3.4. Identify reasons why a person with dementia may become angry

This guide will help you answer 3.4. Identify reasons why a person with dementia may become angry.

Dementia is a progressive condition impacting memory, judgement, language, and behaviour. Anger is a common reaction in people with dementia. It can be confusing for those around them. If you support someone with dementia, understanding the possible reasons for anger is important for giving good care.

Dementia affects the brain in ways that change how a person thinks, feels, and reacts. Anger is often a response to distress. It is rarely about you as a staff member, but about the person’s experience in that moment.

Common Reasons for Anger in Dementia

A person with dementia may become angry for many reasons. These can relate to changes in their brain, their health, their surroundings, or how others behave towards them.

Confusion and Frustration

Memory loss or confusion can make daily life overwhelming. The person might not understand where they are, who people are, or what is happening. This confusion can lead to frustration and then anger.

For example:

• Being unable to find their room
• Forgetting a familiar face
• Not recognising their own belongings
• Struggling to follow a conversation
• Not understanding instructions

Loss of Independence and Control

Dementia often involves losing skills and needing help with personal care. This loss of independence can feel humiliating or upsetting. The person may resent being told what to do, or feel they are being treated like a child.

Signs include:

• Angry reactions during bathing, dressing, or eating
• Refusal to accept help
• Expressing frustration over needing assistance

Communication Difficulties

Dementia affects the ability to speak, understand, read, or write. The person might struggle to find words, keep track of conversations, or make themselves understood. When communication breaks down, anger can follow.

Common issues:

• Not finding the right words
• Not understanding what others say
• Not being understood by staff or family
• Feeling ignored or left out

Physical Discomfort or Pain

People with dementia may not recognise or explain pain or discomfort. Instead, they may become angry when they are in pain, hungry, thirsty, too hot, or too cold. Unmet physical needs can result in distress.

Possible causes include:

• Needing the toilet
• Being hungry, thirsty, or tired
• Illness, injury, or infection
• Being too hot or too cold
• Poor-fitting clothes or shoes

Change of Routine or Environment

A familiar routine and environment help people with dementia feel secure. Sudden changes can lead to confusion, fear, or anger.

Triggers may be:

• A new carer or unfamiliar face
• Rearranged furniture
• Being moved to a different room
• Sudden noise or disruption
• Changes to the daily schedule

Feeling Threatened or Afraid

People with dementia can misinterpret situations, faces, or sounds. They may not understand what is happening, leading to fear or feeling threatened.

Examples include:

• Thinking someone is trying to steal from them
• Feeling someone is being aggressive when offering help
• Worry about personal safety
• Fear during personal care tasks like bathing

Overstimulation or Understimulation

Too much noise, crowded places, or busy environments can overwhelm someone with dementia. They might be unable to process all the information around them.

On the other hand, boredom or loneliness from lack of activity can make the person irritable or angry.

Signs of overstimulation:

• Shouting or lashing out in busy places
• Becoming annoyed in noisy environments

Signs of understimulation:

• Restlessness
• Irritability when left alone for long periods

Unmet Emotional Needs

Feelings of isolation, sadness, boredom, or loss can trigger anger. The person might not understand these feelings or be able to express them clearly.

Examples:

• Missing family or friends
• Feeling left out of activities
• Grieving past losses
• Feeling useless or unwanted

Poor Understanding by Others

If staff or family do not understand the person’s needs or communicate effectively, the person may feel misunderstood and angry.

This includes:

• Rushing tasks without explanation
• Ignoring preferences
• Talking over the person or treating them like a child
• Not listening to their concerns

Medication Side Effects and Medical Conditions

Some medicines have side effects that cause mood changes or confusion. Other illnesses, such as infections, dehydration, or pain, can contribute to anger.

Possible causes:

• Reaction to new or changed medication
• Infections, such as urinary tract infections
• Conditions like constipation or headaches
• Underlying mental health issues

Loss of Familiarity

People with dementia often feel safe with familiar objects, routines, and people. Losing access to personal belongings or routines can create anxiety leading to anger.

Triggers may include:

• Removal of treasured items
• Not seeing familiar faces
• Having daily routines disrupted

Reasons for Anger in Dementia

Reason	Examples
Confusion and frustration	Not recognising place or people
Loss of independence	Resisting help with personal care
Communication difficulties	Not being understood, trouble finding words
Physical discomfort or pain	Needing the toilet, being thirsty, pain
Change of routine/environment	New staff, rearranged furniture, loud noise
Feeling threatened or afraid	Misinterpreting actions or situations
Over- or understimulation	Busy environments, boredom, loneliness
Unmet emotional needs	Sadness, isolation, grief, feeling unwanted
Poor understanding by others	Rushed tasks, not listening, ignoring preferences
Medication/medical conditions	Side effects, infections, pain, mental health
Loss of familiarity	Missing personal items, disrupted routines

Final Thoughts

Anger in dementia is usually a response to discomfort, fear, misunderstanding, or unmet needs. By identifying possible reasons, staff can adjust their support, provide reassurance, and reduce distress.

Responding with patience, empathy, and awareness of these reasons can help keep the person safe and comfortable. If you are unsure about the cause of anger, consider medical issues, check for pain or unmet needs, and review recent changes in routine or environment. Good communication, familiar surroundings, and respect for the person’s wishes will support their wellbeing.