Aggression in Seniors

It can be painful to witness an older parent or partner becoming angry, short-tempered, or aggressive. It can also feel deeply personal or even scary. 

Sudden aggression in older adults is almost always a symptom of something else—it’s not a character flaw, a choice, or even your loved one showing their “true colors.” 

Aggression is often a sign of stress, pain, fear, or a medical issue. This article explains the most common causes, what warning signs to take seriously, and how you can help a senior loved one through an outburst—while still taking care of yourself. 

Key takeaways

• Aggression in older adults usually has an underlying cause such as dementia, pain, or an infection.
• Sudden or severe changes in behavior need prompt medical attention.
• Caregivers can reduce outbursts by focusing on safety, de-escalation, and getting help for the root cause.

Common causes of aggression in older adults

There’s usually a reason that your parent is lashing out with aggressive behaviors. Understanding this can hopefully help you realize it’s not you—and there are solutions to help. The following are some of the common causes of aggression in older adults:

Infection

A urinary tract infection (UTI) is a common cause of agitation and aggression in older adults. UTIs can trigger delirium, or sudden confusion, and aggression is a frequent symptom. In fact, nearly half of the people who develop delirium have an underlying infection.

One of the symptoms of delirium, or sudden confusion, is aggression. Almost 50% of older adults who develop delirium have an infection. 

Pain

Another physical cause of aggression is untreated pain. More than half of older adults have chronic pain, and if your parent also has cognitive impairment like dementia, it can be difficult for them to tell you what’s wrong. Seniors with arthritis or dental issues may not be able to voice that they’re in pain and might lash out physically as a reflex to being touched.

Medication side effects

Older adults absorb and process medications differently from younger adults, and this can cause side effects that wouldn’t necessarily appear in younger adults. Since many older adults take multiple medications, there can be medication interactions that can cause delirium. 

Some medications can cause delirium and lead to aggression in seniors, including sedatives, antiseizure medications, and steroids. Even some allergy medications like Benadryl can cause confusion and aggression in older adults.

Review all the medications your loved one is currently taking with their healthcare provider or a pharmacist. They can help identify if medications are interacting with each other or causing symptoms. 

Cognitive impairment

One way that people with dementia express pain, fear, or even boredom is with aggressive outbursts and behaviors. Research shows 96% of older adults with dementia have some sort of aggressive behavior at least once. 

A 2019 study of people with Alzheimer's—the most common form of dementia—found that those with Alzheimer's are five times more likely to be aggressive than those without the condition. 

Sundowning, a symptom of dementia or Alzheimer’s, can also cause a fight-or-flight response with anxiety and agitation. It happens in the late afternoon and into the night, and may stem from overstimulation (too much noise or too many people). 

Hearing or vision loss

Hearing loss, poor vision, or both can make seniors feel threatened or paranoid and can lead to defensive agitation. For example, and older adult who’s hard of hearing or might think that the whispers from those around them are actually insults, while an older adult with poor vision may experience confusion or even hallucination from shadows cast by low lights in the evening. 

Loss of control

The transition from being a provider to a dependent can show up as anger in old age. Fighting with their caretaker over small things, like what to wear, can often actually be a fight for autonomy.

Changes in routine or environment

Some older adults, especially if they have dementia, can become confused and stressed when there’s a change in their normal routine or environment. 

For example, if your parent is admitted to the hospital, there can be an increase in noise and activity, which can be distressing and frightening. It can lead to aggressive behaviors out of fear. This can be worse if there’s hearing loss or vision concerns as well. 

When anger becomes a safety concern

There are some situations when anger and agitation require attention from a healthcare provider or even emergency care. Here’s how know when anger needs to be addressed right away:

Sudden vs gradual anger

A gradual increase in irritability and anger might reflect stress or cognitive decline in your parent. This can be distressing to you as a caregiver, and it’s important to inform the healthcare provider of any increased changes in behavior as dementia or cognitive decline progresses.  

But if aggression comes on suddenly, this usually points to a new medical condition or emergency such as infection, a medication reaction, or even a stroke. You should get help right away.

