3 simple ways to manage challenging behaviours associated with dementia

The Bottom Line

  • Person-centred care and communication, sensory stimulation and listening to music are three evidence-based therapies that can help reduce agitation and other challenging behaviours for people with dementia.
  • Given that antipsychotic drugs have many side effects, effective non-drug strategies should be considered first.

Dementia can be a devastating diagnosis. The characteristic problems with memory, thinking, language and judgment are a challenge, but there are also “behavioural and psychological symptoms of dementia” (BPSD), including agitation, aggression, wandering, resistance to care, delusions, hallucinations and repetitive speech. These symptoms can be very upsetting for people with dementia as well as their loved ones, and are often the reason people are admitted to long-term care (1).

How do caregivers cope with these challenging behaviours? Often, doctors prescribe medications including antipsychotics, antidepressants and anti-anxiety drugs to help calm patients, but there are problems associated with drug use including side effects that can lead to serious health issues (2-4). Recent evidence recommends a shift in the way we manage challenging symptoms of dementia, valuing non-drug approaches that calm and reassure people as a first treatment step.

What works best? Try one – or all – of these 3 non-drug approaches for people with dementia, supported by recent high quality research. Click on the titles for more information and to read the research summaries.

1. Person-centred care: Getting to know all about you

One of the most promising approaches involves an individualized person-centred model of care in which a person’s background, likes/dislikes, values, culture and abilities are taken into account to develop communication and care strategies that encourage positive responses and interactions (5-7).

Person-centred care has also been shown to benefit caregivers by promoting greater job satisfaction and preventing burnout (8).

2. Sensory stimulation: The healing power of touch

Various types of sensory stimulation, such as hand massage, can help improve behaviours and the general wellbeing of people with dementia (9).

3. Music to soothe and relax

Many people enjoy the uplifting and relaxing qualities of music. Relaxing music has been shown to promote cooperation during meal times. Listening to music of their choice while receiving one-on-one personal care—such as bathing—may also help improve behaviour among people with dementia who are more resistant to care (10). Similarly, receiving five or more sessions of a music-based therapeutic strategy can possibly reduce symptoms of depression and improve overall behavioural issues in people with dementia who are living in long-term care settings (11).

Other drug-free strategies currently being studied for their impact on agitation among nursing home residents include bright light therapy, doll therapy, pet therapy, and aromatherapy (9;12;13).

Considering the rapid rise in the rate of dementia and the toll it takes on individuals, families, caregivers and healthcare systems, it’s not surprising that experts are intent on exploring and testing new treatments and therapies. Non-drug approaches not only avoid the side effects of medication, there is increasing evidence that they help reduce challenging behaviours associated with dementia, making life a bit easier for people with dementia and their caregivers.

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Author Details


  1. Lopez OL, Becker JT, Chang YF, et al. The long-term effects of conventional and atypical antipsychotics in patients with probable Alzheimer`s disease. Am J Psychiatry. 2013; 170(9):1051-1058.
  2. Huybrechts KF, Gerhard T, Crystal S, et al. Differential risk of death in older residents in nursing homes prescribed specific antipsychotic drugs: Population based cohort study. BMJ. 2012; 23:344. doi: 10.1136/bmj.e977.
  3. Bakken MS, Schjott J, Engeland A, et al. Antipsychotic drugs and risk of hip fracture in people aged 60 and older in Norway. J Am Geriatr Soc. 2016; 64(6):1203-1209.
  4. Cummings JL, Lyketsos CG, Peskind ER, et al. Effect of dextromethorphan-quinidine on agitation in patients with Alzheimer disease dementia: a randomized clinical trial. JAMA. 2015; 314(12):1242-1254.
  5. Livingston G, Kelly L, Lewis-Holmes E, et al. Non-pharmacological interventions for agitation in dementia: systematic review of randomized controlled trials. Br J Psychiatry. 2014; 205(6):436-442. 
  6. Legere LE, McNeill S, Schindel Martin L, et al. Nonpharmacological approaches for behavioural and psychological symptoms of dementia in older adults: A systematic review of reviews. J Clin Nurs. 2018; 27(7-8):e1360-e1376. doi: 10.1111/jocn.14007.
  7. Mohler R, Renom A, Reno, H, et al. Personally tailored activities for improving psychosocial outcomes for people with dementia in long-term care. Cochrane Database Syst Rev. 2018; 2:CD009812. doi: 10.1002/14651858.CD009812.pub2. 
  8. Barbosa A, Sousa L, Nolan M, et al. Effects of person-centred care approaches to dementia care on staff: A systematic review. Am J Alzheimers Dis Other Demen. 2014; 30(8):713-722. 
  9. Zimmerman S, Anderson WL, Brode S, et al. Systematic review: Effective characteristics of nursing homes and other residential long-term care settings for people with dementia. J Am Geriatr Soc. 2013; 61:1399-409.
  10. Konno R, Kang HS, Makimoto K. A best-evidence review of intervention studies for minimizing resistance-to-care behaviours for older adults with dementia in nursing homes. J Adv Nurs. 2014; 70(10):2167-2180.  
  11. Van der Steen JT, Smaling HJ, van der Wouden JC, et al. Music-based therapeutic interventions for people with dementia. Cochrane Database Syst Rev. 2018; 7:CD003477. doi: 10.1002/14651858.CD003477.pub4. 
  12. Ayalon L, Gum AM, Feliciano L, et al. Effectiveness of nonpharmacological interventions for the management of neuropsychiatric symptoms in patients with dementia: A systematic review. Arch Intern Med. 2006;166(20):2182-2188.
  13. Stom BS, Ytrehus S, Frov EK. Sensory stimulation for persons with dementia: A review of the literature. J Clin Nurs. 2016; 25(13-14):1805-1834.

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of new and old blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with changing public health recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.