Senior aggression: Why it happens and what you can do (2024)

If viral social media videos are any indicator, we’re becoming progressively crankier as a country. But for seniors facing limited mobility, increased isolation and loneliness, and other major stress factors related to aging, those negative feelings might seem tenfold. But while people of all ages, including senior folks, are bound to experience (and project) negative emotions from time to time, persistent, unprovoked anger in an older adult could be a sign of something more serious, says Dr. David A. Merrill,an adult and geriatric psychiatrist and director of the Pacific Neuroscience Institute’s Pacific Brain Health Center at Providence Saint John’s Health Center in Santa Monica, California.

“It’s not normal for previously non-hostile older adults to start exhibiting ongoing, repeated, out-of-character aggression,” he explains, noting that aggression in seniors is often indicative of a health issue that warrants attention ASAP. “When the behaviors are unprovoked, not associated with any clear triggers or stressors, then it’s worth considering if something more biologic or brain-based is going on beyond a bad day.”

Of course, understanding when that aggression is an anomaly or result of a bad day — and when it’s symptomatic of a serious health issue — can be tricky. And what’s more, if you do suspect a senior in your life needs medical help, how do you go about it without endangering yourself (or them), too?

Here, experts spotlight how to identify senior aggression in older adults, the health factors behind the outbursts and how to get your loved one help fast.

“It’s not normal for previously non-hostile older adults to start exhibiting ongoing, repeated, out-of-character aggression.”


Is it senior aggression or just a single moment of anger?

As Dr. Merrill mentions, when an older adult shows continuous, repeated aggression that is seemingly unprovoked (so it’s not a one-off episode and has been recurring for days, weeks or months), there’s a solid chance their anger is stemming from an internal factor rather than an external one (like a loved one recently passing or an upsetting news headline crossing their path).

As for what the aggression itself entails, that can vary, says Brittany Ferri, who holds her doctorate in integrative mental health and is an occupational therapist specializing in older adults. Here are a few tell-tale signs Ferri says she sees in her clients:

  • Frequent pacing.
  • Increased restlessness.
  • Poor sleep.
  • Speaking in a louder, more pressured tone (especially if that’s not the norm).

But of all the symptoms associated with senior aggression, there’s one in particular (and at a particular time) that’s often the most indicative of a problem that needs professional help, according to Ferri: a readiness to fight, both physically and verbally.

“Being combative is the biggest tell-tale sign that an older adult is having more than just a bad day,” she explains. As for what this combativeness might look like (and what differentiates it from the occasional quarrel)? Ferri says that typically it’ll happen most often while a caregiver is in the process of, well, offering care — i.e. bathing, brushing or assisting them in and out of furniture.

She explains that when a caregiver offers assistance, older adults might walk out of the room or even hit their caregiver, swear at them, become very fearful and start yelling. “There are even some older adults who have been known to bite or spit at others out of fear and general anxiety during these tasks,” she notes.

Alternatively, difficulty following societal norms (say, they’re frequently getting traffic tickets or attempting to steal items from stores) could signal an issue, says Dr. Merrill.

The main way to know there’s a problem, according to both Dr. Merril and Ferri: iIf the behavior is shockingly out-of-the-blue and not on par for the person’s regular demeanor, it’s probably time to step in.

Causes of senior aggression

One-off bad days aside, there are often two main reasons for unprovoked, intense anger in an older adult, says Dr. Merrill: It’s either a biologic or neurologic issue.

Believe it or not, Ferri has found thatone major reason for senior aggression is urinary tract infections (UTIs), which account for nearly one-third of infections in long-term care facilities.

Dr. Merrill agrees. “Acute medical illnesses like urinary tract infections, viral illnesses like COVID-19, pneumonias or skin infections can also cause acute bouts of aggressive responses,” he explains.

If you can rule out those biologic issues and aggression still persists, there could be a neurologic issue at play, which would require a neurological evaluation, says Dr. Merrill.

According to Dr. Merrill, neurological issues can stem from two places: vascular disorders (like having a stroke, which can affect the brain) and neurodegenerative disorders (like Alzheimer’s and dementia). “These both can result in very noticeable behavior changes,” he adds. According to the Alzheimer’s Association, roughly one in nine people over the age of 65 suffer from Alzheimer’s or dementia.

Alongside increased irritability, the Alzheimer’s Association lists some other common indicators of the disease to watch for in a loved one:

  • Challenges in planning, solving problems or completing (usually) familiar tasks.
  • Confusion about time and place
  • Increased vision problems.
  • Difficulty engaging in conversation.
  • Misplacing things or getting lost.
  • Poor decision-making, especially as it relates to self-care.
  • Increased isolation and withdrawal from social activities.

How to help a senior exhibiting aggressive behavior

Although getting to, and hopefully solving the root cause of aggressive behavior is your first step as a caregiver, understanding how to weather those emotional storms — and keep the person you’re caring for and yourself safe from harm — is critical.

First and foremost, says Ferri, try not to patronize your loved one in general — not just when they are showing signs of aggression. She advises considering these three don’ts:

  • Avoid “elder speak,” or talking to an older adult in a way that makes them feel helpless, which will only trigger more aggression.
  • Try not to patronize or assist them in behaviors you know they can do perfectly well.
  • Don’t just assume they don’t know something or can’t do something. Listen to them.

Another tactic Ferri recommends for diffusing aggression? Try distraction. “This could be as simple as suggesting they watch their favorite show or something to keep their hands busy,” she says. “This focuses the brain on something else besides the aggression, especially if it’s a task that person enjoys.”

