Emotional Instability in Elderly: A Case Study of Grandma's Behavior

Grandma is emotionally unstable?

Hello, Doctor: My grandmother is 98 years old.
About a month ago, she mentioned feeling alternating hot and cold in the mornings, getting so hot that she needed a fan and wore short sleeves, then suddenly feeling cold and shivering.
However, for the past three weeks, these symptoms have stopped.
Instead, her mood has become unstable; when her grandson leaves for work in the morning, she suddenly expresses disappointment in him, saying, "I'm very disappointed in you." When the children go out, she sometimes bursts into tears, insisting that she is about to die and calling all the children back home.
After they return, she seems to be in good spirits and acts normally.
She suddenly claimed to have gastrointestinal bleeding and blood in her stool, but hospital tests showed everything was normal.
At times, she sits for long periods or lies down without moving at all.
Other times, she becomes angry and tells the children to get out.
In the past couple of days, she has been insisting on moving to a nursing home.
Currently, my parents live with her, and they are worried about her condition.
Is this behavior intentional, or is it just a part of aging?

A Bing, 90~99 year old female. Ask Date: 2017/12/05

Dr. Liang Yinpan reply Geriatrics

Hello,
My grandmother, who is 98 years old, has been experiencing emotional instability and mood swings.
This could be caused by brain degeneration or pathology, with dementia being the most common condition.
Please take her to a hospital for evaluation by a neurologist or psychiatrist.
Wishing her a speedy recovery.
Changhua Hospital, Geriatrics Department, Liang Yin-Pan
December 11, 2017

Reply Date: 2017/12/05

More Info

Understanding emotional instability in the elderly, particularly in a case like your grandmother's, requires a multifaceted approach that considers both psychological and physiological factors. Your grandmother, at 98 years old, is experiencing a range of behaviors that can be concerning for family members. The symptoms you describe—fluctuating body temperature, emotional outbursts, sudden crying, and claims of serious health issues—can be indicative of several underlying conditions.

Firstly, it is essential to recognize that emotional instability in elderly individuals can often be linked to cognitive decline, such as dementia or Alzheimer's disease. These conditions can lead to changes in mood, personality, and behavior. For instance, individuals with dementia may exhibit sudden emotional outbursts or become easily agitated, which could explain your grandmother's behavior when she expresses disappointment or anger towards her grandchildren.

Moreover, the physical symptoms you mentioned, such as feeling hot and cold, could be related to various medical issues. Elderly individuals often experience changes in their thermoregulation, which can be exacerbated by medications or underlying health conditions. Additionally, the claim of gastrointestinal bleeding, followed by normal test results, may suggest anxiety or somatic symptom disorder, where psychological distress manifests as physical complaints.

Another critical aspect to consider is the potential impact of grief and loss. If your grandmother has experienced significant losses in her life, such as the death of a spouse or close friends, this can lead to feelings of loneliness and despair, which may contribute to her emotional instability. The sudden crying and expressions of feeling overwhelmed could be her way of coping with these feelings.

It is also worth noting that the elderly can sometimes feel a loss of control over their lives, especially if they are reliant on family members for care. This can lead to frustration and anger, as seen in her outbursts when family members leave or when she expresses a desire to move to a nursing home. This desire may stem from a need for more structured care or a feeling of being a burden to her family.

To address these concerns, it is crucial to approach the situation with empathy and understanding. Here are some steps you can take:
1. Medical Evaluation: Encourage your family to take your grandmother for a comprehensive medical evaluation. This should include a physical examination, cognitive assessment, and possibly a referral to a geriatric specialist or psychiatrist who can evaluate her mental health.

2. Open Communication: Foster an environment where your grandmother feels comfortable expressing her feelings. Regularly check in with her about her emotional state and listen to her concerns without judgment.

3. Routine and Structure: Establishing a daily routine can provide a sense of stability and predictability, which may help reduce anxiety and emotional outbursts.

4. Social Engagement: Encourage social interactions, whether through family visits, community activities, or even virtual connections. Social engagement can significantly improve mood and cognitive function in the elderly.

5. Therapeutic Support: If her emotional instability persists, consider seeking the help of a mental health professional who specializes in geriatric care. Therapy can provide her with coping strategies and help her process any underlying grief or anxiety.

6. Family Support: Ensure that family members are educated about the potential challenges of aging and emotional instability. This understanding can foster patience and compassion in interactions with your grandmother.

In conclusion, your grandmother's behavior may be a complex interplay of emotional, psychological, and physical factors. By addressing her needs holistically and ensuring she receives appropriate medical and emotional support, you can help improve her quality of life and emotional well-being.

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