Are you interested in learning more about the behavior and emotions of aging?
In this education module, we review common changes that may take place in later life and the importance of cultivating a positive attitude for successful aging. Included is a review of what you can do as a caregiver to support and encourage healthy and independent aging. 
Topic Quick Links – Click on a topic below to go to that area of the page.
- The Process of Aging 
- Change and Loss 
- Responses to Loss or Change 
- Grief & Grief Stages 
- Signs and Symptoms Suggesting Depression 
- Possible Causes of Depression 
- Treatment of Depression 
- Suicide Rates and Older Adults 
- Recognizing the “Red Flags” of Suicide & Assessing the Risk of Suicide 
- Recognize Signs, Involve a Doctor, Get Treatment 
- Behavioral Changes and What to Do 
- Examples of Difficult Behaviors 
- Possible Causes of Difficult Behaviors and How to Cope 
- Is It Normal Aging or Dementia or Alzheimer’s Disease 
- How Caregivers Help Older Adults 
- Resources for Caregivers 
Aging is another stage of life, like childhood, adolescence, or young adulthood. People age differently and experience aging differently based on heredity, lifestyle, and attitudes. Aging means change – physical, psychological, relationships, social, environment, situation, behavior, spiritual, and intellectual. Everyone adjusts to aging differently. People who did not like change when they were younger don’t generally like it any better as they age. Chances are good that a demanding 80-year-old was a demanding 35-year-old. So the best way to predict how an older person will act is to look back at her behavior in earlier life.
The challenge for older adults (and their caregivers) is accepting and adjusting to changes to build “resilience.”
Aging is a process of adjusting to continual changes. The changes that many older adults experience can affect how they see their lives. Many feel that they have lost their independence. They may experience a loss of self-esteem and may lose a clear image of who they are at this time in their lives. So many changes and adjustments can lead to a lack of confidence in one’s ability to live a meaningful life and continue to make valuable contributions to the community. Older adults may also experience a sense of loss of the respect of others. Common factors that trigger stress from change or loss:
Retirement is not the same for everyone. While some people adjust very well to retirement, others find the transition more difficult. In general, those who retire to meaningful activities are more satisfied than those who retire from a job and have no outside interests.
- Physical changes in vision, hearing, and other senses
All of our senses tend to change with age. Our eyes have more difficulty focusing on near objects and adjusting to changes in light intensity and lenses gradually become clouded. We may have difficulty hearing tones that have a high pitch. Such changes may be especially disruptive for those who have never experienced sensory loss.
As we grow older, we become more likely to develop chronic health problems. Adjusting often depends on our prior health and how well the conditions can be controlled. Someone who has been healthy most of his life may struggle with accepting health problems as he gets older.
Those who are inactive and/or have health problems may experience declines in strength, endurance, and mobility. These may limit daily activities.
We process and retrieve information in different ways as we grow older. For example, we may take longer to recall information. Such changes are usually slight. Stress, medication interactions, depression, dementia, and a number of other conditions can cause serious memory problems. Any significant change in memory should be evaluated by a physician.
- Death & Loss
One of the most difficult changes is the loss of significant people in one’s life, including spouses, family, and friends.
- Home & Personal Possessions
Moving is a chore at any age, but it can be especially difficult for someone who is older. One may be leaving a home of several decades or moving into a smaller home that can’t accommodate all of one’s personal possessions. The loss of familiar surroundings or things requires adjustment.
Incomes usually decline at retirement. Since older people don’t know how long they’ll live or what their expenses will be, they may be reluctant to spend money and/or worry about their financial security.
We all have different ways of coping with loss and change. If we’ve adjusted easily to change during the first 50 years of our lives, we’re likely to be able to adjust easily during the next 50 years. On the other hand, if we’ve resisted change throughout our lives, we will probably continue doing so and experience negative effects that may include the following:
- Physical complaints
There’s a clear relationship between mental and physical well-being. Those who have undergone losses are more likely to experience both minor and major illnesses.
Some people cope by refusing to acknowledge that change has occurred. They may have an “ignore it and it will go away” philosophy.
People may feel that they could have prevented a loss by acting in a different way.
Isolating oneself may be a way of mourning the loss of familiar people and a former lifestyle.
- Sense of helplessness
People may feel that they are at the mercy of their health problems, living arrangements, income limitations, or negative events.
- Overly critical, suspicious behavior
Some people become overly critical, suspicious, and/or paranoid. They do not trust easily and may feel that they are being taken advantage of.
