What to Do When Your Loved One Becomes Violent Due to Dementia

When some think of dementia, they may think of it as a mental illness. Confusing the two occurs frequently as certain mental illnesses and dementia share many of the same symptoms, including difficulty concentrating, confusion, and personality and emotional changes. It’s important to note that while dementia does affect mental health, it is not a mental illness but a disorder of the brain that causes memory loss and trouble with communicating.

Proper diagnosis of mental illnesses or dementia in seniors is vital to ensure that appropriate treatment is provided as soon as possible. The distinction is also extremely relevant when it comes to those who have dementia with behavioral problems such as aggression, violent verbal outbursts, or bouts of physical violence. In many instances, nursing homes avoid admitting people with these types of symptoms and try to discharge residents who develop these types of symptoms. There are very few nursing homes or other long-term care facilities that are willing to treat adults who have dementia with violent behavioral tendencies. There are a very small number of psychiatric geriatric hospitals, but they don’t admit people whose primary diagnosis is dementia because dementia, by itself, is not considered a mental illness or psychiatric problem, in large part because dementia is not susceptible to treatment, and psychiatric hospitals, even those devoted to serving the elderly population, have the goal of getting people better as soon as possible and then discharging them; that is never going to happen with people who have dementia because there is no cure for dementia. Even when an elderly person with dementia has an underlying mental illness such as depression, bipolar disorder, personality disorder, or schizophrenia, once they develop dementia it is often difficult to find adequate treatment because the line between the dementia and the underlying mental illness becomes blurred.

This situation often causes serious practical issues for those who have the symptoms described and their ability to get the care that they require and causes serious problems for their loved ones who are often unable to get people with these symptoms placed in a long-term care facility and are therefore faced with the choice of either continuing to try to care for their loved one at home, or abandoning their loved one in order to protect their own physical and mental health.

The Difference Between Mental Illness and Dementia

This week, the first week in October, is Mental Illness Awareness Week (MIAW), an annual campaign led by the National Alliance on Mental Illness (NAMI) to help raise awareness of mental illness. This awareness week also includes National Depression Screening Day on October 7.

To differentiate between dementia and mental illness, let’s look at some of the common symptoms.

Dementia Symptoms

The most common form of dementia is Alzheimer’s disease, which causes cells in the brain that control memory to die. It is an irreversible condition.

While dementia affects all individuals differently, the main symptoms include:

  • Difficulty communicating: Dementia patients often have a hard time completing sentences or finding the right words. Also, words can get mixed up or used incorrectly.
  • Loss of memory: Forgetfulness will increase as the disease progresses, along with problems remembering how to complete daily activities such as cooking, cleaning, and dressing, among others.
  • Personality and emotional changes: Dementia may cause personality changes in individuals and can affect their moods as well. Those with dementia are often fearful or depressed and can experience severe mood swings.
  • General confusion: Those with dementia are often confused about what time of day it is or even what year they’re living in. They also have a hard time recognizing friends and family members or think they are someone else entirely. Dementia patients may also start losing or misplacing items and may develop paranoia, often accusing others of stealing their belongings.

For more information about common symptoms of dementia, please visit the Alzheimer’s Association website. To read about the seven stages of Alzheimer’s disease, please see this article from Penn Memory Center.

Common Mental Illnesses in Seniors

If a senior is displaying signs of mental illness, it’s important to recognize the symptoms and seek treatment as soon as possible. Some common mental illnesses that seniors may experience are:

  • Depression: Depression is considered the most common mental disorder among seniors. Social isolation plays a major role in emotional wellness, so when a senior spends long periods alone because they are unable to drive or live far away from friends and family, depression can easily set in. Read more about what to do when a loved one has depression in my recent article on the topic. Also, for more information on loneliness and isolation, click here.

There are some key differences between dementia and depression:

o Depression develops much more quickly than dementia — over weeks or months;

o People with dementia may have language problems or not know where they are or what time it is. This is rare with depression;

o Someone with depression may not recall something but will remember it when prompted. Someone with dementia is unlikely to remember.

  • Late onset bipolar disorder: Most patients with bipolar disorder are diagnosed in early adulthood. Late onset bipolar disorder can be difficult to diagnose because of its similarities to dementia symptoms including agitation, manic behavior, and delusions. For more information on bipolar disorder and what to do when a loved one is diagnosed, click here to read my article on this topic.
  • Late onset schizophrenia: This disorder also presents a challenge to diagnose. It can manifest in adults after age 45 and worsen as the patient ages. Symptoms are similar to dementia, once again, with hallucinations and paranoia the most common, but these symptoms are milder than when this illness appears in younger adults.

Mental illnesses are treatable, but a correct diagnosis is extremely important. Even if a senior loved one had good mental health throughout their life, the risk of mental illness in later years is still there. Seek medical treatment as soon as possible if there are any noticeable changes in your loved one so they can diagnose and help you find the right treatment and support.

Supporting Someone with Dementia Who Has Mental Health Problems

It’s common for people with dementia to experience depression, anxiety, or apathy (having no motivation to do things they usually found meaningful). Improving the mental health of someone with dementia can improve their overall quality of life by helping them engage with friends and relatives, by improving their appetite and sleep quality, and by boosting their motivation.

Mental Illness Is Often Under-Recognized and Under-Treated in Older Adults

Do you have a loved one who seems more unhappy, anxious, irritable, or moody than usual? Perhaps they are isolating themselves by not seeing friends and relatives as much, not getting enough sleep, and/or they have stopped doing things that once interested them. Without treatment, mental illness, such as depression, can impair an older adult’s ability to function and enjoy life and can contribute to poor overall health. Compared to older adults without depression, those with depression often need greater assistance with self-care and daily living activities and often recover more slowly from physical disorders. For more details on mental health resources for illnesses, such as depression, and Medicare coverage, please read our article on the subject.

If you are a caregiver who is experiencing mental health issues, click here for helpful resources.

If you have symptoms of dementia, it is also vital to get screened by a doctor now.

Do You Have a Loved One with Dementia and/or Mental Illness?

If you have a loved one with mental illness, a Special Needs Trust is often an essential tool to protect a mentally ill individual’s financial future. This type of trust preserves legal eligibility for federal and state benefits by keeping assets out of the mentally ill person’s name while still allowing those assets to be used to benefit the mentally ill person. Read more here.

If you or a family member has received a diagnosis of dementia, it is highly recommended that you update your estate planning documents as soon as possible, giving strong consideration to creating a long-term care plan that includes an asset protection trust such as our Living Trust Plus® to protect your assets from probate PLUS lawsuits PLUS the potentially devastating expenses of assisted living or nursing home care that may be required along the dementia journey. We offer all potential new clients an initial consultation. Please reach out to us via our website at, or via one of the phone numbers below:

Fairfax Elder Law: 703-691-1888
Fredericksburg Elder Law: 540-479-1435
Rockville Elder Law: 301-519-8041
DC Elder Law: 202-587-2797

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.