Behavioral disorders in old age – spiteful, suspicious, aggressive

In the context of  dementia  , personality changes can occur with age. Many people with dementia show severe behavioral problems, such as aggression in words and actions, sudden changes in mood, distrust of family members or restless pacing at night. Such changes in social behavior are often signs of the onset of dementia – but if no corresponding diagnosis has yet been made, they often puzzle relatives. Here you can find out where changes such as sudden hatred, aggressiveness, maliciousness, delusions, stubbornness or loss of empathy can come in old age and get tips on how to deal with “difficult” older people.

Reasons for personality changes in old age

Dementia is often only associated with forgetfulness, but the gradual progressive loss of cognitive performance and the ability to think is only one side of dementia, the most well-known form of which  is Alzheimer’s disease  .

The disease often leads to behavioral problems. The “grumpy” behavior of the elderly is often justified with the increasing age of the patient and dismissed as “normal” stubbornness in old age. But sudden personality changes in old age, such as aggressiveness, restlessness, distrust, swearing and screaming, are also part of the disease.

Some of these are due to changes in the brain, such as impairment of logical thinking or impulse control. In part, they are also a reaction of those affected to their situation and go back to feelings such as:

  • uncertainty
  • overload
  • Angst
  • helplessness
  • disappointment
  • Frustration
  • guilt
  • self-doubt

If you put yourself in the position of those affected, their behavior often seems less incomprehensible: those who no longer remember people or shared experiences react involuntarily to these people in a negative way. Anyone who notices that they are suddenly finding things difficult that they once took for granted tries to hide this and is dissatisfied with themselves, which often provokes negative reactions from “paternalist” others.

Behavioral disorders often break up families

Such an illness can be an enormous burden for the family, as they have to watch how a loved one is mentally deteriorating before their eyes, can no longer react in a self-determined manner and is increasingly dependent on the help of others.

Sometimes even more serious are the behavioral changes associated with dementia, which have the greatest impact on family life. If a loved one suddenly reacts aggressively, hatefully, spitefully, suspiciously and hostilely towards their closest relatives, if they develop delusions, then the already arduous care is made even more difficult by the enormous emotional burden.

It is often precisely these changes in behavior that are the reason for being admitted to a nursing home and thus tearing the sick person out of their familiar environment – with the result that insecurity, aggression and helplessness are increased.

The most common behavioral problems

Dementia can lead to a wide variety of personality changes and behavioral problems in seniors. The most common changes in personality are presented below.

You can read here which signs can also indicate the onset of dementia.

Restlessness, wandering and restlessness

This is a typical phenomenon in people with dementia. Changes in drive are often the first sign of disorders in the brain. Those affected are driven by an inner restlessness, they constantly want to do something without knowing what they actually want to do. They walk around forgetting what they wanted to do and start doing something else.

Disturbed sleep-wake cycle

Many people with dementia have  trouble sleeping . They wander around in the dark at night. The relatives can then often no longer sleep for fear and concern about accidents and injuries. In contrast to those affected, who then sleep during the day, family members and caregivers can no longer catch up on their sleep, which can also lead to conflicts.

aggression and anger

People with dementia often behave aggressively – for no apparent reason for the relatives – and not just with words, but also with deeds. This behavior is usually triggered by fear or anger at having to ask for something that the patient actually takes for granted.

distrust and hostility

Suddenly people with dementia distrust confidants, acquaintances and relatives, they react hostile and negative towards them. Even the closest relatives, for example, are suspected of having stolen something from them, “stolen”.

despondency and depression

Depressive  moods – caused by mental deterioration – are very common. Many of those affected notice that “something” is no longer right with them. They can no longer cope with their environment and know very well that they are dependent on the help of others. This makes them depressed and sad without being able to do anything about their condition.

Apathy and lack of drive can also be a possible expression. There is often a feeling of shame when those affected withdraw more and more and avoid social contacts. They become lonely inside because no one understands them anymore.

hallucinations and delusions

People with dementia often have hallucinations, meaning they see something that isn’t there, hear voices and noises that aren’t there, or  smell  something that the family isn’t able to perceive.

Many of those affected also suffer from sudden delusions: they accuse their relatives of theft, they feel persecuted by strangers or they no longer recognize themselves in the mirror and believe that a stranger is standing opposite them.

Pay attention to the first warnings

The behavioral problems in particular usually show up two to three years before the diagnosis of “dementia” is made. In many cases, the behavioral disorders are initially dismissed as “normal” side effects of aging, although they are the first warning sign of dementia that may be imminent. The earlier dementia is diagnosed, the earlier appropriate therapy can be initiated.

Here the relatives are required. As soon as you notice the first signs of a change in behavior, you should take the person concerned to their family doctor so that appropriate tests and examinations can be carried out. This can often be difficult, since those affected usually lack insight into the illness, they deny mistakes or deny the changes – this is part of their own coping strategy.

However, you should insist on seeing a doctor. Because even if it is not yet possible to cure dementia, symptoms such as aggressiveness, mistrust or a disturbed sleep-wake cycle can be effectively reduced or even eliminated. The therapy gives those affected the opportunity to actively influence their life planning at an early stage.

It is also important to clarify whether it is actually dementia, because other diseases, such as depression,  hearing loss  or a malfunctioning thyroid gland can also lead to changes that can be confused with dementia.

7 tips for dealing with those affected

Dealing with dementia patients is often difficult for relatives, because they can no longer deal with their feelings with their heads. The sick person is perceived as difficult, spiteful, argumentative, stubborn or aggressive – conversely, a lack of understanding on the part of the relatives often worsens the situation for the sick person, so that they react all the more hostile.

The following tips can help to make dealing with people with dementia easier:

  1. If possible, do not point out mistakes to those affected or criticize them, this usually only worries or embarrasses them. Nor should you expect the person to be able to explain their actions rationally. Instead, it can help to look past the negative and reinforce the positive with praise and encouragement.
  2. Avoid discussions or arguments in which you try to convince those affected with logical arguments. If connections are no longer comprehensible for the person, this often only leads to anger and dissatisfaction. It is better to distract or agree with the person.
  3. Maintain a consistent daily structure, routines and familiar environment.
  4. If something worries or unsettles the person (e.g. dark corners or carpet patterns), try to eliminate the cause or offer comfort and reassurance on an emotional (not logical) level. Physical contact often has a positive effect.
  5. Aggression often arises from insecurity. Serenity, reassurance, and distraction often help provide security and resolve resentment of the situation. Avoid violent confrontations and do not try to hold or harass the person.
  6. If the person hides objects out of a need for security that they can no longer find later and therefore think they have been stolen, help them search and calm them down. If possible, keep track of where the items are usually hidden.
  7. Finally, try not to take the sick person’s behavior personally. It does not happen intentionally, but is a symptom of the disease.

Don’t be afraid to seek help at an early stage – be it information about how to deal with sick people or help with care and nursing that serve to relieve you.

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