Managing aggressive behaviour in dementia care: workshop recap

The workshop “Workshop Recap: Techniques for Managing Aggressive Behavior in Dementia Care” formed part of the 1st National Elderly Welfare Facility Conference and Research Meeting, known as JS Festival in Tochigi. The event brought together aged-care practitioners, facility leaders, researchers and suppliers to examine practical responses to distress, agitation and violence in residential care. Learn more about 筋電図を用いた歩行解析の基礎と応用.

For Australian professionals, the session offered a useful comparison with local practice. A resident who shouts, pushes, strikes or refuses personal care is communicating through behaviour, even when dementia has affected language and judgement. The central message was to protect everyone’s safety while searching for the unmet need behind the incident.

The wider programme combined research presentations, workshops, networking, study tours and an exhibition of products and services. Event background, including the conference’s professional focus and activities, is available through the JS Festival website, which records the meeting as a place for exchanging ideas across the eldercare sector.

Seeing behaviour as a distress signal

Aggressive behaviour in dementia can arise from pain, fear, confusion, exhaustion or a sudden change in surroundings. A urinary infection, constipation, poor hearing, medication side effects or an uncomfortable chair may be more significant than the apparent “temper” of the resident. The workshop encouraged staff to investigate the immediate context before assigning a behavioural label.

Timing and pattern are equally important. Does agitation appear during showering, at shift change, before meals or in the late afternoon? A simple behaviour chart can record what happened before the incident, the exact action, staff responses and what happened afterwards. This ABC approach—antecedent, behaviour and consequence—helps a team identify triggers rather than relying on memory or assumptions.

Preparing before personal care

Many confrontations begin when a worker approaches too quickly or gives several instructions at once. Staff were encouraged to approach from the front, use the person’s preferred name, make eye contact at a comfortable distance and explain one step at a time. Showing a towel, continence product or clothing item can make the next action easier to understand.

Personal care is particularly sensitive because it involves privacy, touch and loss of control. Offering meaningful choices—such as a shower now or in ten minutes, a blue shirt or a white shirt—can restore a sense of agency. In Australian homes, where routines may include culturally specific bathing preferences, religious observance or family involvement, the care plan should record those preferences clearly.

De-escalating an active incident

During an episode, the safest response is usually calm, brief and non-confrontational. Lowering the voice, reducing background noise and allowing extra processing time can work better than correcting a distressed person. Staff should avoid arguing about facts, crowding the resident, blocking the exit or demanding eye contact.

One worker should take the lead while colleagues quietly move other residents away and remove potential hazards. If the person is holding an object, staff need to assess immediate risk rather than snatching it away. Emergency assistance is required when there is serious injury, an imminent threat or a medical concern. Afterwards, a structured debrief should focus on what the person may have experienced, not on blame.

Using movement and sensory information

The workshop connected behaviour support with observation of movement, posture and physical effort. A resident who suddenly becomes unsteady, guards a hip or struggles to stand may be expressing pain through resistance. Research into walking and mobility can broaden assessment, and this gait analysis research illustrates how movement data can help professionals think about function rather than behaviour alone.

Practical assessment does not always require sophisticated equipment. Staff can observe changes in walking speed, transfers, facial expression, breathing and balance. In Australia, a physiotherapist, occupational therapist or nurse practitioner may contribute to a broader review, while allied-health access can vary between metropolitan services in Sydney or Melbourne and smaller regional communities.

Immediate actions that support safety

• Keep a clear route to the exit for the resident and staff.
• Use one calm speaker and short, familiar sentences.
• Reduce noise from televisions, alarms and several conversations.
• Check for pain, toileting needs, hunger, thirst and temperature.
• Move other residents away without creating a spectacle.
• Record the incident factually, including injuries and follow-up.

These steps are most effective when they are rehearsed before a crisis. Regular team discussions can clarify who calls for help, who supports nearby residents and who contacts a family member or clinical lead. Staff should also recognise their own stress signals: a rushed or frightened response can intensify the person’s sense of danger.

Reviewing medication and restrictive practices

Medication should never become the automatic answer to shouting or resistance. A clinical review may be appropriate where psychotropic medicines are being considered, but the purpose, expected benefit, duration and monitoring plan need to be explicit. Non-drug strategies should remain part of the care approach, with changes reviewed when the trigger has been addressed.

Australian providers must also consider the rules governing restrictive practices and the Serious Incident Response Scheme. Under the Aged Care Act 1997 and related requirements, chemical, environmental, mechanical and physical restrictions require careful authorisation, documentation and oversight. Staff need current training in organisational policy, consent, decision-making capacity and reporting duties; a locked door or sedating medicine is not a substitute for skilled support.

Building a consistent team response

Inconsistent reactions can make aggression more likely. If one worker allows a resident time to settle while another insists on immediate compliance, the person receives confusing signals. A shared support plan should describe known triggers, preferred communication, calming interests, safe distances, health alerts and the actions that have helped previously.

The conference’s discussion of service quality also has relevance for Australian private facilities. The quality and profit panel reflects a wider operational question: staffing, training and meaningful activities require investment, yet poor responses to aggression can lead to injury, complaints, staff turnover and avoidable hospital transfers.

Information worth sharing at handover

• The resident’s likely trigger and early warning signs.
• Words, gestures, music or objects that help them settle.
• Any recent pain, infection, medication or sleep changes.
• Safe approaches for showering, dressing and meals.
• What happened during the last incident and what worked.
• Family knowledge about lifelong routines and preferences.

Family and carers often know whether a person disliked being rushed, preferred a particular breakfast or became anxious in unfamiliar rooms. Their knowledge should complement, not replace, clinical assessment. With consent and appropriate privacy safeguards, it can make a support plan more personal and practical.

Adapting ideas to Australian services

Australian care teams work across large metropolitan facilities, small regional homes and increasingly diverse communities. A Melbourne residence may manage multilingual communication and busy visitor traffic, while a regional Queensland or Western Australian service may face fewer specialist resources and longer referral pathways. These realities make simple observation, clear escalation processes and local partnerships especially valuable.

The physical environment matters as well. Heatwaves, glare, dehydration and disrupted sleep can increase discomfort, while open-plan dining rooms may overwhelm someone with dementia. Quiet spaces, shaded outdoor areas and familiar daily routines can support regulation. Suppliers at the JS Festival exhibition demonstrated how equipment and service design can assist care, but products work best when matched to a person’s assessed needs.

Tochigi also provided a useful setting for professional exchange, with study tours and practical travel information available in the Tochigi access guide. For Australian delegates, comparing Japanese facility layouts and routines with local models can prompt useful questions about hospitality, privacy, mobility and community connection.

Measuring whether the approach works

Success should not be measured only by the absence of incidents. Teams can track fewer injuries, shorter episodes, improved participation in personal care, better sleep, reduced emergency transfers and greater staff confidence. The resident’s comfort and dignity remain central, even when behaviour becomes less visibly challenging.

A review after several weeks can show whether the plan is working or needs adjustment. If aggression continues, the team should revisit physical health, communication, environment, relationships and medication rather than simply adding restrictions. The workshop’s enduring lesson was practical: a safe response begins with curiosity, continues through coordinated care and respects the person behind the behaviour.