Navigating Inappropriate Conduct in Loved Ones with Alzheimer's Disease

For the 11 million Americans caring for someone with Alzheimer's or dementia, one of the most challenging aspects isn't the memory loss—it's the troubling behaviors that can emerge. Physical aggression and inappropriate sexual behavior can be particularly distressing, leaving family caregivers feeling helpless, embarrassed, and emotionally drained.

"When people think about dementia, they usually think about forgetfulness and memory impairment," explains Mary Blazek, director of the Geriatric Psychiatry Clinic at the University of Michigan. "But it's behavioral and psychological disturbances that are most disruptive to patients' and caregivers' lives."

Understanding why these behaviors occur and learning effective strategies to care for or manage loved ones with dementia or Alzheimer’s disease can transform your caregiving experience. Let's explore practical approaches backed by experts.

Why Do People with Alzheimer's Sometimes Become Physically Aggressive?

A study in JAMA Network Open found that within just one month, 15% of residents in New York assisted living homes experienced verbal, physical, or sexual resident-on-resident aggression. Another study revealed nearly 8% of assisted living residents engaged in physical aggression toward other residents or staff.

These behaviors stem from brain changes, not malicious intent. Alzheimer's damages areas of the brain affecting memory, language, reasoning, and social behavior. As Cornell University gerontologist Karl Pillemer notes, "There needs to be much more of an effort to single out verbal and physical aggression that occurs in long-term care and begin to create a model of violence-free zones in the same way we have violence-free zones in the schools."

People with dementia may lash out because:

• They've lost social inhibitions

• They're expressing pain, discomfort, or fear

• They feel overstimulated by noise or unfamiliar surroundings

• They're experiencing frustration at their inability to communicate

• They're reacting to a perceived threat

  
  

"Some people are aggressive, and some are violent," notes University of Connecticut researcher Eilon Caspi, "but if you look closely, the vast majority are doing their best while living with a serious brain disease."

How Should I Respond When My Loved One Becomes Physically Aggressive?

When aggression occurs, your response can either escalate or defuse the situation. Consider these expert-recommended approaches:

• Stay calm and speak gently 

People with dementia may not understand your words, but they'll respond to your tone and body language. "Do your best to speak calmly, with your face and posture relaxed," advises William Haley, professor of aging studies at the University of South Florida.

• Look for triggers 

Tracy Wharton, a licensed clinical social worker and dementia researcher, emphasizes that "We can't expect someone who is constantly and unfailingly disoriented to adapt to our environment anymore. We have to adapt to them." Observe patterns to identify what might be triggering the aggression.

• Use the DICE approach 

Dr. Helen Kales, a geriatric psychiatrist at UC Davis, developed the DICE method: Describe, Investigate, Create, and Evaluate. This systematic approach helps caregivers address behavioral symptoms with less personal stress. Dr. Kales shares a success story: "After investigating possible causes and learning that she used to be an avid gardener, the caregivers began taking the woman to the nursing home's courtyard once a day and helping her 'get her hands in the dirt.' This dose of daily 'gardening' stopped her wandering."

• Remember it's the disease, not the person "These behaviors are no one's fault," reminds Dr. Nathaniel Chin, a geriatrician at the University of Wisconsin-Madison. Recognizing this can help you "feel less upset at your loved one."

  
  

What About Inappropriate Sexual Behavior—How Common Is It?

While discussed less frequently, inappropriate sexual behavior affects many families coping with Alzheimer's. This might include:

• Undressing in public

• Making sexual advances toward caregivers or strangers

• Using explicit language uncharacteristic of their pre-dementia personality

• Touching themselves or others inappropriately

  
  

These behaviors emerge from the same brain changes that cause other symptoms—the disease damages areas that control impulse regulation and social awareness.

How Can I Handle Inappropriate Sexual Advances or Behavior?

• Redirect rather than confront 

Instead of scolding, which may increase confusion and agitation, calmly redirect your loved one to another activity. For example, "Let's go have a snack in the kitchen" or "Would you like to listen to some music?"

• Identify patterns and adjust accordingly 

Fayron Epps, a nursing professor at the University of Texas Health Science Center, explains: "As the disease progresses, people lose language skills and communicate more through behavior. As a caregiver, you really have to investigate where this mood is stemming from."

• Address physical needs 

Sometimes inappropriate undressing may signal discomfort—perhaps clothing is too tight, they need to use the restroom, or they're too warm.

• Create appropriate physical touch opportunities 

People with dementia still need physical connection. Regular, appropriate touch—like hand massages, gentle shoulder rubs, or holding hands—may reduce inappropriate seeking of physical contact.

• Adjust the environment 

Consider privacy needs. A person may undress because they're accustomed to doing so in that location (like a bathroom). Clear environmental cues and consistent routines can help.

READ: How to Handle a Loved One Who Suffers from Dementia and Has Dangerous Hallucinations

How Can I Protect My Own Well-being While Caregiving?

Caring for someone with Alzheimer's-related behavioral changes takes a significant emotional toll. Protecting your wellbeing isn't selfish—it's essential.

• Join a support group — Connect with others facing similar challenges. They can provide emotional support and practical strategies you may not have considered.

• Practice self-care routines — Build regular breaks into your schedule. Even short periods of respite can rejuvenate your patience and compassion.

• Consider environmental modifications — Dr. Kales' research shows that exposure to natural light can improve sleep and mood in people with dementia, reducing problematic behaviors. "Taking a morning walk or doing another activity outside can benefit you both," she suggests. If getting outdoors isn't possible, have your loved one sit facing a window or use a light therapy box for about 30 minutes daily.

• Seek professional help when needed — Geriatric psychiatrists, neurologists, and dementia care specialists can offer medication recommendations and behavioral strategies tailored to your situation.

  
  

How Neurology Associates Can Provide Specialized Support

For families navigating the emotional challenges of dementia, professional medical guidance is essential. Neurology Associates Neuroscience Center at Chandler and Mesa locations specializes in developing comprehensive treatment plans for dementia and Alzheimer's disease. 

Our neurologists provide expert evaluation and ongoing management of both cognitive decline and the behavioral symptoms that make caregiving so challenging. Whether you're struggling with a loved one's memory loss, personality changes, or difficulty communicating, Neurology Associates offers flexible appointment options, including telemedicine consultations for qualifying patients, making specialized neurological care more accessible during this difficult journey.

IMPORTANT NOTE: While the coping strategies discussed in this article are valuable for the emotional aspects of caregiving, a medical treatment plan developed by specialists is crucial for managing the neurological aspects of dementia. All care decisions should be made in consultation with healthcare professionals to ensure both effectiveness and safety.