Is this a sign of dementia or are they just being nasty?

Not pre-dementia. Full-blown dementia. Her changes are not subtle, and she can no longer take care of herself. She's been violent. She wouldn't do her therapy, which indicates to me that she wasn't thinking clearly enough to understand the consequences of that.

I'm so sorry, but she's going to need advanced care very soon, and I hope she will find the care she needs.

Yes, sounds like dementia. My mom used to pick fights with me in the beginning stages, but toward the end got really sweet and docile.

I believe your aunt is suffering from some type of dementia. Here is what I wrote in my book "Dementia Care Companion" about rage and aggression. I hope it helps.

Aggression

Anger and frustration are common in dementia. As cognitive decline takes its toll, the patient grows less able to tolerate the challenges of daily life or mold the environment to their needs. The situation is made worse by the fact that impulse control is one of the early casualties in some forms of dementia, such as frontotemporal dementia (FTD). With the loss of this critical function, a patient who never had a tendency toward aggression in the past can exhibit surprising levels of rage and aggression seemingly blowing up out of nowhere.
·      Do not take it personally. Anger and aggression are caused by the patient’s dementia and are not a reflection of their feelings toward you.
·      Stay vigilant. Aggression is dangerous and can cause physical and emotional harm to the caregiver or bystanders. Stay alert for its danger signs and never get complacent about them.
·      Most patients do better at certain times of the day. When possible, plan their more demanding activities, such as bathing, walking, or exercise, during those hours.

Causes of Aggression
Recently, my dad has become aggressive for no apparent reason. There’s been no change in his routine, living environment, caregiver, medication, sleep, or diet.

Aggression can occur for a variety of reasons, including physical discomfort, environmental factors, or communication problems. As with other behavioral problems, one often has to look beyond the obvious to find the reasons for aggression. When a patient is unable to express their pain or discomfort, even a simple headache can go untreated for hours. Look for:
·      Physical discomfort such as pain, fever, urinary tract infection, colds, constipation, fatigue, sleep deprivation, sundowning, and insomnia.
·      Environmental factors such as a loud TV, children running around, crowds and family gatherings (especially if they include people the patient does not know), high or low ambient temperature, or unsuitable lighting.
·      Communication problems such as repeated and complex questions by the caregiver, rushed interaction, or caregiver distress and fatigue. Reduce or eliminate noise, crowds, and other distractions prior to attempting to communicate.
·      Drug interactions and side effects, caused by a new medication (including prescription and over-the-counter meds), change in dosage, or mistakes in administering the drugs.
How to Deal With Aggression
I was in the other room checking my email when my mom walked in angry and hit me. I smiled and said, “It’s okay Mommy, give all the sweets and candies that you have for me!” At that moment her face lit up and her demeanor changed, and she started caressing my face. It turns out she was upset that I was spending too much time away from her.
·      Look for clues right before the onset of aggressive episodes to identify and eliminate the causes of aggression.
·      Don’t ask the patient why they are angry. Instead, try to find the feelings behind their anger.
·      Speak positively to reassure the patient. You can say, “I understand it’s difficult for you,” or “I understand how hard it is.”
·      Comfort the patient by maintaining a relaxed demeanor. Speak in a soft and reassuring tone. Remember that even subtle expressions of anxiety and tension in your demeanor may increase the patient’s anxiety and agitation.
·      Engage with the patient with a confidence that communicates that you trust them and are not afraid of them. Take a

Its dementia. Experienced it with my 86 yr old mother, after her stroke. Vascular dementia post stroke. Please be kind to her as she doesnt know what shes saying or doing.

Build up of toxins from her kidney failure?

At 93 she may have reactions to meds too. Did they do any kind of surgery?

JudyTeen30: Acrimonious behavior shouldn't be tolerated.

I'm not a clinical expert and can't make any kind of diagnosis, but considering your loved one has suffered a broken hip and is now wheelchair-bound, that’s a major and traumatic shift in her lifestyle. More importantly, I'm certain she's experiencing physical pain as well.

My own mother has broken both of her hips, and I recently broke my leg—which has made me more cautious and given me a firsthand understanding of how painful and difficult leg and hip injuries can be. Honestly, I don't even know how my mother manages with two broken hips and a deteriorating knee.

