5 difficult elderly behaviours and how to manage them

As our loved ones age, they might display certain behaviours that would make caregiving more challenging. In this article, we share causes of difficult elderly behaviours and offer you tips on how to manage them.

Jump to the following:

• Causes of difficult elderly behaviours
• Common types of challenging behaviours

Causes of difficult elderly behaviours

To manage challenging behaviours exhibited by a loved one, it is crucial to first get to the root cause of the behaviour. Only after getting to the bottom of things may we understand the situation and find relevant solutions.

Medical conditions such as Alzheimer's or dementia can lead to confusion, fear, and anxiety, often manifesting as aggressive or disruptive behaviour. Changes in environment, routine, or even the caregiver can also trigger disoriented responses. Additionally, physical discomfort or pain, often due to chronic illnesses or lack of mobility, can lead to restlessness and irritability. Sometimes, the behaviour could be a side effect of medication or an indication of unmet needs such as hunger, thirst, or the need for social interaction. Understanding the root cause of these behaviours can help you manage them more effectively.

Common types of challenging behaviours

Challenging or disruptive behaviours can take many forms and there is no one-size-fits-all solution to address them. Learning to identify typical challenging behaviours will allow caregivers to provide better care for their loved ones and promote a safer environment for everyone!

The following are common types of challenging behaviours and accompanying approaches that you may use to tackle them.

1. Aggression

In seniors, aggressive behaviour can manifest in various ways and is often a response to frustration, discomfort, or fear even though biological factors like genetics and hormonal factors could result in them.

Behavioural alteration may be attributed to cognitive disorders like dementia or Alzheimer's. In such cases, your loved ones might struggle with confusion or difficulty communicating, leading to frustration that manifests as aggression. Physical discomfort due to illness, medication side effects, or simply the general discomforts of ageing can also be a trigger. Aggression could be a seniors' way of communicating their unmet needs when they lack other means to do so.

Furthermore, seniors might feel a loss of control over their lives as they become more dependent on others, which might result in aggressive behaviour as an attempt to regain this control. So it is critical for caregivers and health professionals to approach these behaviours with understanding, empathy, and effective intervention strategies that address the root cause rather than just the symptom.

How to manage:

One effective strategy is to remain calm and composed, even in the face of aggression. Responding with aggression can escalate the situation, whereas a calm demeanour can help to diffuse it. Reinforcing positive behaviour with praise or rewards can also be beneficial as it encourages repetition of these positive actions and behaviours.

It's also important to ensure that your loved one's basic needs are being met. Hunger, thirst, or discomfort can often lead to frustration and aggression. Regular reassessment of medication efficacy and side effects is also essential, as changes in medication or dosage can often trigger aggression.

Providing a structured, predictable environment can help to alleviate feelings of confusion or fear that can lead to aggression. This may include maintaining a consistent daily routine, providing clear communication and instructions, and ensuring the environment is safe and comforting.

2. Paranoia, delusions and hallucinations

If your loved one constantly feels like they’re being watched, or are convinced that someone is plotting something against them, they could be experiencing paranoia and delusions.

Paranoia, delusions, and even hallucinations are distressing experiences for seniors. These mental health concerns, often symptoms of conditions such as dementia or schizophrenia, can induce a deep sense of fear, confusion, and disorientation. Paranoia might manifest as irrational suspicions or mistrust, while delusions often involve false beliefs not rooted in reality. Hallucinations, on the other hand, involve perceiving things that are not there.

How to manage:

Patience and empathy are paramount; it's essential to recognise that these experiences are very real to the seniors experiencing them. So do not try to convince your loved ones that they are wrong or mistaken. Instead, maintaining a calm demeanour around them can help reduce their anxiety and agitation, which often exacerbate these symptoms. You can gently reassure your loved one without directly confronting or dismissing their experiences, as this can often lead to escalation.

Regular gentle exercise and maintaining a routine can also help by reducing stress and promoting better sleep. Engaging your loved one in reality-oriented activities, like reading the newspaper or discussing current events, can also be beneficial.

Professional help should be sought if your loved one experiences these. NTUC Health's Family Medicine Clinic has family physicians who can support you and your loved ones in this aspect.

