How to Handle Dementia Related Aggressive Offensive Bad Abusive Behaviors

“They are driving me crazy!”

This phrase is uttered (or screamed) by family members everywhere who are caring for elderly loved ones.

Caregivers often have to deal with unusual, unruly and embarrassing behavior from their care recipients.

The Caregiver Forum is filled with stories of demanding elderly parents, personality changes, hallucinations, and temper tantrums.

In some cases, this is the way some seniors have always acted, but these behaviors can also indicate serious developments in a person’s health, like progressing dementia, depression or a urinary tract infection.

We’ve compiled the top 10 “bad” behaviors that elders exhibit, some of the most common mental and physical causes, and tips for coping with them.

1. Elderly Rage, Anger and Yelling

Age and illness can intensify longstanding personality traits in some unpleasant ways. For example, an irritable person may frequently become enraged, or an impatient person may become demanding and impossible to please. Unfortunately, the primary caregiver is often an angry elder’s main target.

Coping Tip

Try to identify the root cause of their anger. The aging process is not easy. It can spark resentment in seniors who are living with chronic pain, losing friends, experiencing memory issues, and all of the other undignified things that come with getting older.

Alzheimer’s disease and other forms of dementia can also cause these behaviors. With dementia, it is important to remember that the patient doesn’t have full control over their words or actions. As a caregiver, the best thing you can do is not take it personally. Focus on the positive, ignore the negative and take a break from caregiving when you can by finding respite. Get some fresh air, do something you love or call a friend.

Elders often reserve their worst behavior for those they are closest to, like family members. In this case, it may be beneficial to hire in-home care or consider adult day care. Their bad behavior might not surface in front of a stranger, and you get a much-need break.


2. Caring for those with Abusive Behaviors

Occasionally, seniors will lash out at the person who is making the biggest effort to take care of them. Left unchecked, the anger and frustration described above can become so severe that it results in abuse of the caregiver. Stories of mental, emotional, even physical abuse to family members providing care are all too common. In some cases, abuse may stem from a mental illness, such as narcissistic and borderline personality disorders. In other situations, parents turn on the adult child who is showing the most love because they feel safe enough to do so. They don’t consciously abuse this son or daughter, but they lash out to vent frustration.

Coping Tip

Try explaining how their behavior makes you feel. Unfortunately, many caregivers don’t get very far by talking. If the abuse is verbal or emotional, try to make them realize all that you do for them by not doing it for a while. Bring in outside help if your loved one requires supervision and assistance in order to be safe in your absence. Removing yourself from the situation may drive home the point that abusive behavior will not be tolerated. Your loved one may come away from the experience with renewed appreciation for what you do. In the meantime, you’ll get some valuable respite time.

If physical abuse is the issue, then seek professional help. This may consist of a phone call to the authorities, attending counselling, or permanently handing over your loved one’s care to professional caregivers or a long-term care facility.


3. Elders who Refuse to Shower

The issue of elders refusing to take showers, change their clothes and take care of personal hygiene is far more common than most people think. It’s also very frustrating for caregivers.
Sometimes depression is the cause, and another factor could be control. As people age, they lose more and more control over their lives, but one thing they generally can control is dressing and showers. The more you nag them to take a bath and put on fresh clothes, the more they resist.

A decreased sense of sight and smell may be contributing to the problem as well. Our senses dull as we age, so seniors may not detect their own body odor or see how soiled their clothes are. If memory issues are involved, they may lose track of time and not realize how long it’s been since they showered. Lastly, fear and discomfort can play a huge role in their resistance. Many older individuals develop a fear of falling and slipping in the tub, and they are often too embarrassed to ask for help.

Coping Tip

The first step is to determine why they have stopped bathing. If depression is the cause, speak with their doctor. Therapy and medications can help. If modesty is a problem and the elder doesn’t want a family member helping them bathe, they may be open to having a professional caregiver provide bathing assistance.

If they are afraid of the water (or slipping in the tub), there are many types of shower chairs, showerheads and other products that can help. If the person has dementia and is afraid of bathing, then you must be gentle. Don’t insist on a full shower or bath. Begin with a small request, like asking if you can simply wipe off their face. As they get used to this, you can gradually add cleaning other parts of the body. Be sure to chat with them during the process and let them know what you are doing as you go.

Do your best to keep your parent clean, but keep your expectations realistic. Too much nagging is counter-productive, and at the end of the day, you may have to lower your standards and adapt your definition of cleanliness.


4. Senior Swearing, Offensive Language and Inappropriate Comments

When a senior suddenly begins spouting the worst profanities, using offensive language or saying inappropriate things, family members are often baffled as to why and what they can do about it.

Caregivers have shared countless stories in the forum about elders who used to be mild-mannered and proper suddenly cursing at them or calling them insulting names. When it happens in public, it’s embarrassing, and when it happens in private, it’s hurtful.

Coping Tip

When this behavior is out of character for an elder, the start of Alzheimer’s or another form of dementia is a likely cause. If the onset is quite sudden, a urinary tract infection (UTI) is another common culprit. UTIs present very differently in seniors, and symptoms include behavioral changes like agitation.

But if dementia is not an issue and a senior is just plain crass, how do you deal with swearing and rudeness? You can try to set firm ground rules for them. Make it perfectly clear that you will not tolerate such language, especially in public settings. A little bit of guilt may be effective in getting them to realize that their behavior is unacceptable and offensive to other people. Try something like “Dad, if Mom was here right now, she would be appalled by your language,” or “You would never want your grandchildren to hear you speaking like that, would you?”

