Caring for older Australians can be one of the most rewarding careers in healthcare, but it also comes with unique challenges. As the population ages, more people are entering aged care with complex health conditions like dementia, delirium and depression. These conditions, alongside pain, medication side effects and environmental stressors, can sometimes trigger aggressive behaviour. For aged care nurses, carers and support staff, being confronted with aggression can be distressing and even dangerous. But with the right strategies, it’s possible to respond in a way that de-escalates the situation, protects everyone’s safety, and preserves dignity and compassion for the resident.


Aggression isn’t always a choice. It can be the result of:

• Cognitive decline: Dementia and delirium can leave residents confused, scared, or unable to communicate their needs clearly.
• Unmet needs: Pain, hunger, thirst, or discomfort can lead to frustration.
• Environmental factors: Noise, overstimulation, or changes in routine may feel overwhelming.
• Medication and illness: Certain drugs, or illnesses like infections, can alter mood and behaviour.

Understanding the “why” behind aggression helps staff recognise early warning signs and reduce the likelihood of an incident.

When aggression does occur, the immediate response of staff can make all the difference. It is important to stay calm, avoid confrontation and approach the resident in a gentle, empathetic manner. Speaking softly, using their preferred name, and showing understanding can reassure the resident that they are being listened to rather than challenged. Just as important is giving them space, stepping back and removing possible triggers like noisy equipment or additional people who might make them feel crowded.

In these situations, arguing or trying to reason with the resident usually makes matters worse. Instead, validation and reassurance should be the focus. For example, acknowledging that they are upset and asking how you can help provides a sense of control in what may feel like a frightening experience. Sometimes, distraction or redirection can also help, offering a different activity, suggesting a short walk, or returning a few minutes later with a fresh, friendly approach may ease the tension and shift the resident’s focus.

There will be times when initial strategies are insufficient and aggression persists. In these cases, it is essential to involve senior staff, medical officers, or family members who can provide further support. Here’s some steps to follow:

1. Seek support. Involve senior staff, a GP, or family members.
2. Consider medical input. A review of medication, pain management, or underlying illness may be required.
3. Use restraint only as a last resort. Whether medical or mechanical, restraints should be short-term and only when necessary for safety, following your facility’s policies.
4. Call for security if required. If there is immediate danger, prioritise safety for residents and staff.

Aggressive behaviour in aged care should never be dismissed as “just part of the job”. Every incident presents an opportunity to learn. Recording details in a behaviour chart, such as what happened beforehand, how the aggression presented, and how staff responded, can help identify patterns and prevent future episodes. For instance, if aggression consistently arises during personal care or meal times, this may suggest that a particular approach or environment is causing distress.

Dealing with aggression is stressful, and staff wellbeing is just as important as resident wellbeing. Managers should make time to debrief with their teams after incidents, allowing staff to share their experiences, reflect on what worked, and acknowledge the emotional impact. Creating a supportive environment helps staff feel valued and reduces the risk of burnout, ultimately enhancing the care they can provide.

Ongoing training in de-escalation techniques, dementia care and communication skills can also give staff the confidence to respond effectively.

Facilities that invest in education and create calm, familiar environments for residents are often better equipped to prevent aggression before it occurs. Families also play a vital role in sharing what comforts their loved ones or what might set them off, helping staff provide more personalised and effective care.

Aggression in aged care facilities is challenging, but it does not have to compromise safety or compassion. By approaching residents with empathy, understanding potential triggers, and ensuring staff are supported, facilities can manage these behaviours with dignity and professionalism. Each incident provides a chance to learn, adapt, and build a more supportive environment, one that respects the needs of residents while protecting the well-being of those who care for them.