The outbursts you're describing do sound similar to what I witnessed with my mom when she began showing signs of dementia. Her agitation and increasingly argumentative behaviour were some of the early indicators. It wasn't until after her second fall that she was assessed and officially diagnosed.

Dementia can get quite difficult at times. I’ve learned to give her space during those moments and let things go until her mood passes. It’s not easy, but sometimes distance is the only thing that helps manage the emotional toll.

A few possibilities could be going on. First, we don’t really know how nice and caring the staff actually is, when no one is watching. There are at least 2 sides to that job. One where they take care of patients and I think often, the other, where they get paid and paid minimally. They have the jobs most people do not want. I’d imaging it isn’t many people’s calling to be a caregiver. Nevertheless, they may end up doing so, to earn a living. It is an unhappy, even miserable situation, they, too might be mean and experiencing what is called compassion fatigue, on top of that. We also don’t know how their superiors treat them. In any business, often it’s management, that’s the problem and they may be mistreating their employees, by any means necessary. I’m not writing excuses here. I’m outlining the possible realities.

Your mother is unhappy and there’s really nothing anyone can do about it. As a VERY independent person myself, who’s just only hit 60, the thought of losing my independence is crazy making. I can’t even stand sitting here, at this stupid job, working for a virtual idiot. So, the idea that someone will remove me from my home, take me somewhere I don’t want to be, that is unfamiliar to me, to be with people, whom I neither like, nor ever will, imposing themselves upon me, is light years away from where anyone wants to be. My home and belongs, maybe pets are gone. Not a bit of happiness to be found there.

What I “think” I experienced with my mother, might sound absurd. But it is my opinion from that experience that, sometimes, even IF a person has dementia, traits of narcissism or even full blown NPD might be an even bigger problem. The nastiness is also being able to be strategic, in their destruction. In its basic form, misery loves company and they will take it out on the closest person to them. The person they feel cannot or will not leave. And they very much intend to ruin your life, as they feel justified, since their own life feels ruined now. Perhaps, the ONLY time you’ll see them embrace the situation, is when they’re made to feel like a king or queen, ruling over the peasants that are serving them. Then, it might even be bliss. When my mother went to the hospital once, she returned absolutely blissful, because I guess the staff had learned that the best way to treat narcissistic patients, is to treat them like royalty. They won’t even care why they’re there, as long as people appear to be kissing their a$$. And I also understood that when my mother conveyed to me how sweet the staff was, it was because she was trying to imbue upon me, that, too, should be treating her the same. Difference between me and the staff? I wasn’t billing her insurance.

I agree with the above comments. She may have delirium from medical causes or have early dementia. Ask her PCP to do a full medical workup and refer you to a neurologist for a dementia work up.
However, if she is like my mom at all, she won’t agree. My mom sounds a lot like your aunt. She started with the memory decline first, though, and then started having significant behavioral issues. (But yes, there are some dementias where the behavioral issues start first.) Normally, the brain’s “bottom up” feelings, impulses, and agitation are countered by the brain’s “top down” regulatory mechanisms. In dementias, the top down mechanism fails to work, and you have rampant bottom up outbursts and agitation that go unchecked.
Anyway, my mom refused any and all medical treatment (which is another huge issue around being POA, etc), had screaming matches with waitresses in restaurants, cussed like a sailor at Uber drivers, hit me and my brother, pulled her caregiver’s hair, smashed her TV (twice), etc. She’s now on a medication that has calmed her down significantly, thank God.
And this was not my usual mom, who had always been calm and peaceful. Yet it did help me to know that she couldn’t help it, it wasn’t intentional, and that it was very common in dementia.

Anyway, I wish you and your aunt the best. Remember to take care of yourself through all of this.

If she has kidney failure then toxins maybe getting into her bloodstream. This can cause these type of symptoms. I would have labs run targeting the kidneys. Maybe she can be given some axiety meds.

I’d have a medical evaluation done that includes cognitive assessment for dementia. She may need a medication to calm her behaviors

I think from a world away, and having never met your aunt, as an RN I have to tell you that anything we could tell you about the reasons for Aunt's behavior would be purely a guess.

Could be or she is just really angry .