Understanding And Managing Aggressive And Irritable Behaviour: A Guide To Dealing With Difficult Elderly Relatives

In our practice, we frequently encounter narratives of mental, emotional, and sometimes physical abuse directed towards adult children—a distressingly common occurrence. Unless the elder is grappling with a personality disorder or mental illness, they often direct their frustrations towards the one adult child showing the most love, as they feel a sense of safety in doing so. It’s essential to recognize that this behavior isn’t a conscious act of abuse towards their son or daughter; rather, it stems from the elder’s frustration with aging, chronic pain, loss of a spouse and friends, memory issues, incontinence, and other challenges. On one particular day, we attentively listened to Paula as she shared her thoughts, providing a patient and uninterrupted space for her to express herself. Here’s what Paula has to say.

“Having a mother who never worked means she has no understanding of the busyness of life. While I assist in caring for my demanding and self-absorbed mother, thankfully, I have the respite of traveling to Mumbai for three days each month. My brothers managed to escape to the US, fortunate in avoiding the burden. They feign indifference, unwilling to be ensnared in the vortex of her manipulations.”

“Contrary to popular belief, not all parents are a source of joy and care. My mother, a needy and critical figure, has become increasingly dependent over the past two years. She incessantly demands attention, making it impossible for maids to endure her neediness for more than two months. I, unfortunately, bear the brunt of her melodramatic and attention-seeking behavior, reminiscent of a theatrical performance.”

“Let’s be real—being a parent does not grant tyrannical authority. I’m upset, I’m sad. My entire adult life has been devoted to her care, leaving me without the freedom to live my own life. I feel imprisoned, and I mourn for the years I’ll never get back. I pity my late father, who endured her apparent tyranny, fueled by her aristocratic family and inherited wealth.”

“Acknowledging the diversity among mothers and fathers, I realize my unlucky destiny involves caring for my difficult mother. Let’s not elevate them to ‘Gods’ we should joyfully care for. I wouldn’t expose my boys to the level of needy manipulation that some elderly parents impose on their children. Gosh! Paula vents her frustration on her 84-year-old mother.

Caring for an elderly person in your home poses significant challenges, especially if your relationship has been strained. When siblings aren’t cooperative, the situation can persist for months or even years. Managing this alongside a family and a full-time job can be utterly exhausting. Paula’s mother, ever-doting, adds a toxic layer to the complexity. Providing care for an elderly relative leaves you with no breaks—from morning till night and even during sleepless nights, you’re at their beck and call. Dealing with their unreasonable behaviour can be immensely challenging, akin to handling a toddler but five times the size. That’s why Paula, seeking respite, opted to travel to Mumbai for three days on official duty, arranging for a caregiver through an agency during that time.

Listen to Shahida Shahjahan’s story and her advice. The only difference in her case is that it was with her in-laws. “Just because they’re your in-laws doesn’t mean you have to love them unconditionally, especially if the relationship has been bad. Not all in-laws are ideal; they can be mean, narcissistic, and sadistic. If you choose to take on the responsibility of caring for them when they need you, you’re a true hero. You need support, not judgment, to carry on without breaking down.

“Many people, from my experience, care for their parents or in-laws out of a sense of duty. They grapple daily with exhaustion, depression, and demoralisation. Like me, they contend daily with guilt over their feelings—remember, feelings don’t make you a good or bad person; they make you more human. If you feel angry or sad, you feel angry or sad—why hide it? What I see here is people who have bottled up these feelings for so long finally being able to talk to someone who is not judgmental. Have some empathy; the saying that you ‘can’t understand somebody until you have walked a mile in their shoes’ is very true.”

“If you find it challenging to handle the pressure of irritable and demanding behaviour from such individuals, it’s better to distance yourself. That’s precisely what I chose to do. After a few months of attempting to cope with my in-laws, I reached the conclusion that enough is enough—I could no longer tolerate the torture. I asked my husband not to involve me in their affairs, recognising the futility of continuing as their primary caregiver when neither they nor I were happy. Fortunately, my husband understood the implications and appointed a professional caregiver. The positive outcome is that there are no more tantrums with the caregiver, as she is strict and no-nonsense.”

Padmaja aunty expressed her displeasure with her son Sateesh after a lengthy visit to the ophthalmologist. Known for her naturally cranky demeanour, she tends to get upset over even trivial matters. Maheshappa uncle, dissatisfied with how his son Manjunath planted saplings, resorted to cussing and accusing his son of shoddy farm work. Insisting on things happening precisely as he envisions, he uses foul language in his expressions of dissatisfaction. Daphne’s obsession with updating her bank passbook led her to frequent visits to the bank, much to the dismay of her daughter Anita. Despite Anita’s attempts to introduce modern banking methods, Daphne remains annoyed and persistently asks about updating the passbook during their meetings at the care home. The question arises: Why do elders often display stubbornness and complain, even when there are people working hard to help simplify their lives?

