Addressing Disturbing Behavior in Elderly Relatives: A Family's Dilemma

Grandfather exhibits abnormal behavior?

Hello, doctor.
My grandfather is in his 80s and has started exhibiting troubling behaviors over the past year or two.
He has been stealing underwear, targeting both neighbors and his daughter-in-law, and has even sexually harassed his daughter-in-law and exposed himself to the neighbor's children.
We have warned him to stop these actions, but he becomes emotionally unstable and verbally aggressive.
Our family is very distressed and doesn't know how to handle this situation.

Qiu Xiaojie, 30~39 year old female. Ask Date: 2018/12/19

Dr. Xiao Minghong reply Psychiatry

Dear Ms.
Chiu,
Due to the insufficient information you provided, I can only make judgments based on the information currently available.
If there are any shortcomings, I hope you can be understanding.
The symptoms you mentioned, such as stealing underwear and exposing oneself, may appear to be signs of paraphilia; however, paraphilia is rarely diagnosed in the elderly.
It would be advisable to pay attention to your grandfather's memory.
Is there any noticeable decline? Does he forget things he has just said? Does he sometimes seem unaware of what he is doing? These could be signs of dementia.
Additionally, certain medical conditions may also lead to similar behaviors.
If you wish to improve this situation, I recommend seeking further evaluation at a psychiatric outpatient clinic for a more comprehensive assessment and treatment.
Wishing you all the best!
Sincerely,
Dr.
Hsiao Ming-Hung

Reply Date: 2018/12/19

More Info

Addressing disturbing behavior in elderly relatives, particularly in cases like your grandfather's, can be incredibly challenging and distressing for families. It is essential to approach this situation with a combination of compassion, understanding, and a clear plan for intervention.

Firstly, the behaviors you describe—such as stealing underwear and inappropriate sexual behavior—can be indicative of underlying medical or psychological issues. In elderly individuals, these behaviors may stem from various causes, including cognitive decline, dementia (such as Alzheimer's disease), or other mental health disorders. It is crucial to recognize that these actions may not be entirely within the individual's control, especially if they are related to cognitive impairments.

Steps to Address the Situation
1. Medical Evaluation: The first step should be to have your grandfather evaluated by a healthcare professional, preferably a geriatrician or a neurologist. They can conduct a thorough assessment to determine if there are any underlying medical conditions contributing to his behavior. This may include cognitive testing, blood tests, and a review of his medical history.

2. Mental Health Assessment: Alongside a physical evaluation, a mental health assessment is vital. A psychiatrist or psychologist can help identify any mental health issues, such as depression, anxiety, or psychosis, which may be influencing his behavior.
3. Medication Review: If your grandfather is already on medication for other health issues, it is essential to review these with his doctor. Some medications can have side effects that affect behavior, and adjustments may be necessary.

4. Behavioral Interventions: Once a diagnosis is made, behavioral interventions can be implemented. This might include setting clear boundaries and consequences for inappropriate behavior. Family members should communicate these boundaries consistently and calmly, avoiding confrontational language that may escalate his emotions.

5. Support and Counseling: Family counseling can be beneficial for everyone involved. It provides a space for family members to express their feelings and frustrations and learn coping strategies. Additionally, support groups for families dealing with similar issues can offer valuable insights and emotional support.

6. Safety Measures: If your grandfather's behavior poses a risk to others, it may be necessary to implement safety measures. This could involve supervision when he is around vulnerable individuals, such as children, or even considering alternative living arrangements if the situation does not improve.

7. Legal Considerations: In extreme cases, if your grandfather's behavior continues to escalate and poses a significant risk to himself or others, it may be necessary to explore legal options, such as guardianship or involuntary commitment, to ensure his safety and the safety of those around him.

Communication Strategies
When discussing these issues with your grandfather, it is essential to approach him with empathy. Acknowledge his feelings and frustrations, but also express the impact of his actions on the family and others. Using "I" statements can help convey your feelings without placing blame, such as, "I feel worried when I see you acting this way."

Conclusion
Dealing with disturbing behavior in elderly relatives is undoubtedly a complex and emotional issue. It requires a multifaceted approach that includes medical evaluation, behavioral strategies, and family support. By taking these steps, you can help ensure that your grandfather receives the care he needs while also protecting the well-being of your family. Remember, seeking professional help is crucial in navigating these challenging situations, and you do not have to face this alone.

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