3. Hoarding

Sometimes, due to memory loss, some seniors may believe something is stored somewhere but find out it is not. And if they experience such scenarios often enough, they may conclude that someone is hiding or stealing things from them. This may encourage the act of hoarding, whereby one may stockpile an excessive number of items that may not hold value.

Other times, hoarding could result from underlying mental health conditions like obsessive-compulsive disorder. It could also develop after trauma or grief. Personality may also bring about increased hoarding behaviour. For instance, if your loved one is sentimental and cannot bear to give away keepsakes, their personality may result in further collecting of “sentimental” items. They may also hold on to physical items more because they fear their memories will be lost.

How to manage:

You can try reasoning with your loved one and negotiating about which items to throw or give away. Remember to take things slow as pressuring them to discard many things at once may create extreme distress.

Usually, hoarders may be unable to distinguish what is valuable, so creating a memory box may better help them filter out special or meaningful things to keep. A memory box may also slightly ease their fear of memory loss and remind your loved ones of what they treasure.

If your loved one is becoming an extreme hoarder, you should consider reaching out to their doctor as they can recommend behavioural therapies that may be more effective in discouraging hoarding. Ideally, it would be good to take action to reduce hoarding before it leads to unsanitary living conditions that are bad for you and your loved one’s health.

4. Obsessive-Compulsive Behaviour

Obsessive-compulsive behaviour (OCB) in seniors can present unique challenges. Often, these behaviours can intensify as a result of conditions such as dementia or Parkinson's disease. Typical manifestations may include repeated checking, extreme orderliness, or an inability to discard useless items.

How to manage:

Try to manage the environment to reduce triggers for OCB. Organise the living space and keep it clutter-free to prevent obsessive cleaning or hoarding.

Guided relaxation techniques can alleviate anxiety often associated with OCB. Deep-breathing exercises or gentle yoga can induce a calming effect. Encourage regular physical activity, like walking or light stretching, to boost mood and reduce anxiety.

Open communication is essential. Talk to your loved one about their behaviours in a non-judgmental, empathetic manner. Encourage them to express their feelings and fears related to these behaviours.

Seeking professional support is crucial. A mental health professional can provide therapeutic strategies and, if necessary, medication to manage OCB effectively. Remember, it’s not about eliminating the behaviour entirely, but about helping your loved one manage it in a way that doesn’t interfere with their quality of life.

5. Repetitive behaviour

Repetitive behaviour and OCB, while similar, hold distinct characteristics, especially when observed in seniors. Repetitive behaviour in seniors, often seen in conditions like Alzheimer's or other forms of dementia, is characterised by certain actions or tasks being done over and over again. These can include repetitive speech, such as asking the same question repeatedly, or physical behaviours like pacing, hand wringing, or organising items. This behaviour often stems from anxiety, boredom, or the inability to process new information and can be a sign of cognitive decline. OCB, on the other hand, is characterised by irrational, persistent thoughts (obsessions) that create anxiety, leading to compulsive behaviours performed to alleviate the distress. While repetitive behaviour may be due to decreased cognitive function or simply habit, OCB is more rooted in anxiety and is often accompanied by feelings of distress if the behaviours or rituals cannot be carried out.

Repetitive behaviour in seniors can be difficult to manage and can also lead to frustration for both the individual and their caregivers. However, it is important to understand that this behaviour is a symptom of an underlying condition and not intentional.

How to manage:

Identifying triggers and trying to eliminate or reduce them can help. This could mean finding ways to decrease anxiety, providing activities to combat boredom, or simplifying tasks and routines for easier processing.

It is also important to communicate with your loved ones and validate their feelings, even if they are repeating themselves. This can help reduce frustration and provide a sense of comfort for the individual.

In some cases, medication may be prescribed to help manage repetitive behaviour in seniors. However, this should always be discussed with a healthcare professional and used as a last resort.

Caregivers of seniors with repetitive behaviour may also benefit from support groups or counselling to help cope with the challenges and stress that come with caring for an individual with cognitive decline. Overall, patience, understanding, and proper communication are key in managing and supporting seniors with repetitive behaviour.