Residents’ mood & behaviour: for care staff
Behind a shout, a refusal or a quiet withdrawal there is usually a person trying to tell you something. Here is how to listen, stay safe and pass it on.
Behaviour is communication
Most hard moments are a need, a fear or a loss talking.
Older adults in care may not always have the words, energy or chance to say what is wrong. Pain, fear, boredom, grief or not hearing well can come out as anger, pacing, refusing care or going quiet.
You see residents every day, so you are often the first to notice a change. This guide helps you respond calmly, keep yourself safe, and know what to pass on to the nurse.
Read more
- Is something hurting, or do they need the toilet?
- Are they hungry, thirsty, too hot or too cold?
- Can they hear and see what is going on?
- Is it too noisy, too busy or too boring?
- Has something changed: a loss, a move, a cancelled visit?
Read more
- Caring for older adults: everyday skills: dignity, communication and families
- Dementia: changes in behaviour: sundowning, distress in personal care and calm responses
- Looking after yourself in care work: for when the hard moments stay with you
- Loneliness & loss in later life: written for older adults and families
By the numbers
Aggression, mood and suicide risk in later life.
Behaviour toward staff
Mood and suicide
When words or behaviour hurt
Not taking it to heart, and keeping yourself safe.
Being shouted at, insulted or hit by someone you are caring for is painful. It is also common. In a study of large U.S. nursing homes, nursing assistants reported that about 1 in 6 residents had directed aggressive behaviour at them over just two weeks, most often screaming. It happened most during morning care, in residents’ rooms.
OSHA reports that nearly 1 in 5 recorded assaults on health care and social assistance workers in 2010 happened in nursing and residential care facilities, and that many more incidents probably go unreported.
Read more
- Fear or embarrassment during personal care
- Feeling rushed
- Grief, anger or loss of control over their life
- Not hearing or understanding what is happening
- Pain, discomfort, or needing the toilet
- Sudden illness or confusion
Residents who needed help with morning care, and those with mood or behaviour changes, were more likely to be aggressive toward staff.
Read more
Things that help
- If safe, step away for a moment and come back, or swap with a coworker
- Notice if comments target your race, faith or accent. That is not okay, and you can report it
- Remind yourself: “This is about their pain, not my worth.”
- Take a breath before you respond. Slow your voice and your body
- Talk it over with someone at the end of the shift, instead of carrying it home
Read more
OSHA advises employers to have a workplace violence prevention program, to train staff, to involve direct-care workers in spotting risks, and to make sure every report is investigated and addressed.
- Ask for a care plan update for residents who are often aggressive
- Get checked if you are injured, and look after yourself afterward
- Keep an exit clear and avoid being cornered
- Report every incident, even “small” ones, so patterns can be spotted
Responding to agitation calmly
Look for the cause, calm yourself first, then calm the moment.
Agitation can look like pacing, calling out, refusing care, or anger. It is often a sign of an unmet need: pain, fear, boredom, hunger, thirst, needing the toilet, being too hot or cold, or too much noise.
A calm response
- Check yourself first: breathe out slowly, drop your shoulders, soften your voice.
- Make sure everyone is safe. Give the person space.
- Come to their eye level, from the front, and use their name.
- Acknowledge the feeling: “You look worried. I’m here.”
- Look for the cause: pain, toilet, hunger, noise, fear, a hearing aid that is out.
- Offer something soothing: a quieter spot, a drink, music they love, a walk.
- If personal care is the trigger and it can wait, try again later or with a different carer.
- Afterward, note what happened and what helped, and share it at handoff.
Read more
- Arguing or correcting
- Raising your voice
- Rushing or pulling
- Several staff crowding around
- Talking about the person in front of them
Read more
Aggression toward staff happened most during morning care, in residents’ rooms.
- Explain each step before you do it
- Keep the person covered and warm
- Let them do what they can themselves
- Offer a choice of time, if the care can wait
- Try a carer they know and trust
Read more
Noticing what tends to upset someone, and what calms them, helps the whole team respond the same way. A short shared plan can prevent many hard moments.
Sudden confusion: when to act fast
A sudden change is not “just old age”. Tell the nurse straight away.
Sudden confusion is different from slow changes over time. It can be delirium, which needs urgent medical assessment. Infections, including urinary infections, are a common cause in older people, along with stroke, low blood sugar and head injury.
