Addressing Abnormal Behaviors in Elderly Patients with Parkinson's Disease

Abnormal behavior in the elderly

Hello Dr.
Shen,
My father is 79 years old and has been diagnosed with Parkinson's disease for about 10 years.
In recent years, the effectiveness of his medication has decreased, and his mobility has become increasingly impaired.
His cognitive function has also declined; he often struggles to understand time and people, and sometimes he is incoherent.
My mother's health is also poor, and we have applied for a caregiver to assist my father with bathing and walking in the mornings.
Recently, we have noticed that my father, who has always been very disciplined, sometimes behaves inappropriately towards the caregiver, who is in her 50s.
Due to my father's declining mobility, we initially considered hiring a foreign domestic helper, but my mother opposed this due to concerns about potential conflicts.

I have read some articles suggesting that such abnormal behavior in the elderly could be a symptom of dementia.
Should we seek medical treatment for this situation? Is there a possibility that medication could help improve it? How should family members handle inappropriate behavior from an elderly person?

Xiao Guai Ma, 40~49 year old female. Ask Date: 2016/04/10

Dr. Shen Zhengnan reply Geriatrics

Hello, Ms.
Xiao Guai.
After a period of illness, Parkinson's disease patients, especially the elderly, have about a 20% chance of developing dementia.
Based on your description, the changes in your father's orientation and behavioral control indeed warrant consideration of the possibility of concurrent dementia.
In cases of Parkinson's disease with dementia, in addition to treating the original motor symptoms, it is also necessary to address the cognitive function, emotional, and behavioral changes caused by dementia.
For cognitive decline, you may consult a neurologist to evaluate the possibility of prescribing medications to prevent further deterioration.
As for inappropriate sexual behaviors, the management can be more challenging.
Elderly individuals with dementia, particularly grandfathers, may exhibit inappropriate sexual behaviors due to impaired cognition, judgment, and impulse control.
They may have needs but do not know how to address them or may act on impulses inappropriately.
This behavior can be considered from several perspectives:
1.
Does your grandfather have needs that he cannot manage? If so, you may ask a spouse or male family member for assistance.
2.
Is it related to stimuli from the surrounding environment? For example, does the presence of young women or physical contact trigger such behaviors? If so, care measures that require physical contact, such as bathing, could be handled by a spouse or male family member.
3.
After developing dementia, does he focus on basic physiological needs due to a lack of other activities? If so, providing more daily activities for your grandfather to engage in may help.
4.
Is your grandfather overly concerned about a decline in sexual ability, leading him to seek confidence and self-esteem through sexual behaviors? If so, you can explain the relationship between sexual ability and age to him.
Regarding inappropriate sexual behaviors potentially caused by medication, if there are accompanying emotional issues such as agitation or irritability, medications for those issues may help improve the inappropriate sexual behaviors.
However, relying solely on medication to reduce sexual impulses can be challenging.
Clinically, many grandmothers hesitate to hire caregivers due to concerns that it might lead their grandfathers to develop inappropriate thoughts.
Alternatively, they may hire caregivers but frequently find excuses to reject their help, which can impact the arrangement of caregiving resources.
It is important to explain the nature of your grandfather's behaviors to your grandmother and discuss management strategies together, rather than insisting on sole caregiving, which can affect the quality of care.
I hope this information is helpful to you, and I wish your family health and happiness! Shen Zhengnan

Reply Date: 2016/04/10

More Info

Addressing abnormal behaviors in elderly patients with Parkinson's disease, particularly when these behaviors manifest as inappropriate sexual advances, can be a complex and sensitive issue. Your father's situation, where he has been living with Parkinson's disease for over a decade and is now exhibiting behaviors that are concerning, requires careful consideration and a multi-faceted approach.

Firstly, it is essential to understand that Parkinson's disease can lead to various cognitive and behavioral changes, especially in its later stages. As the disease progresses, patients may experience a decline in cognitive functions, including memory, judgment, and impulse control. This decline can sometimes result in inappropriate behaviors, including sexual advances, which may not reflect the individual's true character but rather a symptom of their condition.

Given your father's age and the progression of his Parkinson's disease, it is crucial to consult with a neurologist or geriatric specialist. They can conduct a thorough assessment to determine whether your father is experiencing dementia or other cognitive impairments alongside his Parkinson's disease. This evaluation may include cognitive tests, a review of his medical history, and possibly imaging studies to assess brain function.

In terms of treatment, if cognitive decline is confirmed, there are medications available that can help manage symptoms of dementia associated with Parkinson's disease. These medications may not completely reverse cognitive decline but can improve quality of life and help manage behavioral symptoms. It is important to work closely with healthcare professionals to find the most appropriate treatment plan tailored to your father's specific needs.

Regarding the inappropriate behaviors, there are several strategies that family members and caregivers can employ:
1. Communication: Open and honest communication with your father about his behavior is essential. It may be helpful to gently remind him of appropriate boundaries and the impact of his actions on others.

2. Environmental Modifications: Consider modifying the caregiving environment to reduce triggers that may lead to inappropriate behaviors. For instance, if certain situations or stimuli provoke these behaviors, try to minimize exposure to them.

3. Engagement in Activities: Keeping your father engaged in meaningful activities can help redirect his focus and reduce instances of inappropriate behavior. Activities that stimulate cognitive function, such as puzzles, games, or even light physical exercise, can be beneficial.

4. Support for Caregivers: It is also vital for your mother and other family members to seek support. Caring for someone with Parkinson's disease can be emotionally and physically taxing, and having a support system can help manage stress and provide guidance on handling difficult situations.

5. Professional Guidance: If the behavior persists or escalates, it may be necessary to involve a mental health professional who specializes in geriatric care. They can provide strategies for managing these behaviors and offer counseling for both your father and your family.

In conclusion, addressing abnormal behaviors in elderly patients with Parkinson's disease requires a comprehensive approach that includes medical evaluation, appropriate treatment, and supportive strategies for both the patient and caregivers. It is essential to approach the situation with empathy and understanding, recognizing that these behaviors are often symptoms of the underlying disease rather than intentional actions. Seeking professional help and maintaining open lines of communication will be key in navigating this challenging situation.

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