“They are driving me crazy!” This phrase is uttered (or screamed) by family members everywhere who are caring for elderly loved ones. Caregivers often deal with unusual, unruly and embarrassing behavior from their care recipients. The AgingCare.com Caregiver Forum is filled with stories of irrational elderly parents, personality changes, hallucinations and temper tantrums.

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In some cases, this is the way some seniors have always acted. However, new behaviors and personality changes can also indicate serious developments in an elder’s health, such as progressing dementia, depression or a urinary tract infection (UTI).

10 Elderly Behavior Problems and How to Handle Them

We’ve compiled ten “bad” behaviors that older adults commonly exhibit, some of the potential mental and physical causes, and tips for coping with them.

Elderly Anger, Hostility and Outbursts

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, an angry elder’s main target is often their primary caregiver.

How to Deal With Anger in the Elderly

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 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 as often as you can by finding respite care. Get some fresh air, do something you love or call a friend to vent.

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. Mean, angry behaviors might not surface in front of strangers, and you’ll get a much-needed break while others are meeting your loved one’s care needs.

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Abusive Behavior

Occasionally, seniors will lash out at the person who is making the biggest effort to ensure their happiness and well-being. Left unchecked, the anger and frustration described above can become so severe that it results in abuse of the caregiver.

Stories of mental, emotional and even physical abuse of family members providing care are all too common. In some cases, abusive behavior may stem from a mental illness, such as narcissistic personality disorder (NPD) or borderline personality disorder (BPD). 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 rather vent their frustrations in an unhealthy way by lashing out.

How to Deal With an Elder’s Abusive Behavior

Try explaining how their behavior makes you feel. However, many caregivers don’t get very far by talking. If the abuse is verbal or emotional, help them realize how much you do for them by stepping back for a while. If your loved one requires supervision and assistance to ensure their safety, then bring in outside help to take over your duties. Removing yourself from the situation may drive home the point that abusive behavior will not be tolerated. Your loved one might come away from the experience with renewed appreciation for what you do. In the meantime, you’ll get some valuable respite.

If physical abuse is the issue, then seek professional help. This may consist of a phone call to the police or adult protective services (APS), attending counselling, or permanently handing over your loved one’s care to a court-appointed guardian, professional caregivers or a long-term care facility.

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Refusing to Shower or Bathe

The issue of elders refusing to bathe, change their clothes and maintain good personal hygiene is far more common than most people think. It’s also very frustrating for family caregivers. Sometimes depression is the cause, but another factor could be a desire for autonomy. As people age, they lose more and more control over their lives. However, one thing they generally can control is how they dress and when they shower. It seems the more you nag older adults to take a bath and put on fresh clothes, the more they resist.

Declining senses 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 even realize how long it’s been since they last bathed. 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 With Poor Hygiene in Seniors

The first step is to determine why an elder has stopped bathing. If depression is the cause, speak with their doctor about solutions like therapy and antidepressant medication. If modesty is a problem and the senior doesn’t want a family member helping them bathe, they may be open to having a professional caregiver provide bathing assistance.

If an elder is afraid of the water or slipping in the tub, there are many types of shower chairs, handheld showerheads, grab bars and other senior bathing products that can provide added stability and comfort. Be extra gentle and patient with dementia patients who are afraid of bathing.

Do your best to keep your parent clean, but keep your expectations realistic. At the end of the day, you may have to lower your standards and adjust your definition of cleanliness. Bathing once or twice a week is usually enough for seniors without incontinence issues to avoid skin breakdown and infections.

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Excessive Cursing, Offensive Language and Inappropriate Behavior

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 these verbal outbursts happen in private, they’re hurtful; When they happen in public, it’s downright embarrassing.

Coping With Verbally Aggressive Behavior in the Elderly

When this behavior is out of character for an elder and gradually gets worse, the start of Alzheimer’s disease or another form of dementia is a likely cause. If the onset is quite sudden, a urinary tract infection is another common culprit. UTIs present very differently in seniors than in younger individuals, and symptoms often 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 were 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. The outburst may end once they’re focused on something else, especially for dementia patients. 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 in the first place. If none of these suggestions works, your best bet is to learn not to take this behavior personally. When a senior becomes hostile, back off, disappear for a little while and wait for it to blow over.

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Paranoia, Delusions and Hallucinations

Paranoia and hallucinations in the elderly can take many forms. Seniors may make false accusations of theft or abuse, 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.

How to Handle Mental Health Issues in the Elderly

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 when so you can discuss it with their doctor as soon as possible. This behavior could be explained by something as simple as a side effect of a new medication they are taking, dehydration or a UTI.

