[Aggressivity in the elderly: when and how to treat?]

Aggressivity in the elderly subject is often attributed to a personality that could be termed "difficult". This diagnosis risks over-looking required pharmacological therapy, which can ultimately lead to abrupt institution of emergency treatment, in the absence of previous diagnostic steps, of a high-dose sedative that can result in confusion and prolonged decubitus. Our experience with elderly persons who display aggressivity favors the hypothesis of a mood disorder, an anxiety-depressional state of hostility. Using an anti-depressant, sedative or not, as a therapeutic test has the interest of provoking a high response. Aggressive behaviour disappears or is better tolerated by the patient's family. Suicide can be considered as a form of aggressivity turned against oneself, and the second interest of antidepression treatment is the decreased risk of suicide.