Guidance on the behavioral and psychological symptoms of dementia (BPSD) — agitation, wandering, resistance to care — continues to recommend nonpharmacologic, person-centered strategies as first-line, reserving antipsychotics for situations where there is risk of harm, because those medications carry serious risks in older adults with dementia.
The practical message is to look for the trigger behind a behavior: pain, a full bladder, hunger, overstimulation, fear, or an unmet need. Structured routines, calm environments, validation rather than correction, and addressing physical needs often de-escalate symptoms without medication.
Why this matters on shift
Agitation in dementia is often a signal of an unmet need, not a problem to medicate. Nurses are best placed to spot the trigger — pain, a full bladder, overstimulation — and prevent both the distress and the risks of an unnecessary antipsychotic.