Best Practices for Approaching Combative Dementia Patients


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Dementia is a progressive brain disorder that affects a person’s cognitive abilities, memory, and behavior. In the later stages of the disease, some patients can become combative and aggressive, making it difficult for caregivers to provide the necessary care. As a hospice nurse, it’s important to know how to approach and manage combative dementia patients to ensure their comfort and safety. Here are some best practices to consider:

Be aware of triggers

Combative behavior in dementia patients can often be triggered by environmental factors, such as loud noises or unfamiliar surroundings. It’s essential to observe and identify these triggers and try to eliminate or reduce them to prevent outbursts. It’s also crucial to recognize that some medications or medical conditions can cause irritability or agitation.

Maintain a calm and non-threatening approach

Approaching a combative dementia patient with a calm and non-threatening demeanor is essential to prevent escalating situations. Always approach the patient slowly and avoid sudden movements that may startle or frighten them. Try to make eye contact, speak in a soft and soothing voice, and use simple language to convey your message.

And may I suggest, ditch the mask — and those unaware of the ineffectiveness of masks for most situations including the C-Word read the extensive study completed in January of this year — and smile, smile, smile and let the dementia patient see your beautiful face and smile.

Validate their feelings

Dementia patients may experience a range of emotions, such as frustration, anxiety, or confusion. Acknowledge their feelings and try to empathize with them. Validating their emotions can help them feel heard and understood, reducing the likelihood of combative behavior.

I strongly suggest anyone working with dementia patients read the article about Validation Therapy as I’ve used the techniques established by Naomi Feil for years with remarkable success.

Use positive reinforcement

Positive reinforcement can help redirect combative dementia patients’ behavior and encourage them to engage in positive activities. Praise and reward good behavior and try to redirect their attention to a calming activity, such as listening to music or doing a puzzle.

Ensure safety

In situations where a dementia patient becomes combative, safety is paramount. Ensure that the patient is safe from harm and that other patients or staff are not at risk of injury.

To Avoid Doing

Avoid taking any action that would be considered a physical restraint. If you physically restrain a patient, you may be charged with battery. If you are concerned that you may be trapped in a situation, avoid the situation until you get help as you do not want to be in front of a judge explaining why you attacked (battery) and caused harm (battery) a patient with dementia.

Avoid speaking to the dementia patient as if they are a child. Please do not use “baby talk,” and try to avoid terms of endearment the family did not give permission to use.

Avoid threatening (assault) the patient if they do not listen to you or act a certain way. While potentially less of a criminal offense than battery, assault is still significant crime.

If you remember the patient with dementia deserves respect, kindness, gentleness and love you will do well.


Caring for combative dementia patients requires compassion, patience, and understanding. By following these best practices, hospice nurses can help maintain a safe and comfortable environment for both the patient and staff. Remember to stay calm, validate their feelings, and always ensure their safety.




Peter M. Abraham, BSN, RN

RN experience: cardiology, long-term care, rehab, rural home hospice. Find new articles at