimer Scotland

This is the leading dementia charity in the country. They operate a 24-hour Freephone Dementia Helpline (0808 808 3000) and provide Dementia Advisors in most local authority areas. Advisors can visit you at home, explain how dementia may progress, and connect you with local Memory Cafés and peer support groups.

2. Self-Directed Support (SDS)

Under the Social Care (Self-directed Support) (Scotland) Act 2013, you have the right to choice and control over how your care budget is used. Instead of care being arranged without your input, SDS allows you to:

Employ your own personal assistant — often someone your loved one already trusts.
Purchase specialist equipment or telecare, such as door sensors to help manage wandering.
Arrange respite care, giving you time to rest and recover.

3. Adults with Incapacity (Scotland) Act 2000

This legal framework protects people who are no longer able to make decisions for themselves. It allows families to apply for Power of Attorney or Guardianship.

Why it matters: If your loved one becomes distressed and needs medical or care decisions made on their behalf, having Welfare Power of Attorney ensures that decisions are made by you — based on their wishes — rather than by the state.

One of the most effective ways to reduce daily stress is to remove the fear of the unknown. In Scotland, a Carer’s Emergency Plan ensures that if something happens to you, the person you care for will continue to receive support.

The carer’s emergency plan: your peace of mind

A Carer’s Emergency Plan is a simple written document that comes into effect when you are unexpectedly unable to provide care. It is not just for medical emergencies, but for any situation where you are delayed or unwell.

What to include in your plan:

Emergency contacts: At least two trusted people who know your loved one well and have access to the home.
The “user manual”: Notes on likes, dislikes, routines, and known triggers for stress or distress.
Medication details: Where medications are stored and the current dosage schedule.
The Herbert Protocol: If wandering is a risk, keep a completed Herbert Protocol form available. This Police Scotland initiative contains vital information that helps locate missing vulnerable adults quickly.
The Carer’s Emergency Card: Available through your local council. This wallet-sized card alerts emergency services that you are a carer and triggers your emergency plan if needed.

Also Read:

Prescription Drugs and Dementia: What Carers Must Watch Out For

Dementia check

This short survey is designed to help you identify potential early signs of dementia in a loved one. By answering a series of simple, real-life questions, you’ll receive a score that may indicate whether further medical advice could be beneficial. The questions focus on memory, behaviour, communication, and daily functioning – key areas where early changes are often first noticed.

Take the survey

How 1st Focus Homecare can support you

At 1st Focus, we understand that managing Alzheimer’s disease and dementia is not a nine-to-five responsibility. It is an ongoing journey that requires patience, understanding, and specialist skill. Based in Edinburgh and supporting surrounding areas, we help families navigate challenging behaviour with dignity, compassion, and expert care.

We can support your family by:

Specialist dementia care: Our care team is trained to understand stress and distress. We do not simply supervise — we engage individuals in person-centred activities that reduce agitation and promote calm.
Respite and sitting services: To prevent carer burnout, we offer companion sit-in services. This allows you to attend appointments, take a break, or rest, knowing your loved one is safe and supported.
Emergency and short-term support: When circumstances change suddenly, we work closely with local councils to help put rapid-response care packages in place.
Navigating the system: We provide practical guidance on accessing Self-Directed Support (SDS) and help you build a care plan that fits your family’s life — not a one-size-fits-all service.

Taking the next step

You do not need to wait for a crisis to ask for help. Sometimes, having a professional carer visit for just a few hours each week can provide the reset you need to continue caring for your loved one with warmth, patience, and confidence.

Call us on 0131 510 7878 to find out how we can support you.