Any suggestions on how to more properly handle my mother in law who now explodes at the drop of the hat at anyone and has zero patience?

Thanks for the update, Alpha. Let's hope that the pacemaker does the trick.

If her untoward behaviors continue in rehab, consider a consult with a geriatric psychiatrist. Most rehabs have access to their services.

Your profile says your mother is living on her own with home aides. So, I'm going to assume that she doesn't have advanced dementia.
You handle this kind of behavior exactly the way you'd handle a child having a tantrum.
Completely ignore her and pay her no attention whatsoever when she behaves this way.
Give a bit of it back to her by letting her know that nobody is going to serve her and that you and everyone will do for her on your own time.
Put her in her place a bit because once this kind of behavior has been allowed to establish, it's very hard to reverse.

Hate to "preach," but canNOT emphasize enough the importance of UTI testing.

My parents did quite well (all things considered), but time & time again (while both were alive and after Dad was gone) if there were REAL problems with "anger and meaness," I would have them tested for UTI & (at least) 95% of the time when that was treated, they were back to normal.

Why? No one could ever explain it.

But it is a simple test & can produce AMAZING results.

Your mother-in-law has gone through two traumatic events and either one of those events will cause a person to be very emotional. On top of this, she has dementia. With dementia comes a loss of communication skills The manners that she’s exhibited for the vast majority of her life have been disrupted by her dementia and her grief. I suggest you watch some videos on YouTube by Teepa Snow. She discusses how the left and the right sides of the brain function normally and with dementia, Her videos will help you understand why your mother-in-law is behaving the way she is. Some rules of thumb on communicating with a person with dementia:
1. Empathy goes a very, very long way. Put yourself in her shoes with the loss of your spouse and very painful back issues. I have a herniated disc and when it was acting up its worst, it was the worst pain I’ve ever been through, including childbirth.
2. Reflect what she is saying back to her. This lets her know that you hear her and will comfort her.
3. Give her limited information on her condition. Be honest, but you don’t want to scare her and you don’t want to overwhelm her with information she cannot process.
4. Distraction, distraction, distraction. Find ways to distract her. Change the subject to something positive, something fun, something she enjoys hearing about it, I.e.., her grandchildren. Use music, poetry, prayer, photos, and talk to her about her husband. Share stories about him. Let her express her grief. A word of caution though, If her dementia is so advanced that she can’t remember that her spouse has died, then you don’t want to keep bringing that up to her because it’ll be like she is hearing the news for the first time every time it’s brought up. If this is the case, when she asks for him, just tell her that he’s gone to the store or some other excuse. She won’t remember.
5. Use lots of humor. Give her silly and outrageous responses to her requests and demands that will bring a smile to her face. This creates distraction as well.
6. Tell her you love her. Give her as much affection as she will accept. We all need love and affection.
7. Understand that these outbursts are a part of her condition and are her brain’s ability to communicate at this point. With dementia comes a loss in language skills, vocabulary, comprehension, and the ability to produce formal language. However, the brain retains the ability to say expletives, sexual talk, racial talk, and ugly words, It is hard for us to see this as the brain retains the ability to converse—you know, the back-and-forth of conversation. Dementia patients retain the rhythm and intensity of a conversation, but they cannot make out words. They hear sounds, but not the words.

Yourr mother-in-law is doing the best she can given her circumstances. You are a wonderful daughter-in-law because you reached out to find solutions instead of fighting with her.

can she talk? the yelling and screaming, from what I have experienced, comes from her frustration. put yourself in her shoes she only wants to be the way she was. she needs to find a new way, some can but some can't, to be the way she was. when you put yourself in her shoes think of ways you can help to help her to cope with that frustration. not much help but never stop trying.

Has her medications changed?

Have you tried talking to her as a child to let her know this is unacceptable?

When she does this, let her know just like a child that she has to ask nicely when she wants something done or it won't be done.

Leave the room when she acts like this and let her know you'll be back once she is ready to be polite and respectful just like she is treated.

Please watch some of Teepa Snow’s video’s. I’ve learned so much from her about dementia.
Also, please read “The 36 hour day”. Both have been invaluable dealing with my 99 year old Mom.
There is no magic bullet but tools to help us navigate.
Mom lives at home with 24/7 care..... I live down the hall from her and manage her care and life.

My heart goes out to you both.

