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Understanding and Managing Aggression in the Elderly

In our formative years respecting and caring for our elders is taught as a way of life. It has been like an instruction, without a question. However, as individuals age, changes in health, cognition, and emotions can sometimes lead to behavioral challenges, including aggression and violence. While it’s not a common occurrence among older adults, these behaviors can be distressing for both the elderly and the family around them.

While handling aggression in the elderly requires empathy, patience, and a structured approach it’s not as easy as it sounds.

Tanzeem Sheikh shares her experience with her aunt who is dealing with an early onset of dementia and gets difficult to handle when she goes through disruptions in her memory.

“The outbursts are very sudden. One moment we are all sitting and having dinner and the next moment she suddenly starts staring at one of us and starts pushing away the cutlery on the table,” says Sheikh who now is searching for an assisted living facility for her aunt. According to the 43-year-old homemaker from Bengaluru, the sudden aggression and the guilt associated with not being able to handle the situation calmly is too much to deal with.

But are health conditions the only triggers?

 “Aggression in the elderly can be triggered by various factors. Driven by a combination of physical, emotional, and cognitive issues, it often emerges as a response to specific stimuli or situations,” says Fatima. J, a Bengaluru-based counselor.

Dr. Gary Chapman, Senior Associate Dean for Geriatric Medicine, at Emory University

says, “Understanding that aggressive behavior in older adults is often a response to an underlying issue is crucial. It may stem from pain, discomfort, or the inability to communicate needs. Compassionate care involves addressing these underlying causes rather than just managing the behavior.”

Factors that Trigger Aggression in Elders

• Pain and Discomfort: Physical discomfort, chronic pain, or undiagnosed health issues can cause distress, leading to aggressive behavior in the elderly.

• Cognitive Decline: Dementia, Alzheimer’s, or other cognitive conditions can result in confusion, frustration, and agitation, leading to aggression.

• Environmental Factors: Changes in routine, unfamiliar environments, or excessive noise can trigger anxiety and provoke aggressive reactions.

How to Deal with an Aggressive Elderly Person

1. Remain calm and patient: Approach the situation calmly, speaking in a soothing tone, and maintaining a non-confrontational demeanor. Use clear, simple language, and provide step-by-step instructions. Avoid arguing or contradicting them, as this can escalate the situation.

According to Dr. Karen L. Fortuna, Assistant Professor, Department of Psychiatry, Geisel School of Medicine at Dartmouth, in cases of aggression, validating the individual’s feelings and maintaining a calm environment can significantly de-escalate the situation. Sometimes, simple reassurance and redirection can prevent further distress and agitation.

2. Validate feelings: Acknowledge their feelings and empathize with their frustration or discomfort, even if you cannot fully understand their perspective.

3. Provide reassurance: Offer reassurance and redirect their focus by engaging in calming activities or discussing familiar topics.

Dr. Cameron J. Camp, Director of Research and Development, at the Center for Applied Research in Dementia, adds that maintaining a familiar routine can provide comfort and predictability for older adults, reducing their anxiety and the likelihood of aggressive outbursts. He also says that consistency in caregiving approaches can significantly impact their emotional well-being.

4. Create a safe environment: Ensure safety by removing potentially harmful objects and maintaining a calm, predictable atmosphere.

5. Identify triggers: Keep track of events or situations that trigger aggression. Understanding these triggers can help in preventive measures.

6. Seek professional help: Consult healthcare professionals, including geriatric specialists, psychiatrists, or therapists, for guidance and support in managing aggressive behavior.

7. Seek support: Caregiving can be emotionally taxing. Reach out to support groups, counseling, rehabilitation, or continuum care services to alleviate caregiver stress.

8. Practice Self care: Prioritize your well-being by engaging in activities that reduce stress, such as exercise, hobbies, or meditation. Dr. Jane Tilly, Senior Strategic Policy Advisor, Administration for Community Living, U.S. Department of Health and Human Services

Insists that caregivers need to take care of their own mental and physical health to prevent burnout and help in providing better care for older adults experiencing aggressive behavior.

9. Educate yourself: Learn more about the underlying conditions or illnesses causing aggression to understand better and manage the situation effectively. According to Dr. Laura Gitlin, Dean of the College of Nursing and Health Professions, Drexel University, “Caregivers play a critical role in managing aggression in the elderly. Educating oneself about the person’s condition and behavior triggers is key to providing effective and compassionate care. Patience and understanding are vital in navigating these challenging situations.”

However, it is important to note that if the situation becomes uncontrollable, poses a risk to the elderly individual or others, or if there’s an immediate danger, do not hesitate to contact emergency services for assistance.