Caring for angry elders: what makes them that way, and what you can do about it

Nursing Homes, Nov-Dec, 1998 by Norma McKinnon

For all human beings, anger can be an ordinary reaction to life situations or indicative of emotional illness. It is particularly important for those working with older individuals to understand and competently manage their patients'/residents' anger. If not, resident care and the facility's reputation for quality service can be diminished.

Anger can be healthy, and this should be recognized. For some elders, anger correlates with good mental health. The "anger juices" keep the older person alive. Validation of such anger by the caregiver is a must. To do this, the caregiver can make comments such as "You seem frustrated" or "You're feeling angry today, aren't you?"

Comments such as "She's just looking for attention" are generally unfounded. Maybe the elder is justified in her or his behavior. The caregiver must always ask him- or herself why this behavior is occurring. Then that caregiver can move on to discovering how the anger can be managed in a constructive fashion. The rechanneling of anger can be promoted through the use of physical activity, resident councils, recreation activities and other socially acceptable means.

Elders should not be made to sit and absorb pain. They cannot run away like younger people, nor can they engage in strenuous physical activity; thus the tension builds. Sometimes the caregiver must work with the system to make the environment more adaptable to the elder's anger, rather than trying to force the elder to adapt to the environment. If the elder's anger is not dealt with effectively, the anger may turn inward, transforming into depression and, in the worst cases, suicide.

Depression is regarded as an alternative to anger - anger turned inward. Depression presents particularly difficult problems in the elderly population. When people were clinically depressed during the 1930s, there were no mental health centers available, only mental hospitals. This meant that people "went to bed" or were nurtured by their family when they were mentally ill. Consequently, elders will often say they have never been depressed because they have never been clinically treated. It is suggested that if you are trying to discover a history of depression in the elderly, they be asked if they have ever felt depressed or, put another way, had to "take time out from life."

Another significant consideration in dealing with geriatric depression results from the stereotyping that has traditionally surrounded the mentally ill. Even in today's society, the image of the mentally ill is subject to considerable skepticism by many elderly (and others).

Nevertheless, in dealing with angry elders, it can help to evaluate, to the extent possible, the quality of the older person's past relationships with parents, siblings, children and friends. If the elder is in a long-term care facility, are family pictures on the wall? Does the elder prize them? Relevant questions include the following: What was the elder's birth order? Did the elder lose a parent or a sibling? Was he or she victimized or abused by siblings? What was the quality of her or his parenting? How did the elder handle conflict and life stressors?

It is also important to consider the elder's work history. How important was work to him or her? Did the elder's work revolve around a family that has now dissolved? Was there an "empty-nest syndrome," and what impact did this have on the marriage partners?

Complete assessment of an emotional disorder also includes a sexual history. Very often, reluctance to discuss sexual history is generally the caregiver's problem rather than the elder's. After establishing rapport with the elder, try asking him or her about the closeness of the relationship with his or her spouse, and whether or not this might be figuring into a sense of loss and depression.

The last aspect of the resident history to be addressed involves how the elder views her or his life. Does the elder perceive herself or himself to have been the family scapegoat? The hero? Does the elder feel guilty about anything she or he did or did not do when younger? It may be that the elder's anger is characteristic - a part of the suit of clothing the person has worn since childhood. Another possibility is that the elder's anger response has become conditioned over time. The elder could be trying to gain attention or to distance himself or herself from others through the use of anger. If the elder's personal boundaries were repeatedly violated during childhood, the elder might have created increased personal space through the use of anger, and is creating the same situation now at the age of ninety in a nursing home.

We must also remember that life was not easy for many, or perhaps most, children when these elders were growing up. Children were often forced to spend time apart from their families because of poor economic conditions. Contrary to the depiction of family life in shows like The Waltons or Little House on the Prairie, the elder might have been deprived and abused. There might not have been enough food to eat or sufficient clothing to wear. Helping an older person to reminisce might bring losses, rather than heartwarming memories, to the surface.