When Someone with Dementia Refuses or Gets Frustrated with an Activity

You set everything up, offer a game or a walk, and hear “No.” Or the activity starts well and ends with a pushed-away tablet and a sharp word. It is discouraging, and it is very common. Refusal and frustration are usually a message, not stubbornness. Working out what the message is often shows you what to try next.

Why does someone with dementia refuse activities?

Usually there is a reason, even if the person cannot put it into words. The Alzheimer’s Association notes that resistance may mean the person cannot do the task or is afraid to try. Common causes include:

• It feels too hard. The activity now needs skills dementia has made difficult, and failing in front of someone is embarrassing.
• It feels childish. Adults notice cartoonish pictures, sing-song voices and activities that look like they were made for kids.
• Tiredness. Many people have less energy later in the day. See calm late-afternoon activities.
• Physical discomfort. The National Institute on Aging (NIA) lists pain, lack of sleep, trouble seeing or hearing, constipation, hunger, thirst and side effects of new medicines as possible causes of distress.
• Too much going on. A loud TV, several conversations or a crowded room can be overwhelming.
• Feeling pushed. The NIA names being pushed to do something that Alzheimer’s has made very hard, or to remember events or people, as a cause of agitation.
• Low mood. Losing interest in things can be a sign of depression, which is worth raising with a doctor.
• They simply don’t want to. Adults are allowed to say no.

What should I try when they say no?

Accept the no calmly, then change something: the time, the activity, the difficulty or the way you ask.

1. Let it go for now. “That’s fine. Maybe later.” Then move on to something else without a sigh.
2. Try again later. The Alzheimer’s Association suggests trying again later, or at a different time of day.
3. Make it smaller. One match instead of a whole game. One towel instead of the laundry basket. Fewer pictures, fewer choices, pictures left visible.
4. Offer two options. “Would you like to look at the bird pictures or listen to some music?” A choice gives back a sense of control.
5. Ask for help instead of performance. “Could you help me sort these?” or “Can you tell me which color looks best?” Being needed feels very different from being tested.
6. Start it yourself. Begin the activity beside them without asking. Many people join in once something is already happening, and if they do not, you have still spent time together.
7. Switch to something physical or soothing. A short walk, music, a snack, folding laundry, or a shared calm breathing pause. The NIA suggests redirecting attention to music, a book or a walk.
8. Let them do it their way. If they want to play differently than the rules say, go with it. The Alzheimer’s Association advises being flexible.

What should I say when they get frustrated?

Slow down, lower your voice and reassure. The Alzheimer’s Association guidance on agitation suggests backing off and asking permission, using calm, positive statements, and offering a guided choice between two options. Phrases in that spirit:

• “I’m sorry, this one is annoying. Let’s stop.”
• “You’re doing fine. I’m right here.”
• “Do you have time to help me with something else?”
• “Shall we have a cup of tea instead?”

Then end the activity without making it a big deal. Our communication tips have more on what to say.

What should I avoid?

Some natural reactions tend to make things worse.

• Arguing or insisting. “Come on, just one more” or “You love this” rarely helps.
• Quizzing or correcting. “You know what this is” or “No, that one’s wrong” adds pressure.
• Taking it personally. The NIA reminds caregivers that the disease, not the person, causes these changes.
• Crowding or rushing. The Alzheimer’s Association advises not to raise your voice, show alarm, corner, crowd, restrain, criticize, ignore or argue with the person, and to avoid sudden movements out of their view.
• Using guilt. “I set all this up for you” leaves both of you feeling worse.
• Labeling. “Stubborn” or “difficult” hides the real reason and makes it harder to solve.

How can I find out what is behind repeated refusals?

Keep a simple note for a week or two. The NIA says tracking behavior changes can help caregivers and health care providers recognize a pattern and work out the cause.

Jot down:

• the time of day;
• what you offered and how you asked;
• what was happening around you (noise, visitors, TV);
• how they slept, ate and drank, and when they last used the bathroom;
• any new medicines or recent illness.

Patterns often appear quickly: refusals that only happen after 4 p.m., only with a certain game, or only when the TV is on. The Family Caregiver Alliance’s guide to dementia behaviors puts it simply: we cannot change the person, but we can change our own behavior and the environment.

When should I talk to a doctor about refusal or frustration?

Talk to a doctor when behavior changes suddenly, quickly, or along with signs of illness. The NIA says sudden or rapidly fluctuating changes in behavior, especially if the person has had an infection or recent medication changes, should be brought to a doctor’s attention immediately.

Contact their doctor promptly if you notice:

• sudden confusion or a big change over hours or days;
• signs of pain, such as wincing, guarding part of the body, or new trouble moving;
• fever or other signs of an infection;
• new or changed medicines followed by a change in behavior;
• loss of interest in almost everything, tearfulness or withdrawal lasting more than a couple of weeks;
• refusing food or drink.

The Alzheimer’s Association recommends a thorough medical checkup for anyone with behavioral symptoms, especially when they appear suddenly. The Family Caregiver Alliance also advises checking with the doctor first, because behavior problems may have a medical cause. Do not start, stop or change any medicine without talking to a doctor or pharmacist.

If anyone is in danger or there are signs of a medical emergency, call 911. The NIA suggests telling the dispatcher that the person has dementia.

Is it okay if we do nothing at all?

Yes. Some days the best activity is no activity: sitting together, holding hands, listening to a favorite record, or watching birds out the window. That is not a failure. Our guide to playing together explains why stopping early, or never starting, can be the right call.