Verbal vs physical aggression

Verbal and physical aggression require different responses. Verbal symptoms like snapping, insults, and yelling can be addressed with gentle support and a doctor’s evaluation to rule out a physical cause like a UTI or even stress. But physical outbursts of aggression like hitting, biting, throwing objects, or threatening harm raise concerns for immediate safety. 

Some red flags that warrant a trip to the ER or immediate call to a doctor include:

• Hallucinations or severe paranoia
• New confusion or disorientation
• Self-harm or threats of harm

Coping tips for aggressive outbursts

It can be difficult to deal with a parent or spouse who is displaying aggressive behaviors. Remember, aggression among the elderly is almost always due to a specific reason. Here are some tips on how to cope with aggressive outbursts:

• Safety first: Most importantly, if you feel your safety is threatened or you’re at risk of being hurt, remove yourself from harm’s way. You can’t help if you’re injured yourself. If they aren’t able to calm down, get help from someone else, or call emergency services. Let emergency responders know if the senior has dementia. 
• Identify the cause: Is the room too loud? Is your parent too hot or cold? Are they thirsty? Consider what might be going on to trigger an angry reaction. 
• Decrease stimulation: Keep the noise level low and dim bright lights. Don’t crowd your parent or ask them to sit down. Ask extra people to step out. If you find yourself feeling worked up, take some deep breaths and speak calmly and slowly.  
• Acknowledge feelings and redirect: Let your parent know you hear them, and validate how they’re feeling. Avoid arguing or reasoning during an outburst. Then try distracting them with music, going for a walk, or offering a snack. 
• Use helpful phrases: Use short, simple sentences. This can include “You’re safe,” “I’m here to help,” or “Let’s take a break.”

Finding mental health support for aggression in seniors

Some mental health conditions, like depression and anxiety, can cause aggression. Cognitive behavioral therapy (CBT) can help older adults manage anxiety and depression symptoms, including aggression. Therapy can also help seniors process difficult emotions from a loss of independence or profound grief, reducing the emotional pressure-cooker that can lead to outbursts. 

Medicare covers mental health services, including therapy, making it feasible for seniors to get the counseling they need without financial hardship. In fact, most of our Medicare patients have a $0 copay. And therapy over the phone or virtually can make it easier for older adults who have limited mobility or access to transportation.  

Caregiving is emotionally taxing. Being yelled at or hit by a parent is traumatic. Therapy isn’t just helpful for a senior in your care, but also for you as the caregiver for your own emotional regulation and safety. Some adult children are seniors themselves and may qualify for Medicare-covered therapy. Get started today by scheduling a complimentary call with our director of care to answer your questions and match you with an experienced therapist who understands what you’re going through, and how to help. 

Senior anger and aggression FAQ

The questions below address common concerns about anger and aggression in older adults.

Why is my elderly husband so angry all the time? 

Some common reasons for anger and aggression in older adults can include pain, infection, medication effects, or cognitive changes like dementia. 

Can dehydration cause aggression in seniors? 

Yes, dehydration could cause your senior to become aggressive. According to the Cleveland Clinic, dehydration can cause confusion and anxiety, and these symptoms can be worse in those with dementia. 

How can I tell if it’s a bad day or a real problem?

Look for sudden changes from your parent’s usual baseline behavior. Everyone can have an off-day, but a sudden, angry escalation that’s out of character might signal a problem such as a medication reaction, infection, or stroke.

Can angry outbursts be caused by a mental health condition?

Yes, angry outbursts can be caused by mental health conditions like depression and anxiety, particularly if that person has dementia. 

