Personality in later life

Most people stay recognizably themselves as they grow older. A curious person usually stays curious, and a careful person stays careful. Many people also grow calmer and more content with age. At the same time, very late life and poor health can bring some changes.

There is one change families should never ignore: a big, new shift in personality that does not fit the person they know. This can be a sign of depression, a medicine side effect, an infection or a brain illness such as dementia. This page explains what is typical, what is not, and what to do.

What usually happens to personality with age

Stability. In a Scottish study of people in their 70s and 80s, individuals kept their place compared with one another very well over time.² In other words, the people who were most outgoing or most organized at 70 tended to stay that way.

Gentle average shifts. Emotional stability tends to rise across the whole life span.¹ When researchers compared people in their late 60s with people in their 80s, the older group scored higher on agreeableness and conscientiousness.² The two groups grew up in different eras, so part of this gap may reflect their generation rather than age. Many older adults also report a better emotional life. In a study where adults rated their feelings several times a day for a week, repeated over 10 years, older age went with more positive feelings, steadier moods, and more mixed feelings, such as joy and sadness at once.⁴

The oldest years. Change often speeds up in the 80s and near the end of life:

• The same Scottish study found almost no average change from age 69 to 72. But from 81 to 87, people became somewhat less outgoing, less agreeable, less organized and less open.²
• A German study of people in their last years of life found that neuroticism tended to rise, while extraversion and openness fell.³
• Poor health was linked to bigger drops in extraversion and openness. Loneliness was linked to higher neuroticism. People who stayed socially active stayed more outgoing and open.³

These late changes are usually gradual and tied to health and life circumstances. They are different from a sudden, dramatic change.

Wisdom

Some things may get better with age. In one study, people read about conflicts between groups and between individuals, then predicted how things would turn out. Compared with young and middle-aged adults, older adults more often considered several points of view, allowed for compromise, and accepted the limits of what they knew.⁵ This happened even though some other thinking skills had declined.⁵

Wisdom is not guaranteed by age. But later life can be a time of perspective and patience. See Purpose and meaning in later life and Reminiscence and life review.

What is normal, and what is not

The key questions are: Is this new? Is it out of character? Is it getting worse? If the answer is yes, it is worth a medical checkup.

When a personality change is a warning sign

Many different conditions can change how a person acts. Some are easy to treat.

Depression

Depression in older adults does not always look like sadness. Clues can include irritability, worry, hopelessness ("What's the use?"), loss of pleasure, memory complaints, slowed movement, and not taking care of oneself.⁶ Families may see this as the person "getting difficult," when in fact they are depressed. Depression is treatable at any age. See Depression in later life.

Delirium: a sudden change

Delirium is a sudden, severe state of confusion. It can come with personality changes such as anger, agitation, sadness, irritability or being overly cheerful. The person's state may shift quickly from sleepy to agitated and back.⁷ Common causes include infections such as urinary tract infections and pneumonia, surgery, and some medicines, including pain medicines and sedatives.⁷ A rapid change in mental state needs prompt medical care.⁷ See Dementia, depression or delirium?

Medicines

Some medicines can change behavior. For example, ropinirole, a drug used for Parkinson's disease and restless legs syndrome, can cause intense urges to gamble, shop, eat or have sex in some people. Families are urged to know this risk so they can call the doctor if it happens.⁸ Pain medicines, sedatives and drugs with anticholinergic effects can also cause delirium.⁷

Never stop or change a medicine on your own. Talk with your doctor or pharmacist before changing anything. See Medicines and mood in later life.

Frontotemporal dementia (FTD)

In the behavioral form of FTD, personality and behavior often change first. A person may say rude or improper things, act on impulse, lose interest in family, seem to stop caring about others' feelings, repeat actions, or eat compulsively.⁹ Memory may be fine at first.⁹ The person is often not aware of these changes.⁹

FTD tends to start younger than other dementias. About 60% of people with it are between 45 and 64.⁹ It is sometimes mistaken for depression, or for willful bad behavior.⁹ See Frontotemporal dementia and Disinhibition.

Alzheimer's disease

Mood and personality changes can appear in the mild stage of Alzheimer's, along with more anxiety or aggression, loss of initiative and poor judgment.¹⁰ A person may become confused, suspicious, depressed, fearful or anxious, and get upset easily outside their comfort zone.¹¹ See Alzheimer's disease and Normal aging or dementia?

Other medical causes

Thyroid, kidney or liver problems, low vitamin B12, head injury, brain tumors or blood clots, infections, alcohol or drug misuse and sleep problems can all affect thinking and behavior. Many of these improve with treatment.¹² See Treatable conditions that look like dementia.

What families can do

1. Write down what you see. Note specific examples, when the change began, how often it happens and whether it is getting worse. Concrete examples help the doctor more than "Dad isn't himself."
2. Watch for emergencies. Sudden confusion or a quick change in behavior needs prompt medical care.⁷ Call 911 if the person is in danger.
3. Make a full medicine list. Include prescriptions, over-the-counter drugs and supplements, and any recent changes.
4. Book a doctor visit and go along. If the person may not want you to say things in front of them, share your notes ahead of time.
5. Ask what tests are needed. A doctor may do an exam, blood tests and memory and thinking tests. They may also check for depression and order a brain scan or a referral to a specialist.^9,10
6. Do not argue or blame. The person may not see the change in themselves.⁹ Stay calm and kind.
7. Protect safety and money. Impulsive choices can lead to unsafe driving, risky spending or scams. See Scams and financial abuse.
8. Get support for yourself. The Alzheimer's Association has a free 24-hour helpline at 800-272-3900.¹¹ The Eldercare Locator, at 800-677-1116, can connect you with local services.¹⁰

For help preparing, see Your first doctor visit about memory, Geriatric psychiatry and Starting the conversation.

Lifelong personality patterns in later life

A personality disorder begins early in life, not in old age. Some older adults have lived with one for decades. A new change that starts late in life is a different matter and calls for a medical checkup first. See Personality disorders and personality change in later life and Personality traits vs. personality disorders.

Staying yourself as you age

Staying socially active was linked to staying more outgoing and open late in life, and loneliness to more worry and upset.³ Simple steps that help mood and brain health, such as regular contact with people, activity and good sleep, are worth keeping up. See Mind and social life, Loneliness in later life and Retirement and mental health.

Common questions

My father has become grumpier with age. Is that normal?

Some irritability about disrupted routines can be typical.¹¹ But steady grumpiness, hopeless talk or pulling away can be signs of depression, which is treatable.⁶ It is worth mentioning to his doctor.

Can personality change be the first sign of dementia?

Yes, in some types. In behavioral FTD, personality changes often come before memory problems.⁹ Mood and personality changes can also be early signs of Alzheimer's.^10,11 Many other causes are treatable, so get a full checkup.¹²

My mother suddenly became confused and agitated in the hospital. Is this dementia?

It may be delirium, which is common in hospitals, especially in older adults. Tell the care team right away. Delirium often clears when the cause is treated, though it can take weeks.⁷

When to get help

See a doctor if you or a loved one has:

• A big change in personality or behavior that is new and out of character
• New confusion, suspicion, apathy or impulsive behavior
• Low mood, irritability or loss of interest lasting more than two weeks
• Behavior changes after starting or changing a medicine

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.