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

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

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).