Right off the bat - I would do two things. First I would talk to the medical people and see if something can be done and is going on. Second, at once, do NOT allow this to take place no matter who, why, what, when or where. It is outright abuse - dementia or not - and why should YOU HAVE TO SUFFER BECAUSE OF HER BEHAVIORS? I would set a boundary at once strong enough to stop her in her tracks. If you have to fight back and tell her off and try to stop her, do it. They don't understand and will continue but at least you are trying and setting a limit. Let her know this is NOT going to continue. I suspect she will not stop. So I think you know what to do, you have to remove her and place her into an appropriate facility. No one should ever have to put up with this and if they do, they are pure fools. There is no other option that I can see. Be tough. She is no longer the person she once was.

As others have said, it might be dementia and/or other physical ailments, and it might take several doctors to determine the cause(s) of these outbursts. After my mom got Alzheimer's, she could blow up at the drop of a hat over nothing. Like in your situation, she used to be quite calm and patient. I tried to exhibit those same qualities when she'd have a temper tantrum over nothing. I knew it woud pass eventually. Sometimes, the well-meaning advice of trying to re-direct her worked, but most of the time it didn't. It was a trial and error game, figuring out how to deal with her. Sometimes, her attitude just had to run its course.

You may want to consult with her primary. Something else may be going on with her. This is a very extreme personality change. Could very well be dementia.
No cure but several family members are living calmer days with some mild low dose medication both prescription and some OTC with doctor's approval of course.

It sounds like she may have dementia. People with dementia often revert to childlike behavior. Sadly, there is no cure. Usually there is mental decline, going through several stages. While she can still sign legal papers, make sure all of her paperwork is in order: Powers of Attorney for medical and legal matters, a living will with her medical directives, a will if she has assets, the POA should be on file with Social Security and Medicare as someone who can speak on her behalf (you can do this with a phone call with her sitting there to agree to this), and most financial institutions have their own POA forms. You may need an attorney if she has assets, and to help with the forms. There are also nonprofit organizations that can counsel seniors about these things. Can you or her medical POA speak with her doctor about her personality changes? If it goes along with agitation, perhaps there are some calming medications she can take. Some are natural with no side effects. All the best to her and the family!

All: Without appearing even more redundant than I may already seem to have been here, I wanted to thank everyone for your many stellar posts to my personal friend, Alphabase. Without a doubt, he appreciates it very much.

Does she have dementia, if so it is that talking not her as you knew her. If not has she had a neuro assessment at all? This change in behaviour has to have a cause, maybe one that can be medicated so she can stay in the home, maybe one that needs her to be in a facility used to caring for mentally challenged people but she is going to need an assessment, can you get her admitted to a psych ward for them to do that?

You say your MIL is regularly seeing a pulmonologist, and since it has emerged that there are heart issues too, yes?

First of all I suggest you find out more about her specific health conditions. You will find information on most serious chronic disease which explains what the person is going through, how it might affect them in day to day life, and how families and caregivers can best help.

In both heart and lung disease, it's important to understand quite how exhausted and frightened a person can feel especially if they are stressed or over-exerting themselves. Um, best I give you two examples.

Gentleman with advanced pulmonary fibrosis, serious shortness of breath, became depleted very rapidly on standing, mobilising, washing, dressing - any activity. What his wife, who looked after him beautifully, couldn't understand was that listening, hearing, answering, speaking, thinking also take up oxygen. When he gave her curt answers, or winced when she talked to him, she felt hurt and disrespected. But the man felt as if he was drowning, all the time. He literally didn't have anything to spare.

Lady we're currently supporting has advanced COPD and is on 24/7 oxygen. I like her a lot. I am the only one of my service who does. She is *incredibly* rude and impatient - or so you think, until you mentally add back in all the normal courtesies that she no longer has breath for. She barks instructions at you - do this! No! Not like that! Like this! Put that there! Give me that! - and if you get something wrong (i.e. don't do it exactly as she would) she snatches the task from your hands and virtually pushes you out of the way. But, no, she can't spare breath for please or thank you; she doesn't have the energy to wait; and because she thinks we're all bossy morons she won't sit tight by the fire and let us bring her her meal - she pushes her O2 canister into the kitchen and stands there keeping us under close supervision.

So. Key factor is probably that your MIL is feeling physically dreadful. When she needs something and shows signs of impatience (or you know there's going to be a delay, so you can anticipate she will), reassure her that the thing will be done, then courteously insist that she gets comfortable first and focuses on relaxation. If she has this sort of sense of humour, you can look her in the eye and say "yes, I'll get onto that right away, but Breathing Comes First. Soon as you're comfortable I'll fetch your drink/magazine/cat o'nine tails..."

Best of luck, May you never feel as bad as she perhaps does.