You used to mention that my father/mother wasn’t like this. When a typically gentle and loving parent begins using profanities, foul language, or making inappropriate remarks, family members are left bewildered, wondering why and how to address it. Such behavior disrupts the otherwise tranquil family atmosphere. Stories circulate about parents who were once mild-mannered and proper, now suddenly cursing at their son or daughter-in-law, or resorting to insulting names. It’s embarrassing in public, hurtful in private, and if frequent, it can lead to resentment.

If your once sweet and timid mother has become implacable, or your previously cheerful and supportive husband has turned adamant and angry in old age, it’s a significant red flag. You may be questioning why this change in behaviour is occurring. While some individuals have a longstanding tendency to be negative and complain, which you might need to tolerate or overlook, new personality changes warrant closer scrutiny. One key question to ask is whether this behaviour is a recent development. Fortunately, addressing new personality changes is often more manageable, and many issues can be resolved.

The case diary of authors practicing as social gerontologists is filled with instances of challenging elderly parents exhibiting demanding behaviour, personality shifts in later years, hallucinations, temper tantrums, and even instances of abuse. It becomes apparent that it’s not just one behaviour that changes but several. This prompts us to explore these challenging behaviours in the elderly, identify potential causes, and discuss effective management strategies. We’ve compiled a list of difficult behaviours often exhibited by elderly parents, accompanied by some helpful tips. Firstly, let’s delve into the causes behind these irrational behaviours. Behavioural changes in the elderly are typically connected to shifts in situations or circumstances. Here are some potential explanations.

One potential cause is a urinary tract infection (UTI), which can noticeably affect a senior’s behaviour. While typical UTI symptoms include pain and urgency to urinate, older individuals may display atypical signs like irritability, anger, and confusion. Additionally, elders, often managing various chronic conditions, may experience personality changes due to medications with significant side effects. Psychiatric drugs and other medications, such as anti-seizure drugs, statins, blood pressure medications, and anti-inflammatories, can contribute to alterations in mood and behaviour.

The complaints of pain from elders often overlooked, yet the impact on their quality of life and functionality is significant. Beyond the physical effects, pain can lead to mental and emotional distress. Chronic pain patients commonly report elevated negative mood states, including anger-hostility, depression-dejection, fatigue-inertia, and tension-anxiety.

Boredom is often cited as the source of irritation, particularly in the post-retirement phase when individuals find themselves homebound without a defined purpose. The negativity they experience is compounded by factors like limited mobility, reduced energy, and other age-related changes affecting independence and daily routines. With fewer distractions, many seniors may focus on the downsides of their lives or actively seek things to complain about, turning the act of complaining into a new “pastime” as they adjust to a slower pace of life.

Changes in personality can signal the onset of dementia, and cognitive issues might go unnoticed by those close if the individual is adept at compensating for their impairment. Even if forgetfulness isn’t immediately evident, increased irritability and frustration can manifest due to struggles with basic tasks and memory lapses. Alzheimer’s disease, fronto-temporal dementia, and other forms of dementia are often linked to notable shifts in personality.

Having explored potential causes of challenging behaviours, let’s now delve into specific types of behaviours and strategies for managing them.

1. Aggressive Behavior

An illustrative case is Balasubramoniam, who exhibits early signs of dementia, leaving his wife to bear the brunt of his aggression as other caregivers have departed. His behavior has escalated to physically striking those attempting to assist him. For families and caregivers, the transformation of a loved one into a verbally aggressive individual, hurling insults or curses, often comes as a startling and distressing revelation. Engaging in profanities, offensive language, or expressing inappropriate remarks are among the aggressive behaviors that the elderly may unexpectedly display.

2. Hostility and Anger

Old age and diseases can cause certain personality traits to become distinct in unpleasant ways. If an elderly person by nature irritable prior to their condition, they may get angry more frequently, or become impossible to calm down and appease. Sometimes, the elderly may become upset if external help is offered, and they may lash out in anger at the mention of external help. This is why, Balasubramaniam never allowed carers to attend to him.

3. Attention-seeking Behaviour

When a family member, like Saroja caring for her husband Balasubramaniam, becomes the primary caregiver, the care recipient may demand excessive attention and time. While the bond developed over the years is understandable, this expectation becomes unreasonable, particularly when caregivers have their own lives and commitments. Elders who are still independent but lean heavily on a family caregiver for all their physical and emotional needs can cause frustration for the caregiver, feeling constantly at the care recipient’s beck and call.

4. Paranoia, Suspicions, or Delusions

Paranoia and hallucinations in the elderly can manifest in peculiar ways, such as accusing family members of theft or imagining unseen individuals. Kaveriamma, for example, believes there are intruders in the dark room who intend to steal her ornaments, leading to a refusal to turn off the lights. Elders may make false accusations of theft or abuse due to mental health issues, resulting in paranoia and hallucinations. This can be challenging for caregivers, as seen with Radha aunty, who perceives ants crawling through her body, presenting difficulties in providing reassurance.