Those who feel out of control may try to regain control by taking on an attitude of “my way or no way.”
- Selective memory
Some people may cope by remembering either the best or the worst about events and people in their life. They may distort the reality of how the events happened or who the people were. They hold on to a fantasy instead of a reality.
Going back to old behaviors or ways of coping may be a way to deal with painful events.
It is common to dwell on how things used to be and how they have changed. Wishing for things to be as they were when someone was younger affects a person’s ability to “bounce back” and live a full life in the present.
When people feel that they have little control over the present or have regrets about the past, they may react in anger. They may lash out at family members and sometimes being most critical of those who are most supportive. They know that family will not go away and still love them in spite of their anger.
- Depression and anxiety
Although not something that most people want to discuss, depression and anxiety can be very real reactions to loss and uncertainty for anyone at any age. It is important to help someone know that these feelings are normal and to get help if the feelings interfere with daily living beyond a few days of feeling sad.
Grief is a normal reaction to the loss of people, former lifestyles, relationships, health, vision, hearing, ability level, mobility, or independence. Living through grief takes time and talking with others or even getting professional health helps an older adult adjust to the loss.
Groundbreaking research on death and dying by Elizabeth Kubler Ross identified stages of grief that are now recognized as normal for any type of loss or change. The grieving process does not take place in steps but in cycles. People move in and out of the following stages at their own pace.
- Denial – In this stage, a person is unwilling or unable to accept the loss. She does not want to talk about the loss and rarely realizes that the loss has occurred. In this stage of grief, the individual feels numb and not herself. During this stage, someone may cry, become enraged, or be overly critical or sarcastic. In this stage a person`s usual behavior and emotions may be magnified.
- Anger – When the individual recognizes that denial cannot continue, she may become frustrated, especially at people close to them. “Why me? It’s not fair!” and “Why would this happen?” are common thoughts.
- Bargaining – In this stage, he attempts to gain control of an often uncontrollable situation. This stage is a series of “If only…” statements. He may “make a deal with a higher power” to delay the pain or change the outcome.
- Depression – During this stage, he may become silent, refuse visitors, and spend much of the time mournful and sullen. They experience loneliness and a sense of isolation. In this stage, the individual may withdraw, sleep more than usual, overeat or not eat enough. Thoughts may include: “I’m so sad, why bother with anything?”, “I’m going to die soon, so what’s the point?”, “I miss my loved one; why go on?”.
- Acceptance She is able to accept that the loss has occurred, or the change has happened and that things will not be the same. Emotions are calmer. She begins to live the new life after the change although the memory of the old life or the person who is gone remains. Problems happen when a person is ‘stuck` and is unable to work through the grief or denies that there are problems. Knowing these stages will help caregiver understand what is normal. As caregivers, we can help an older adult struggle with the loss. We also may be experiencing loss ourselves. We may have lost a parent or spouse as we once knew them or the loss of a lifestyle because of our caregiving responsibilities Thoughts may be “It’s going to be okay.” “I can’t fight it; I may as well accept it.”
Other reactions to grief can include:
- Physical symptoms
A person may experience headaches, stomach ailments, ‘heartburn` sensation, fatigue, or a general sense of not feeling well.
- Panic – He may feel fear and a lack of control over her situation and environment.
- Guilt related to the loss She may think that she caused the change or loss. She may also experience ‘survivor guilt` because she has been spared from death or illness and is less “deserving” than a loved one who has died or gotten sick.
- Hostility Part of the emotional reaction may be hostile behavior, starting arguments, verbal attacks, and “acting out.”
- Inability to resume usual activities A normal experience of grief is a difficulty in “moving on” after the loss.
- Glimpse of hope Gradually, those who’ve experienced losses begin to have better days and assume more normal activities.
Signs and Symptoms Suggesting Depression
Depression is more than an occasional feeling of sadness or the natural grief associated with a loss. It is a group of long-lasting or recurring emotions and behaviors that interfere with a person’s normal activities. If you or someone you know has experienced several of the following signs of depression for two weeks or more, professional help should be considered:
- Depressed mood
- Feelings of worthlessness, hopelessness, helplessness, and/or inappropriate guilt
- Changes in eating habits with significant weight loss or gain
- Changes in sleeping habits (sleeping too little; disturbed sleep; or sleeping too much)
- Decreased energy or increased fatigue
- Change in movement – either slowed or agitated
- Inability to concentrate or make decisions
- Memory loss, confusion, disorientation
- Irritability, short-temper
- Persistent sadness or anxiety
- Neglect of self care
- Too much concern with physical problems
- Chronic aches or pains not related to diagnosed illness
- Loss of pleasure in daily activities
- Withdrawal from usual activities and relationships
- Stress and loss
As people grow older, their losses can multiply. Losses may be manageable by themselves but overwhelming when combined with other losses. Note: What often adds to the grief of the elderly is that these losses are likely to: a) be multiple or b) come one right after another.