References

1. Mayo Clinic. (2022). Delirium. https://www.mayoclinic.org/diseases-conditions/delirium/symptoms-causes/syc-20371386
2. Dutta, C., Pasha, K., Paul, S., Abbas, M. S., Nassar, S. T., Tasha, T., Desai, A., Bajgain, A., Ali, A., & Mohammed, L. (2022). Urinary Tract Infection Induced Delirium in Elderly Patients: A Systematic Review. Cureus, 14(12), e32321. https://doi.org/10.7759/cureus.32321. https://pmc.ncbi.nlm.nih.gov/articles/PMC9827929/
3. University of Florida Health. (2023). 7 Reasons Older Adults Are at Risk for Drug-Related Problems. https://online.aging.ufl.edu/2023/11/20/7-reasons-older-adults-are-at-risk-for-drug-related-problems/
4. Weidmann, A.E., Proppé, G.B., Matthíasdóttir, R. et al. (2025). Medication-induced causes of delirium in patients with and without dementia: a systematic review of published neurology guidelines. Int J Clin Pharm 47, 606–623. https://doi.org/10.1007/s11096-024-01861-4. https://link.springer.com/article/10.1007/s11096-024-01861-4
5. Tinnirello, A., Mazzoleni, S., & Santi, C. (2021). Chronic Pain in the Elderly: Mechanisms and Distinctive Features. Biomolecules, 11(8), 1256. https://doi.org/10.3390/biom11081256. https://pmc.ncbi.nlm.nih.gov/articles/PMC8391112/ 
6. Mayo Clinic. (2024). Medicine use in older adults. https://www.mayoclinic.org/healthy-lifestyle/healthy-aging/in-depth/medications-older-adults/art-20572714
7. Kennedy, M., Koehl, J., Shenvi, C. L., Greenberg, A., Zurek, O., LaMantia, M., & Lo, A. X. (2020). The agitated older adult in the emergency department: A narrative review of common causes and management strategies. Journal of the American College of Emergency Physicians Open, 1(5), 812. https://doi.org/10.1002/emp2.12110. https://pmc.ncbi.nlm.nih.gov/articles/PMC7593470/
8. Jackson, J. L., & Mallory, R. (2009). Aggression and Violence Among Elderly Patients, a Growing Health Problem. Journal of General Internal Medicine, 24(10), 1167. https://doi.org/10.1007/s11606-009-1099-1. https://pmc.ncbi.nlm.nih.gov/articles/PMC2745572/
9. Yu, R., Topiwala, A., Jacoby, R., & Fazel, S. (2019). Aggressive Behaviors in Alzheimer Disease and Mild Cognitive Impairment: Systematic Review and Meta-Analysis. The American Journal of Geriatric Psychiatry, 27(3), 290. https://doi.org/10.1016/j.jagp.2018.10.008. https://pmc.ncbi.nlm.nih.gov/articles/PMC6399100/
10. Alzheimer's Association. (n.d.). Sleep Issues and Sundowning. https://www.alz.org/help-support/caregiving/stages-behaviors/sleep-issues-sundowning
11. Liu, J., Lewis, G., & Evans, L. (2012). Understanding Aggressive Behavior Across the Life Span. Journal of Psychiatric and Mental Health Nursing, 20(2), 156. https://doi.org/10.1111/j.1365-2850.2012.01902.x. https://pmc.ncbi.nlm.nih.gov/articles/PMC3411865/
12. Choi-Kwon, S., & Kim, J. S. (2022). Anger, a Result and Cause of Stroke: A Narrative Review. Journal of Stroke, 24(3), 311. https://doi.org/10.5853/jos.2022.02516. https://pmc.ncbi.nlm.nih.gov/articles/PMC9561222/
13. Thériault, É. R., & Grant, A. (2020). Depression and Aggressive Behaviour in Continuing Care: How Cognitive Impairment Might Not Explain the Whole Story. Journal of Long-term Care, 0(2020), 1–12. Doi: 10.31389/jltc.15. https://journal.ilpnetwork.org/articles/10.31389/jltc.15
14. Alzheimer's Association. (n.d.). Anxiety and Agitation. https://www.alz.org/help-support/caregiving/stages-behaviors/anxiety-agitation
15. Chan, P., Bhar, S., Davison, T. E., Doyle, C., Knight, B. G., Koder, D., Laidlaw, K., Pachana, N. A., Wells, Y., & Wuthrich, V. M. (2018). Characteristics of Cognitive Behavioral Therapy for Older Adults Living in Residential Care: Protocol for a Systematic Review. JMIR Research Protocols, 7(7), e164. https://doi.org/10.2196/resprot.9902. https://pmc.ncbi.nlm.nih.gov/articles/PMC6053602/
16. Cleveland Clinic. (2023). Drink Up: The Connection Between Age and Dehydration. https://health.clevelandclinic.org/drink-up-dehydration-is-an-often-overlooked-health-risk-for-seniors