5. Refusing to Bathe

Elderly caregivers commonly face challenges with seniors adamantly refusing to bathe. Pavithran uncle, for instance, was fixated on using the commode and avoided showering altogether. Reasons for this rejection of personal hygiene range from fear of falling to feelings of isolation and depression. Convincing seniors to bathe can be stressful, with factors like reduced social interactions or limited mobility leading individuals like 92-year-old George uncle to question the necessity of daily showers, especially when social activities are limited.

6. Obsessive-Compulsive Behaviours

Thangam aunty, at 76 years old, demonstrates obsessive-compulsive behaviours, particularly in her daily ritual of folding the same towel for 24 hours. Her case is identified as OCD, and such obsessions and compulsions can be linked to an addictive personality or a history of obsessive-compulsive disorder. Elderly individuals with these tendencies may exhibit behaviours like incessantly picking at their skin, hoarding excessive tissue packets, or persistent concerns about medication schedules. These behaviours can significantly disrupt the daily lives of seniors and pose challenges for their caregivers. Obsessive behaviour may also be associated with various other disorders, including anxiety, depression, or dementia.

7. Hoarding Behaviour

Padma aunty’s house emitted a foul odour, prompting neighbours to contact her son, residing three hours away in Mysore. Upon inspection, they discovered a two-week supply of milk packets, groceries, and some items damaged by rats under her bed. Padma aunty’s age-related sensory “blunting” prevented her from realising when the milk and groceries had gone bad. Hoarding is not merely excessive collecting or untidiness; it is recognised as a mental illness under hoarding disorder. A common challenge arises when adult children attempt to persuade their parents, like Padma aunty, to declutter and stop accumulating items. Rooted in conditions ranging from obsessive-compulsive disorder and depression to memory loss and mental confusion, hoarding behaviour in parents can have various underlying causes.

8. Financial Mismanagement (Overspending or Frugality)

Some elders exhibit frugality, while others tend toward overspending, leading to potential financial challenges. Overspending may result in heavy debts from activities like gambling, excessive shopping, or falling victim to scams. On the opposite end, some may resist spending on essential needs such as medication, food, or long-term care. Both extremes are harmful. Despite forgetfulness, elders often insist on managing their finances independently, making it challenging for adult children to track their financial situation. Whether dealing with frugality or overspending, adult children must intervene at the appropriate time.

Dealing with irrational behaviour in elderly parents is a complex task that requires strategic handling. Understanding the root cause of such behaviour is crucial, requiring close attention to discern the underlying frustration or fear triggering it. To address and change this behaviour, one must identify the source, which could be unrelated to the apparent expressions of anger or negativity. By understanding and addressing the true cause, there is a potential for improvement.

Treating elderly parents in a ‘child-like’ manner can be demeaning, regardless of their dependence, infirmity, or memory issues. Despite their vulnerabilities, elders possess a wealth of life experiences, and it’s crucial to recognise them as adults. This approach is essential to avoid causing distress or insult to your parents, preserving a respectful relationship that acknowledges their autonomy and dignity.

Elders often resist change due to their aversion to it. For instance, if you’re considering hiring help for your elderly mother during the day, her initial reaction might be, ‘I can manage, I don’t need anyone.’ To navigate this resistance, express your concern differently, emphasising your worry for her well-being and the anxiety it causes you to imagine something happening while you’re at work. By framing it as a favour to you, your mother may be more open to the idea without focusing on why it would benefit her.

Dealing with irrational behaviour in your caregiving journey can lead to conflicts with your parent. To maintain a positive environment for both parties, it’s crucial to decide when, where, and how you involve yourself in their care. This approach helps you stay calm and focused, enabling you to choose your battles wisely and determine when to let certain issues go.

The words and actions of elderly parents can be hurtful, but it’s essential to let them roll off. Frustrations can build up, leading to bursts of negativity. Recognise that they may not remember what they said yesterday. Refrain from giving undue importance to such words, considering them expressions of frustration. Don’t give credence to such words and as we said it’s mere frustration and whenever possible, try to communicate that you care and are here for them. Giving this reassurance may go a long way in keeping a stable relationship.

There are moments when it feels like you’re on the verge of breaking down while dealing with nonsensical and illogical elderly parents. In such instances, the sensible approach is to take a step back. If you find yourself struggling, seeking help is crucial. This assistance can take various forms, such as hiring outside help for your parents or asking other family members to contribute. After stepping back, prioritise self-care and respite. Don’t let guilt, anxiety, and resentment overwhelm your life. It’s essential to find outlets to express your feelings and decompress. Some, like Malathi, even turn to therapy for a healthy release. Caring for elderly parents, especially in the face of irrational and querulous behaviour, can be a challenging journey. These tips aim to help you manage the situation and maintain strong bonds with your loved ones during the caregiving process.