Senior aggression: Why it happens and what you can do

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 older adults, are bound to experience (and project) negative emotions from time to time, persistent, unprovoked anger 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 aggressive behavior in seniors, 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.”

— Dr. David A. Merrill, adult and geriatric psychiatrist

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

As 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 Merrill. 

The main way to know there’s a problem, according to both 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. 

What causes aggression in seniors?

One-off bad days aside, there are often two main reasons for aggressive behavior in seniors, says 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. 

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 Merrill. 

According to 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.”

— Brittany Ferri, occupational therapist

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 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. 

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,” 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.