- Substance Abuse
Alcohol, prescription and non-prescription drugs.
- Physical Illness
Research has established a clear link between brain chemistry and depression. Medical illnesses can increase the likelihood of depression. Known causes can be Parkinson’s Disease, strokes, diabetes, and certain forms of cancer.
- Hormonal changes
Including thyroid function and menopause
Some blood pressure medications increase the risk of depression. Interactions of medication causing unwanted side effects that can trigger depression.
- Decrease in mobility
Limited Physical Activity or lack of adequate exercise
Lack of emotional and social outlets.
- Excess Stress
Poor stress management skills and tools.
- History of Depression
Having a history of a major depression increases risk of recurrence.
- Family history of depression
If your close relatives have depression, you could inherit a greater risk of having depression
- Substance abuse
Alcohol, prescription and non-prescription drugs.
Depression is one of the most successfully treated illnesses, usually with medication. When properly diagnosed and treated, more than 80% improve. Untreated, depression is likely to persist and may cause:
- Wasted health care dollars
- Substance abuse
- Increased risk for suicide
- Medical complications of chronic illness or even death
Medications frequently prescribed include the serotonin uptake inhibitors (SSRIs): Zoloft, Paxil and other anti-depressants. These medications have fewer side effects that many older medications.
As many as 70% of older persons who completed suicide visited their primary care doctor within the previous four weeks. As many of 40% saw a doctor within the week before the suicide.
- Depression is the most common risk factor for suicide
- Older adults have the highest suicide rate of any group in America – 50% higher than the general population
- Each year, 6,000 older Americans kill themselves
- Older adults are less likely than younger people to seek or respond to offers of help designed to prevent suicide
- Older adults make fewer suicide gestures but more often succeed at suicide attempts, planning over a period of time
- The highest rates of suicide occur in persons over age 70.
There are some suicide trends based on gender or race/ethnicity:
- Suicide rates do not increase with age among women
- White men – 45% more common among those aged 65 to 69 years, 85% more common among those aged 70 to 74, and more than three and a half times more common among those 85 and older than among white men aged 15 to 19 years
- Suicide rates among black men peak late in life
- No data found for older Hispanic/Latino older male suicide
These factors can be red flags warning of potential for suicide if they are a pattern of behavior over a period of time:
- Talk about or preoccupation with death
- Give away prized possessions
- Take unnecessary risks
- Have had a recent loss or expect one
- Increase use of alcohol, drugs or other medications
- Fail to take prescribed medicines or follow required diets
- Acquire a weapon
- Make comments such as “my family would be better off without me”
- Neglect self-care and personal hygiene
- Take a sudden interest in putting affairs in order
- Give away possessions (although sometimes older adults begin to “pass along” family items which may be normal)
- Take a sudden interest or disinterest in religion.
Don’t accept that depression is normal as people grow older. Get help! Talk to a health care professional.:
- Ask about possible side effects of medications
- Talk about changes in how the person is feeling and changes in usual behavior and routines
- Ask about a referral to a mental health professional who understands older adults
- Most importantly, seek treatment promptly
- Contact 2-1-1, Mental Health Association or local Mental Health Mental Retardation (MHMR) Center for more information and referrals.
Changes in a person’s usual behavior and routine can indicate a change in health and mental status. Be observant and think about what the behavior may mean. Take some practical steps:
- Really listen to his/her concerns. For example, stop cleaning the house or driving or preparing a meal and sit down, make eye contact, and really listen.
- Ask your family member what he/she needs and work with him/her to come close to meeting their needs.
- If your older relative is no longer able to do something that he wants to do, help him find alternatives.
- Set some healthy limits for yourself. Tell your family member what you can and cannot do based on your skills and your other time, work, and family commitments.
- Talk to siblings and other family members and ask for their help.
- Set up a Job Jar or “To Do” list. Talk to your older relative and ask him/her to make a list of things that need to be done.