Oftentimes, paranoia and hallucinations are associated with dementia. When this is the case, caregiving experts seem to agree that the best thing to do is go with the flow. Do not try to talk dementia patients 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 and may make them more upset. Acknowledge the senior’s concerns and perception of reality in a soothing voice. If they are scared or agitated, redirect them while assuring that they are safe and you will help them through the experience.

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Obsessive or Compulsive Behaviors

Saving tissues, worrying if it’s time to take their medications, 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 and compulsive behaviors are sometimes related to an addictive personality or a history of obsessive-compulsive disorder (OCD).

Coping With Elderly Obsessive Behaviors

View your parent’s obsessive-compulsive behaviors as a symptom, not a character flaw. Obsessive behavior can be related to several disorders, including anxiety, depression, dementia and other neurological issues. It is important to discuss a senior’s symptoms with their doctor, especially if they are interfering with their quality of life 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, though. 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, itchy, dry skin may feed a senior’s compulsion to pick and scratch. Keeping their skin moisturized and covered with clothing may minimize the issue. Distraction and redirection can also be helpful.

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Hoarding

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 to blame. 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 “useful” items and obsessively save money due to 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.

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How to Handle Hoarding Behaviors

You can try to reason with your loved one and even talk about items to throw out or give away. Creating a memory box or an organizational system for keeping “special things” may help tame the chaos. With extreme hoarders, behavioral intervention therapies and family counseling could make a big difference in how you cope. In some cases, you may need help from adult protective services if the senior’s behavior has led to unsafe or unsanitary living conditions. This is unfortunately common with stubborn elders with dementia who cannot or will not address their hoarding problems.

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Refusing to Accept Outside Caregivers

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 new caregivers into their homes. Other elders will welcome home health aides in only long enough to tell them that they are fired!

Coping With Elders Refusing Care

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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 in-home care, which could include 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. Experienced home care companies know how to handle situations like this, so don’t hesitate to ask for their advice. 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.

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Overspending or Extreme Frugality

Many family caregivers are pulling out their hair over their loved ones’ excessive 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, such as medications, adult briefs and long-term care.

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

How to Deal With Stubborn Aging Parents’ Finances

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 suspect cognitive decline), it is crucial to tackle this head on. For many seniors, mismanaging money is one of the first signs of dementia. If the matter goes unnoticed or unaddressed for long, it can have a serious impact on the type and amount of care an elder can afford in the future. Hopefully you and your loved one have already planned legally for this kind of situation with a durable power of attorney for finances document.

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

On the other end of the spectrum, a money hoarder’s behaviors may be the result of deeply engrained Depression-era values and other hardships they’ve experienced. Seniors who once struggled to pay bills and take care of their families probably don’t want to see their family members go through financial hardships on their behalf either. Showing them the out-of-pocket costs that you are paying for their care might help open their eyes.

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Demanding and Attention Seeking Behavior

Once a family member becomes a caregiver, the care recipient might see this as a 24/7 commitment. However, caregivers have other obligations and priorities like work, family, and their own physical and mental health. Seniors who are still capable of doing things for themselves can easily become completely dependent on a caregiver for all their physical and emotional needs. It is one thing when they truly need extensive assistance, but when this dependency is elective, it can make their demands even more frustrating. Some seniors even go so far as to “sabotage” their caregivers’ plans for any activities other than providing care, including work, vacations and family time. This is unacceptable.

How to Deal With an Elderly Parent Who Is Demanding and Needy

You must make yourself a priority. Caregiving can easily turn into a full-time job if you let it. Setting boundaries with a demanding senior is crucial and failing to do so is a recipe for caregiver burnout.

Do whatever you must to get your parent involved in activities and social events that do not directly involve you. Depending on their capabilities, adult day care, book clubs, senior centers, volunteer opportunities and art classes could all be viable options for getting a loved one to focus on something other than your attention. They will probably go kicking and screaming, but having other people to interact with combats loneliness and makes them less dependent on you. If your parent is housebound, enlist other family members, friends, fellow churchgoers, or a hired companion to visit on a regular basis and give you a break. Home companions are available through home care companies to provide non-medical care services (companion care).

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Sources: Aging changes in the senses (https://medlineplus.gov/ency/article/004013.htm); Suspicions and Delusions (https://www.alz.org/help-support/caregiving/stages-behaviors/suspicions-delusions); Delirium—Symptoms and Causes (https://www.mayoclinic.org/diseases-conditions/delirium/symptoms-causes/syc-20371386)