Read more
- Difficulty paying attention or remembering things
- Feeling disoriented, or not knowing where they are
- Seeing or hearing things that aren’t there
- Trouble thinking or speaking clearly or quickly
A simple check is to ask the person their name, age and today’s date. If they seem unsure or can’t answer, they may need medical help.
Read more
- Avoid asking lots of questions
- Don’t stop them moving around unless they are in danger
- Stay with the person, say who you are and where they are
- Use simple words and short sentences
Read more
- Any fall, bump or new pain
- Changes in eating, drinking or going to the toilet
- How they were yesterday compared with today
- When you first noticed the change
Spotting depression and suicide risk
You see residents every day. You may notice changes first.
Depression is not a normal part of ageing, and most older adults improve when it is treated. But it is often missed, because people may think it is just ageing, and because it can be mistaken for physical illness.
Changes worth passing on to the nurse
- Eating much less, or losing weight
- Giving away belongings, or talking about death or not wanting to live
- Saying things like “I’m a burden” or “What’s the point?”
- Seeming flat, tearful, irritable or hopeless
- Sleeping much more or much less
- Staying in their room, or stopping activities they used to enjoy
Read more
In 2023, the U.S. suicide rate for men aged 75 and over was 40.7 per 100,000, higher than for any other age group of men or women.
If a resident talks about wanting to die, ask them directly and kindly. Asking about suicide does not put the idea in someone’s head. Stay with them and get the nurse or your supervisor right away.
Read more
- Ask open questions: “How are you really doing today?”
- Encourage small pleasures: a walk outside, a call to family, music
- Let them help with something, so they feel useful
- Listen without rushing to cheer them up
- Sit down at their level for a minute, even on a busy shift
Read more
Depression is more common in people with health conditions such as heart disease or cancer, in people whose daily functioning has become limited, and in people with sleep problems.
Loneliness and losses that build up
Home, health, friends, independence: residents grieve many things.
Residents live with many losses: home, health, independence, friends and partners. A study of nursing home staff found grief care should pay attention to these non-death losses, and to how losses build up over time.
Nursing home staff describe grief care as a balance between being involved and keeping an appropriate distance. You don’t need to fix the loss. Noticing it, and making room for it, already helps.
Read more
- A driving licence, a garden or a pet
- Being the one who looks after others
- Friends who stopped visiting
- Privacy and control over their day
- Their own home and neighbourhood
Read more
Older people with hearing problems may withdraw from others because they feel frustrated or embarrassed about not understanding what is being said.
Read more
- Help them call or video-chat family
- Introduce residents with shared interests
- Invite, and walk with them to, one activity
- Sit for two minutes and ask about their life
- Use their name and remember what they told you
When and where to get help
Who to tell, how fast, and support for you afterward.
Read more
- Call 911 if anyone is in immediate danger
- Get the nurse straight away for sudden confusion or behaviour change
- Stay with a resident who talks about wanting to die, and get the nurse or supervisor
Read more
- Record what you noticed, with dates
- Share what helped and what made it worse
- Ask for a care plan review if things keep happening
Read more
- Report any incident where you were hurt or threatened
- Talk it through with a coworker or supervisor
- Use your Employee Assistance Program, if you have one
- See the Looking after yourself in care work guide
📝 Worksheets for this guide
Fill these in privately in the app. Your answers stay on your phone.
Sources
- Journal of General Internal Medicine (via PubMed) (2013). Verbal and physical aggression directed at nursing home staff by residents (Lachs MS, et al.)
- Occupational Safety and Health Administration (OSHA). Healthcare: Workplace Violence
- Centers for Disease Control and Prevention (CDC) (2024). Depression and Aging
- National Institute of Mental Health (NIMH) (2023 data). Suicide (statistics)
- NHS (UK National Health Service). Sudden confusion (delirium)
- Journal of Advanced Nursing (via PubMed) (2016). Grief and loss in older people residing in nursing homes: (un)detected by nurses and care-assistants? (Van Humbeeck L, et al.)
- NHS (UK National Health Service). Hearing loss
- National Institute on Aging (NIA), NIH. Loneliness and Social Isolation — Tips for Staying Connected
This guide is for education and self-care. It is not a diagnosis or a substitute for professional care. Please talk to a counselor or clinical provider about your health. Reviewed October 2026.