Then ask for help from other family members, church volunteers, neighbors, or other people who have offered to help.
These are some examples of difficult behaviors you might encounter:
- Combativeness, aggressiveness
- Restlessness and wandering
- Mood swings
- Over-controlling behavior
- Critical and demanding behavior
Look for the cause of the behavior, including major changes and losses:
May include undiagnosed physical illness such as constipation, urinary tract infections, dehydration, etc. Watch for signs of pain or illness and seek medical care.
- Medication side effect
Ask the doctor to change the dosage or switch to another medication
- Lack of proper nutrition
Is it related to a physical illness or does the food does not taste good? Make sure dentures are properly fitted. If cooking is a problem, check with the Area Agency on Aging about congregate meals in senior centers or home-delivered meals through Meals on Wheels.
- Uncomfortable environment
Is it too cold, hot, bright, loud, etc? Adjust the temperature, dim lights, close blinds, turn volume down.
Provide an atmosphere and opportunity for rest. Ask the doctor if medication might be appropriate.
- Sensory loss
Visual problems or hearing loss may result in hearing or seeing things. Insufficient lighting may play tricks. Unfamiliar noises or changes in the surrounding may lead to fear. Provide corrective lenses or hearing aids as needed.
- Lack of activity
Encourage physical activity as tolerated.
- Feelings of powerlessness and loss of control
Provide assistive devices and allow the elder to make choices as appropriate.
- Confusion or memory Loss
Maintain a calm environment and reassure the person. Use memory aids.
- Be consistent
Keep household furnishings and objects in the same place. Do things the same way at the same time each day. When changes must be made, prepare and support the elder
These changes are part of the normal aging process. The age of loss varies with individuals, but generally there is not much loss before the age of 70.
- Some memory loss is normal but gradual; “Senior Moments” and “It’s on the tip of my tongue”
- Short-term memory is most affected
- Long-term memory is least affected
- Forget names but not faces
- Confuses timing of events
These changes can be affected by poor nutrition, lifelong stress, or other illnesses, such as Parkinson’s disease, depression, or alcoholism.
Dementia is a neurological disorder that causes general and progressive problems affecting memory, ability to learn new information, communication, judgment and coordination.
- Usually accompanied by personality and behavior changes
- Onset is gradual
- Condition gets progressively worse
- Other medical conditions, such as hypothyroidism and B12 deficiency, do need to be ruled out since they can produce similar symptoms.
Alzheimer’s is a disease that causes injury to nerve cells in the brain. It results in disrupted memory, thinking and functioning.
- Everyone who has Alzheimer’s disease has dementia
- Not everyone who has dementia has Alzheimer’s Disease
- Not the same progression for everyone, but the stages are predictable
- Somewhat greater risk for people with family history of Alzheimer’s disease
- Race or ethnicity does not seem to be a factor
- Reducing risk factors
Health: regular checkups and immunizations to prevent illness: influenza, tetanus and others; dental care; diet and exercise (stretching, balance, endurance, and strength
Safety: removing obstacles to prevent falls, checking smoke alarms, checking water temperature; regular driving tests, monitoring citations, observing affects of alcohol
- Using health care, family and community support
- Increasing knowledge of illness or disability
- Reinforcing a sense of productivity and involvement
- Helping make choices to determine the course of his/her own life
- Being supportive
- Bringing a positive attitude
- If necessary, learn how to perform first aid and CPR; lift without injury; use hover and chair lifts; do bed transfers and use bathroom chairs
- Taking care of yourself and clearly defining your role and limitations
- Call 2-1-1 throughout Texas for information and access to health and human service information for all ages.
- Call 800-252-9240 to find local Texas Area Agency on Aging.
- Call 800-677-1116 – Elder Care Locator service to find help throughout the U.S.
Use resources such as Area Agency on Aging  (AAA). Types of assistance provided by AAAs:
- Information and referral
- Caregiver education and training
- Caregiver respite
- Caregiver support coordination
- Case management
- Transportation assistance
Assistance available through AAAs for persons age 60 and older may include:
- Benefits counseling
- Ombudsman – advocacy for those who live in nursing homes and assisted living facilities
- Home-delivered meals
- Congregate meals
- Light housekeeping
Be sure to check out our Resource Directory , FAQ , and Educational Events Calendar  for more great information! Permission is granted to duplicate any and all parts of this page to use in education programs supporting family members caring for elders.
We hope this information is helpful to you in the important work you do as a family caregiver.
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