Strategies for Responding to Strangers with Dementia

Posted by Elaine C. Pereira on November 8, 2019

Our guest blogger, Elaine C. Pereira, MA OTR/L CDP CDC is an author, speaker, and certified dementia practitioner and caregiver. Contact her at

Regardless of one’s experience with individuals with dementia or apparent behavioral instability, unexpected encounters can be delicate to manage. 

Public settings are by definition open to everyone. Anyone can be there and anything can happen. People experiencing dementia, whether alone or in the company of another adult, may approach someone else randomly and initiate interaction. They might reach out to touch someone gently, firmly or exhibit aggressive behaviors.  They might just start talking, share a story, or raise their voice in a hostile tone. 

It’s impossible to know the specific underlying cause of a stranger’s verbal outburst or out-of-context behavior. There are potentially many varied medical diagnoses at play: Autism, dementia/Alzheimer’s, mental health issues, stroke and more. Unless the individual is physically threatening and self-protection is warranted, cautious body language along with neutral verbal response strategies can help to diffuse unwelcome remarks/behaviors. 

Each of the following events are real. Consider the encounters and management strategies employed. 

Close Encounters in Public: Consciously or not, there is an expectation of reasonable personal space in public, and a perceived invasion of one’s physical surroundings can be threatening or unnecessary. 

A woman had pulled her grocery cart close to the shelves in a store with wide aisles. While she concentrated on locating her favorite brand of coffee, another woman firmly touched her shoulder and blurted out: “Did you know that pets get dementia too?” Unfazed the shopper replied, “Yes. I do.” The woman muttered something else and walked away. 

This exchange could have played out very differently had the shopper been confrontational, but her words of validation were on point. 

Be Alert and Observant. “If you see something, say something.” This placard is posted in airports and many other venues such as theaters and stadiums. 

A big, disheveled looking man plopped down onto a bench seat at an airport. Very animatedly, he started rambling loudly about his missing credit card. His actions, however, were inconsistent with trying to find said credit card. Someone who is genuinely missing anything important will pat down their pockets, rifle through their wallet, check the floor and surroundings, and retrace their steps. This man did none of these.

An uncomfortable female passenger, observing his flighty, disconnected gestures, reported him to a gate agent. When it came time to board, an approachable agent very slowly talked to the disheveled gentleman and quietly said, "I think we’ve found your credit card." Without any fuss they stepped aside while others continued to board. The “agent" turned out to be an air marshal, who by validating this man's experience was able to diffused a potentially volatile situation. 

Best Practice Response Strategies


1.  Never touch someone else unless your or their safety is in jeopardy. Physical contact can be misconstrued, quickly escalating to a flash point. As events are playing out in real time, no one has all the facts.

2.  Take one moment to do a quick assessment of the situation. Is anyone’s safety in jeopardy? Can a few well-chosen words moderate the situation?  

3.  Never argue with or correct what the person is saying. Someone with dementia, mental health issues or other neurological conditions may not fully process what they just said nor what your reply is. To the woman who said “Did you know that pets get dementia too?”, a confrontational reply would be “No they don’t!” (For the record, pets can exhibit dementia too.)

4.  Be aware of your tone. It’s not what you say but how you say it. Keep your voice neutral and avoid being condescending or judgmental.

5.  Use non-verbal responses and gestures. A simple smile is universally recognized as a positive expression. Demonstrate neutral body language avoiding eye rolls or finger pointing.

6.  Consider notifying security or the police. This can be a difficult judgment call but like the sign says, “If you see something, say something.” Maybe the individual is in danger and not a danger.