What Makes Elderly People Aggressive And Paranoid, And How Do You Deal?

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.

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.

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

READ Frontotemporal Dementia: Symptoms, Diagnosis and Treatment

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. 

Coping With Aggressive, Paranoid And Deluded Elderly People

In my line of work as a carer to the elderly, I have encountered many different things. Thankfully, few elders have ever been outwardly aggressive towards me, but one lady physically assaulted me while another became convinced that I was, along with other carers and neighbors, conspiring against her. Yet another was always extremely unhappy and would yell when my contract wouldn't allow me to do the things she demanded, or I wasn't fast enough for her liking. 

As a carer, rather than a relative, "floating above the situation" as an observer, someone not personally affected, becomes second nature after a while. I can only recommend that relatives attempt to behave in a similar manner, emotionally detaching themselves from difficult episodes as much as they are able. Here are some tips for you. 

Don't Try To Convince Them

What happens when you try to convince people who suffer from paranoia or delusions that they are wrong, or even that they need psychiatric assistance? Let's just say this: I have never personally experienced a good outcome to that kind of attempt, and will never try again! You will have an angry loved-one on your hand, one who will most likely come to believe that you are part of the problem if they didn't already, and you be be left emotionally drained. 

I have told some of the above customers, for instance, that dealing with those feelings must be very difficult, or that I am sorry they are in such distress. Those simple statements do not reinforce a delusion, but also avoid putting someone with delusions on the defensive. The same can be applied to angry people who do not suffer from delusions. 

Distract And De-Escalate

When the lady I mentioned above, who physically assaulted me, got angry, I'd simply ignore what happened, take a step back, and ask her if she knew where the garlic was, at what time her favorite show started, or ask her to come help me decide what washing she wanted put on. Distracting an elder with dementia with something completely different can often help them snap out of their aggressive episodes quickly. 

Don't Take It Personally

Having a loved-one, especially one who used to be a very kind and caring person, turn on you like that can be draining. While this behavior is ongoing, remember — if at all possible — that their actions aren't about you but about their own perception of the world. When an elder engages in aggressive behavior, something is obviously troubling them.

READ What to Do About Nosy (or Aggressive) Neighbors In The Nursing Home

Should you greatly be affected by your loved-one's behavior towards you, something that is very understandable indeed, consider seeking individual or group therapy or discuss your feelings with your spouse, a friend, another relative, or even people on internet discussion boards who are going through something similar.