Purpose Much has been written about helping those with dementia. But what about those for whom distress is not primarily related to a neurological cause and there is no psychiatric history? The purpose of this paper is to offer a guide for allied health professionals and family carers to manage distress in older people who are able to engage in language based communication and who are experiencing significant change or loss. Design/methodology/approach This practice informed paper draws on the authors’ extensive experience working as a mental health social worker who specializes in work with older people in the community and in care, with family carers and in educating allied health professionals on how to manage presentations of distress in older people. Findings Three foundational management strategies are discussed: understand the reason for distress, implement the C.A.R.E. Plan and maximize comfort in exploration and referral. Research limitations/implications This viewpoint piece has not been substantiated through research and does not reflect training in the field of clinical geropsychology. Originality/value The ideas in this paper are original and are practical solutions to common problems that can be faced by workers or family in close contact with older people. The information can be applied immediately to whatever setting is relevant for the reader and is written in easy to understand language. Furthermore, its aim is not only to increase skill and confidence for the reader but also to promote the emotional and psychological wellbeing of older people.