“If your loved one is used to waking up to two eggs and a slice of bacon, even a small change like having just one egg can disrupt their mental status.”


As for preventing aggression, Ferri says it’s important to keep life predictable. “For example, if your loved one is used to waking up to two eggs and a slice of bacon, even a small change like having just one egg can disrupt their mental status,” she explains. “It may seem as though they’re being picky, but these changes are enough to alert their brain that something’s wrong, and cause them to be disoriented and possibly aggressive.”

When to seek professional help

Both Dr. Merrill and Ferri agree that, if a senior’s aggressive behavior is seemingly out-of-the-blue and becomes more consistent, it’s time to enlist professional help. Your first step: Reach out to the senior’s primary care physician ASAP. Or, if you’re a loved one, let their professional caregiver know.

Dr. Merrill says that, depending on whatever’s ailing a senior showing aggression, they can most often be prescribed a medication or treatment plan that can help. However, he stresses that medication involves some considerable discussion among caregiver(s), family members and importantly, the older adult themselves.

“You need to weigh the risk and benefit analysis,” Dr. Merrill says. “Some medications for [for senior aggression] come with side effects, so it’s important to make sure everyone on the care team is onboard.”

And if an older adult exhibiting anger is in danger or poised to endanger someone else, call 9-1-1 immediately.

Senior aggression: Why it happens and what you can do (2024)


What causes aggression in the elderly? ›

Reasons for the person's behaviour could include: difficulties to do with dementia – for example, memory loss, language or orientation problems. their mental and physical health – for example, they may have pain or discomfort that they are unable to communicate.

What to do if elderly gets aggressive? ›

Here are some ways you can cope with agitation or aggression:
  1. Reassure the person. ...
  2. Allow the person to keep as much control in his or her life as possible.
  3. Try to keep a routine, such as bathing, dressing, and eating at the same time each day.
  4. Build quiet times into the day, along with activities.
May 17, 2017

At what stage of dementia does aggression occur? ›

Aggression usually starts in the mid-stage of dementia. This is the time when other behaviours, such as hoarding wandering, and compulsive behaviour are also prone to develop. In most types of dementia, the aggressive symptoms occur when the patient becomes more dependent with daily activities.

What causes extreme agitation in the elderly? ›

Agitation and restlessness is poorly understood in older adults, but is generally considered to have multifactorial etiology, including genetics, physical disease, changes in the brain, unmet needs, and unaddressed pain.

How do you calm an angry elderly person? ›

Use music, massage or exercise to help soothe the person. Shift the focus to another activity. The immediate situation or activity may have unintentionally caused the aggressive response. Try something different.

What are 10 factors that can cause aggression in the elderly? ›

The clinician might consider the following NDB proximal factors as possible causes of aggression: constipation, pain, hunger, thirst, sleep disorders, environmental factors (light, noise, crowding), or frustration due to insufficient assistance with basic activities of daily living (ADLs) 15, 29.

What is the 5 word memory test? ›

Introduction: The five-word test (5WT) is a serial verbal memory test with semantic cuing. It is proposed to rapidly evaluate memory of aging people and has previously shown its sensitivity and its specificity in identifying patients with AD.

What is the number one trigger for dementia behavior? ›

Some of the more common triggers for dementia like a change in environment, having personal space invaded, or being emotionally overwhelmed may be easier to handle if you mentally practice your response before you react.

What is the first line treatment for aggression in dementia? ›

Brexpiprazole (Rexulti®) is the only atypical antipsychotic that is FDA-approved for agitation associated with dementia due to Alzheimer's. Atypical antipsychotics are a group of antipsychotic drugs that target the serotonin and dopamine chemical pathways in the brain.

Where do you put dementia patients with aggressive behavior? ›

Memory care may be a good fit for aggressive dementia patients. These facilities have staff trained in dementia who can help manage aggression and keep residents calm.

What stage of death is agitation? ›

Agitation is a term that describes anxious, restless and unsettled behaviour. It can be linked to emotional, physical or spiritual distress. Terminal agitation means agitation that occurs in the last few days of life.

What are the 10 warning signs of dementia? ›

These resources are available at your local Alzheimer Society office.
  • Sign 1: Memory loss that affects day-to-day abilities. ...
  • Sign 2: Difficulty performing familiar tasks. ...
  • Sign 3: Problems with language. ...
  • Sign 4: Disorientation to time and place. ...
  • Sign 5: Impaired judgment. ...
  • Sign 6: Problems with abstract thinking.

What medication reduces agitation in dementia? ›

Anti-psychotics—especially risperidone, aripiprazole, and olanzapine—have been evaluated in multiple studies and demonstrated improvement in severe agitation, aggression, and psychosis (e.g., delusions, hallucinations) among patients with AD [34].

Is anger a symptom of early dementia? ›

Changes in behaviour, judgement and moods

Becoming quiet, withdrawn or restless – or frustrated or angry – can be early signs of dementia. Someone may develop repetitive behaviour – for example, they ask the same question over and over again, do the same thing repeatedly or make multiple phone calls to the same person.

What is the most common cause of aggression in someone with dementia? ›

Some reasons why a person with dementia might be aggressive include: The person might be feeling unheard or misunderstood. The person might be feeling threatened or frightened. The person might be feeling embarrassed, frustrated or annoyed because they need help to do things they used to do independently.

What are the first signs of personality changes in dementia patients? ›

Changes in mood and personality

Individuals living with Alzheimer's or other dementia may experience mood and personality changes. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, with friends or when out of their comfort zone.

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