When a swearing tirade sets in, another technique is to use distraction. Their fit may end once they’re focused on something else. Try bringing up happy times from the old days. Elders love to reminisce, and prompting them to change the subject and tap into their long-term memory will likely cause them to forget about whatever it is that set them off. If none of these suggestions work, your best bet is to learn not to take this behavior personally. Back off, disappear and wait for it to blow over.


5. Paranoia and Hallucinations in the Elderly

Paranoia and hallucinations in the elderly can take many forms. Seniors may accuse family members of stealing, see people and things that aren’t there, or believe someone is trying to harm them. These behaviors can be especially difficult for caregivers to witness and try to remedy.

Coping Tip

Hallucinations and delusions in elders are serious warning signs of a physical or mental problem. Keep track of what your loved one is experiencing and discuss it with their doctor as soon as possible. This behavior could be something as simple as be a side effect of a medication they are taking, or it could point to a UTI.

Oftentimes, paranoia and hallucinations are associated with Alzheimer’s disease or dementia. When this is the case, caregiving experts seem to agree that the best thing to do is just relax and go with the flow. Do not, try to talk them out of a delusion. Validation is a good coping technique, because what the elder is seeing, hearing or experiencing is very real to them. Convincing them otherwise is fruitless. Acknowledge the senior’s concerns and perception of reality in a soothing voice. If they are scared or agitated, assure them that they are safe and you will help them through experience.


6. Seniors with Strange Obsessions

Saving tissues, worrying if it’s time to take their meds, constantly picking at their skin, and hypochondria, are all types of obsessive behaviors that can disrupt the daily lives of seniors and their caregivers. Obsessions are sometimes related to an addictive personality, or a history of obsessive-compulsive disorder (OCD).

Coping Tip

View your parent’s obsessive-compulsive behaviors as a symptom, not a character flaw. Obsessive behavior can be related to a number of disorders, including anxiety, depression, dementia, or other neurological issues. It is important to discuss a senior’s symptoms with their doctor, especially if they are interfering with their happiness and daily routines. Therapy and/or medication may be the answer.

Watch for things that trigger your parent’s obsessive behavior. If their compulsions seem to be related to a specific event or activity, avoid it as much as possible. Do not participate in their obsessions. If you have helped with rituals in the past, change this pattern immediately. Try to find ways to minimize or eliminate triggers if possible. For example, dry, itchy skin may feed a senior’s compulsion to pick and scratch. Keeping their skin moisturized and covered with clothing may help minimize the issue. Distraction and redirection can also be helpful.


7. Hoarding and Aging Adults

When a senior hoards (acquires and fails to throw out a large number of items), once again, the onset of Alzheimer’s or dementia could be at fault. Someone’s pre-Alzheimer’s personality may trigger increased hoarding behavior at the onset of the disease.

For example, an elderly parent who was already anxious about aging and the possibility of outliving their resources, may begin to collect things and save money due to their feeling overwhelmed by what lies ahead. Others hold on to items because they fear their memories will be lost without tangible evidence of the past.

Coping Tip

You can try to reason with them and even talk about items to throw out or give away. Creating a memory box or an organizational method for keeping “special things” may help tame the chaos. With extreme hoarders, medication and family counseling could make a big difference in how you cope. In some cases, you may need help from adult protective services (APS) if the senior’s behavior has led to unsafe or unsanitary living conditions.


8. Refusing to Let Outside Caregivers into The House

It is an important milestone when family caregivers decide to hire in-home care for their loved ones, but this plan is often derailed when seniors refuse to let the caregivers in. Other elders will let the professionals in only to tell them that they are fired!

Coping Tip

The presence of an outsider suggests to the elder that their family can’t (or doesn’t want to) take care of them. It also magnifies the extent of their needs and makes them feel vulnerable. Work to understand your loved one’s reasons for resisting. This could be fear, embarrassment, resentment, or some mix of the three. Talk to them about their feelings, and work together to find solutions that everyone can live with. For example, if Mom hates the thought of letting a stranger into her home, arrange for her to meet the professional caregiver at the home care company’s office or at a café for coffee first.

Ask your loved one to simply give home care a try on a temporary basis. Instead of immediately introducing full days of hands-on care, it may help to have someone come in for one day a week for a few hours just to do light housekeeping, like vacuuming and washing clothes. Experienced home care companies know how to handle situations like this, so consult them when necessary. Once the senior gets used to having someone in the house and establishes trust with a caregiver, they will be more comfortable with accepting additional help.


9. Senior Over-Spending or Extreme Frugality

Many caregivers are pulling out their hair over their loved ones’ spending habits. Some seniors rack up debt, gamble, or send money to charities and scammers, while others refuse to spend a single penny on things they actually need—like medications and long-term care.

Money is already a bit of a taboo topic of discussion, but questioning a parent’s ability to handle their finances complicates things even further. This issue is directly tied to their power and independence. When seniors lose independence in some areas, they often try to make up for this loss in another way. Spending (or saving) is one of those ways.

Coping Tip

If you choose to address this issue, seniors will usually insist there is no problem. It’s their money and they can spend it as they choose. They do have a right to manage their own finances, but if they are not competent (or you have suspicions of cognitive decline), it is crucial to tackle this head on. For many seniors, mismanaging money is one of the first signs of dementia.

When carelessness or excessive penny pinching is the culprit, bringing in a third party can help. This could be a financial adviser, a spiritual leader, a friend—anyone whose opinion the senior will respect. For over-spenders, present the total amount spent on their shopping sprees. Sometimes they need to see the effects of their behavior in black and white terms.

On the other end of the spectrum, money hoarders’ behaviors may be the result of having lived through the Great Depression and other hardships. Seniors who once feared being able to pay bills and take care of their family likely don’t want to see a family member go through financial hardships on their behalf either. Showing them the out-of-pocket expenses regarding their care that you are paying might help open their eyes.