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Has an elderly loved-one of yours become aggressive, paranoid, and deluded? Causes are more varied than you may think. What are they, and how do you cope?

Has an elderly person you care about suddenly or gradually started to display extremely aggressive and violent behavior? While you are bound to be extremely upset that the person you knew and loved now seems to be gone, you will also be wondering what is causing their behavior, looking for ways to improve their quality of life, and hoping to keep yourself safe and sane in the face of these emotionally-taxing symptoms. 

What Makes Previously Nice Senior Citizens Aggressive?

Dementia — which exists in many different forms, with Alzheimer's merely being the most well-known — can have a tremendous impact on a person's mental state and behavior. These symptoms are clinically referred to as "behavioral and psychological symptoms of dementia", or BPSD for short. Becoming distrustful of other people, even their close relatives, to the point of paranoia, and simply not being able to recognize their loved-ones and carers any more, are both clear causes of aggressive behavior: if you believed you had a stranger in your home or you were dealing with someone who was conspiring against you, you'd be cross too.

Dementia can also, however, lead to sudden bouts of aggression, including yelling, attacking people, and throwing objects.

Ultimately, these behaviors are caused by a diminished ability to judge situations, by feelings of powerlessness and desperation, by fear, and by the reduced ability to express themselves in any other way. 

Delirium, a condition that severely alters a person's state of consciousness, is another cause of aggressive behavior in senior citizens. Delirium can be caused by a range of things, including alcohol overuse, medications gone wrong, and infections — including, very frequently, urinary tract infections. 

Mental health disorders including schizophrenia, anxiety disorders, bipolar disorder, depression, and delusional disorder can all be to blame for aggressive behaviors in elderly people as well. In this case, however, it is very likely that the person already has a history of such behaviors. Mental disorders can, sometimes, be late-onset, though — while rare, it is possible for the first symptoms of a mental disorder to only appear in old age. One noteworthy thing to remember is that symptoms of Post-Traumatic Stress Disorder can pop up decades after traumatic events. Especially if the elder in question is a war veteran, this possibility should not be discounted.

Elderly people who do not have a previous history of mental illness should always be evaluated for the more likely causes of aggressive and delusional behavior before a mental health diagnosis is achieved, however. 

Finally, remember that aggressive behaviors without paranoia or delusions may simply be the result of an elderly person being unhappy with their life. 

Just how common is this sort of thing? Let's take a look:

  • An estimated 12.1 percent of elderly patients with cognitive impairments suffer from paranoia. 
  • Around 14.1 percent of senior citizens suffer from increased feelings of suspicion towards people, an estimation that includes elders who do not have dementia and related disorders.
  • Paranoid ideation is present in approximately 6.9 percent of elders.
  • Around 5.5 percent of senior citizens experience delusions. 

If you are the child, other relative, or carer of an elderly person who has begun to display aggressive behaviors, and your loved-one has not already been diagnosed with one of the above conditions, it is time to alert their healthcare provider. Elderly people who have already received a diagnosis, meanwhile, are a different story: all you can do as a loved-one is cope the best you can, try to avoid triggers that make your elder angry, and attempt to de-escalate aggressive episodes. 

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