Guidance for Seniors Facing Unexplained Symptoms and Treatment Challenges

Symptoms indicating that elderly individuals are uncertain about the direction of their medical care?

Hello Dr.
Hsiao,
I have a 69-year-old female patient who lives alone.
She has a history of lupus erythematosus for seven to eight years and cardiovascular calcification for one year, and she is on a stable medication regimen without steroids.
Four months ago, she reported experiencing a stabbing and cutting pain in her skin.
After evaluation by a neurologist, she underwent a nerve conduction study and was prescribed medication, which provided some relief.

However, for the past two weeks, she has been experiencing a rolling sensation on her back while sleeping, as if something is pressing down on her from under the bed, causing her significant panic and preventing her from sleeping.
In severe instances, she even perceives a pressing sensation from chairs while awake, but this does not occur when she is accompanied by someone at home or when she visits others.
During the day, she appears to have good energy, but her inability to sleep is leading to increasing physical weakness.

She has consulted nearly ten different healthcare providers, including neurologists, psychiatrists, family medicine doctors, and emergency medicine specialists, but no abnormalities have been found.
Consequently, she has given up on medical treatment, believing that doctors cannot identify the problem, and has shifted her focus to seeking guidance from a temple, with no improvement.

The patient has never expressed a need for companionship; she simply wants to resolve her situation and return to her previous lifestyle.
What would you recommend in terms of further evaluation or care strategies? Thank you for your time and response.

wan bei, 30~39 year old female. Ask Date: 2016/10/31

Dr. Xiao Minghong reply Psychiatry

Hello,
This elderly female currently has primary issues with abnormal skin sensations and insomnia.
However, due to the extensive areas affected, it may be prudent to first consider diseases that present with multiple symptoms and involve various regions, such as systemic lupus erythematosus, which may cause peripheral neuropathy, affect the central nervous system, and present with skin symptoms.
It is advisable to discuss these related conditions with her physician during the follow-up visit.

Additionally, if her symptoms improve when accompanied by others, this may suggest some psychological or social factors at play.
If she is open to it, discussing her insomnia with a psychiatrist could be beneficial.
Given the limited information provided and the apparent complexity of her condition, it is recommended that you take her for a personal medical evaluation to ensure a comprehensive assessment and care.
Best wishes,
Dr.
Hsiang Ming-Hong

Reply Date: 2016/10/31

More Info

Dear Inquirer,
Thank you for reaching out with your concerns regarding the health challenges faced by your elderly relative. It is evident that she has been through a lot, managing lupus erythematosus and cardiovascular calcification, and now experiencing new and distressing symptoms. The situation you describe is complex and requires a thoughtful approach to ensure her well-being.

Firstly, it is important to acknowledge that unexplained symptoms in seniors can often be multifactorial. In your relative's case, the combination of her existing medical conditions, the medications she is taking, and her psychological state may all contribute to her current experiences. The sensations of pain, pressure, and the feeling of rolling or being pressed upon, especially when they seem to diminish in the presence of others, could suggest a psychosomatic component, where psychological factors manifest as physical symptoms.

Given that she has seen multiple healthcare providers without a definitive diagnosis, it may be beneficial to consider a few key strategies:
1. Comprehensive Assessment: While she has already consulted various specialists, it might be worthwhile to seek a comprehensive geriatric assessment. This type of evaluation looks at the whole person, including physical health, mental health, functional ability, and social circumstances. A geriatrician can help coordinate care and ensure that all aspects of her health are considered.

2. Mental Health Support: The symptoms of anxiety and fear, particularly those that interfere with sleep, can significantly impact her quality of life. Engaging a mental health professional, such as a psychologist or psychiatrist, may provide her with coping strategies and therapeutic options. Cognitive-behavioral therapy (CBT) has been shown to be effective for anxiety and sleep disturbances.

3. Medication Review: It is crucial to review her current medications with a healthcare provider. Some medications can have side effects that may contribute to her symptoms. A geriatric pharmacist can also provide insights into potential drug interactions or side effects that may not have been considered.

4. Sleep Hygiene: Since sleep disturbances are a significant issue, implementing good sleep hygiene practices can be beneficial. This includes maintaining a regular sleep schedule, creating a comfortable sleep environment, and avoiding stimulants close to bedtime. Relaxation techniques, such as deep breathing exercises or mindfulness, may also help her manage anxiety and improve sleep quality.

5. Social Support: While she may not express a need for companionship, social isolation can exacerbate feelings of anxiety and depression. Encouraging her to engage in community activities or support groups can provide her with a sense of belonging and reduce feelings of loneliness.

6. Alternative Therapies: If she is open to it, exploring alternative therapies such as acupuncture, massage, or yoga may provide relief from physical symptoms and promote relaxation. However, it is essential to discuss these options with her healthcare provider to ensure they are safe and appropriate.

7. Family Involvement: As a family member, your support is invaluable. Regular check-ins, offering to accompany her to appointments, or simply spending time with her can help her feel less isolated and more supported in her health journey.

In conclusion, while it is understandable that she may feel disillusioned with the healthcare system after multiple visits without clear answers, it is crucial to continue seeking appropriate care. A multidisciplinary approach that includes medical, psychological, and social support may provide her with the best chance of improving her symptoms and overall quality of life. Encourage her to remain open to the possibility of further evaluation and support, and reassure her that she is not alone in this journey.

Best wishes for her health and well-being.

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