Tell her very calmly that you're happy to help her, but not when she's screaming at the top of her lungs. That you'll deal with her when she's calm and in a better mood, and to let you know when that might be, and you'll see if you're available.

There isn't always a medical explanation for bad behavior. Even with dementia at play, elders know how far they can and cannot push their loved ones. If MIL wants something badly enough and knows she must act civilized in order to get it, watch and see how long it takes her to clean up her act.

You're not her whipping boy nor should you be the target of her horrific outbursts. Nobody should. She's old and frustrated by her limitations, which is understandable, but to treat you in such a nasty manner is not.

If she has dementia, she is experiencing anxiety and frustration all the time. She is trying to manage a world that seems confusing and frightening by controlling everything and everybody. Please get her an appointment with a doctor:
1 - start with her primacy care doctor to rule out infections, blood chemistry imbalances, or anything that might lower her oxygenation to her brain;
2 - if that checks out OK, she may need to be seen by a neurologist for further evaluation of "brain causes" (strokes, decreased perfusion to brain, or new types of dementia....) and/or
3 - a geriatric psychiatrist to evaluate and treat behavior problems.

Going forward, your MIL will probably do better in a consistent environment that is simplified (less new things or stimuli to react to) and consistent routines. She will probably be prescribed anti-anxiety medications and maybe some other medications. Please realize it can take weeks for a psych medication to be effective and for your MIL to get used to sedating side effects.

If your MIL had a general anesthetic, it can have a real impact on the brain, bring on worse dementia, and make behaviour problems worse. I had quite a long eye operation under locals (with an anesthetist monitoring the locals, top-ups, etc etc) because the retina has a direct link to the brain and they avoid a general if at all possible. Is this a possibility for the sudden changes (as well as the UTI)?

Don't panic, and just hope that things settle down ASAP. Love, Margaret

So, to sum it all up regarding my MIL. She had one surgery which was hernia surgery, and with this, we were able to get in-home care for a while. Naturally, this was temporary. She recovered from this and was up and running. Then a little later down the road, she called us up complaining she could not breathe. So she was brought to the hospital once again and this time they addressed her issue by placing a stent in her. She sees a pulmonologist regularly for her breathing issues, but now it came out that the root cause was something with her heart, hence the stent placed into her. This is as accurate as I can get and I hope I brought everyone up to speed accurately. My MIL is used to driving around and doing errands and her own shopping and such, but after her first surgery, I was driving her and my FIL around everywhere. Perhaps she is also frustrated that she is dependent on us these days? That could be added to her frustration. We are concerned about her driving again because of her being short fuzed and her temper issues. I love her dearly and hope things can improve for her.

alphabase...what you mentioned in your response...
Your MIL is going through a lot right now.
After being in the hospital for surgery there can be a delay with recovering from anesthesia. And again more likely that she has a UTI
She is also Grieving now and that is a lot to take.
It may be Depression, Grief, recovery from the hospital stay as well as the surgery. I would discuss this with her doctor ASAP.

Hello dear Alphabase: Imho, I suggest that you have your MIL tested for a U.T.I. in the form of a complete urinalysis and not a simple dip stick test. Grandma54 and BarbBrooklyn have also mentioned a possible U.T.I. Please investigate possible changes in her life also.💜

Has she been diagnosed with anything specific?
Is this a very recent thing or has it been building up over time?
If it is very recent you might want to check for UTI. There are over the counter tests that can be purchased and might be good just to give you an idea what is going on. If it shows positive for an infection her doctor will want a more accurate results.
If she has been diagnosed with dementia this might be a progression of the dementia.
Some dementias do present with anger and or violence more than others. If this is the case an accurate diagnosis is important.
Since this is the time of year for Open Enrollment you might be more likely to get her to the doctor for an End of Year check up (or at least use that as an excuse if she is one to resist going to the doctor. ) *Make the excuse quick since open enrollment ends soon*
As far as the outburst goes..don't feed the beast. Do not argue. If you have to walk out of the room.
If she is fully capable of caring for herself encourage her to do correctly what others have done "incorrectly".

What sort of things are setting MIL off?

Does she want things done "Right Now!" ? My Mother does - it looks like she cannot trust her memory to hold the request for any longer than 'now'.

Tantrum behaviour may be due to verbal or social skills diminishing? Sorry to compare to a toddler, but when the child grows & can express themself better, the tantrums reduce. It can be a sort of reverse of that.

I would get her in to see a geriatric psychiatrist after having her first checked for a urinary tract infection. Those can cause behavioral symptoms in elders.