Understanding and Coping with Behavioral Changes in Elders

One unchangeable fact of life is that people never stop changing, no matter how old they get. Aging brings a cascade of physical and emotional changes, which can lead to a variety of behavioral changes that can baffle or worry an older adult’s loved ones.
As America’s population increasingly grays – the proportion of those 65 and over will account for 20% of U.S. residents within 25 years, according to the American Psychological Association – being aware of normal changes associated with age is even more paramount.
But what behavioral changes are typical and what aren’t? Sometimes it’s difficult to tell the difference. Educating yourself enables you to help your parents, or other loved ones to be more happy and healthy as they age. While it can be challenging to care for a loved one whose behavior has changed from what you’re used to, patience – along with appropriate medical care and attention – often reaps rewards.
What’s normal, what’s not, and how to respond
Following are top examples of behavioral changes common in older adults and also elaborates on what might signal a problem and how to react:
#1: Memory lapses or forgetfulness
What’s normal/not: Forgetting where you put your keys or the name of a movie star is common when you get older. So is occasionally having trouble finding the right word or forgetting why you walked into a room. But the specter of dementia is huge, with about 10% of all those over 65 and up to half of those 85 and older developing dementia. Symptoms might include varying degrees of memory loss, language difficulty, poor judgment, problems concentrating and impaired visual perception. Loss that affects daily functioning should be evaluated right away.
It’s wise for seniors and their families to be alert to warning signs, but there’s no need to be unnerved by every memory lapse. The warning signs of dementia typically include not just problems remembering, but problems communicating and reasoning.
What to do: If more signs of dementia become apparent, or there is concern that changes could affect one’s ability to handle finances; it’s important to see a primary care physician or geriatrician to rule out other causes that might be easily treatable. Diagnostic tools typically start with a complete physical and neurological exam, brain imaging, and cognitive assessment. The MOCA or the Montreal Cognitive Assessment tool is more sensitive to early changes in reasoning than the MMSE or Mini Mental Status Exam. However, that may not be sensitive enough. A normal screen may not mean “no decline in cognitive function” and neuropsychological testing may be needed for concerns with changes of judgement that put elders at risk of financial elder abuse.
#2: Low mood after experiencing loss
What’s normal/not: It’s often said that aging is largely about loss, as seniors often experience the deaths of a spouse, friends, siblings or other contemporaries. It’s understandable to suffer low periods following these losses. But watch out for depression and anxiety, which are often overlooked and untreated in older Americans because they can coincide with other late-life problems, according to the American Psychological Association. Up to 20% of older adults in the U.S. have experienced depression, a persistent feeling of sadness that can include changes in sleep, appetite, energy level and other areas. Mood changes, apathy or anger may also signal early dementia.
What to do: If you’re concerned, get your loved one evaluated by their physician. Many psychological interventions, including counseling and medication, are highly effective at treating depression. It’s important not to let someone’s low mood continue indefinitely without intervening. If you suspect there’s a problem, you’re often right. Medications may not be the answer. First, is to include elders in daily activity; bring them to church or other religious services, keep them active and engaged. Avoid sleeping pills and “anti-anxiety pills such as Xanax and Ativan which can lead to more depression, falls and disinhibition. Withdrawal can look like worsening dementia, with confusion, agitation.
#3: Discouragement or anger as health declines
What’s normal/not: Retirement and moving out of the family home are major life events that don’t just signal increasing freedom – they often stem from declining health, as minor, chronic conditions add up or major health problems get even worse. For some older adults, the development of a disabling illness can bring about a depressive episode, according to the National Alliance on Mental Illness (NAMI). Also, anger or aggression – which can show up as emotional or verbal abuse lashed out at loved ones – can be particularly difficult to handle.
What to do: Talk about the normal feelings a senior might be having in response to their declining health – don’t sweep them under the rug. Say, ‘It must be painful for you to have to adjust to this.’ Empathy goes a long way. Consider seeing a doctor with the senior to evaluate troubling behavioral symptoms and consider a day program, or a daytime caregiver to give both the senior and their caregiver a break from the normal dynamic.
#4: Takes longer to learn new things
What’s normal/not: On top of a normal decline in short-term memory in older adults, it’s also common to see a lengthening of “response time” – meaning they learn more slowly and retain new information less effectively. Many seniors who “age well” make a conscious effort to maintain mental alertness by reading widely, learning new skills, taking classes and/or maintaining social contacts with people from a variety of age groups. It is very important to have your loved one in the environment where they can succeed. It is also important to be honest about what they can do now, not what they had done in the past. That said, don’t sell the elder short and not give them the opportunity to stretch and grow; be observant and flexible.
What to do: If your loved one consistently seems unable to retain new information or place it in context with what they already knew, it could be normal aging or it could be a sign of oncoming dementia. A primary care physician may understand or a geriatrician can evaluate them with special tests of mental performance and suggest ways to increase alertness and cognitive engagement.
Elizabeth Landsverk, MD, Geriatrician