and Managing Auditory Hallucinations in Elderly Patients

Vasculitis

Dear Dr.
Chiu,
Hello.
My aunt, who is 85 years old, fell at home two years ago and fractured the area where her thigh connects to her hip.
She underwent surgery and had steel pins inserted.
During the medical evaluation, she was also diagnosed with mitral valve insufficiency and experienced heart failure, which required her to be admitted to the intensive care unit.
After being discharged, our family was unable to provide the necessary care, so we hired an Indonesian caregiver.
About two months before the Lunar New Year this year, she began to experience auditory hallucinations.
Initially, she only heard the voices of two relatives (my uncle and my second uncle), but now she hears all her deceased family members, including her grandparents, uncles, and even figures like Yama (the King of Hell), the Goddess of Mercy, the Emperor, and various deities.
She has also visited the hospital but received no conclusive results.
She suffers from severe insomnia and has been taking sleeping pills for six months.
Currently, she keeps insisting that these people are coming to take her life and feels the need to go outside, often leaving the house at 5:30 AM and returning only around 7 PM.

Our family is busy with work and school, and when we return home, we find it exhausting to listen to her repetitive statements.
However, aside from the severe auditory hallucinations, she does not exhibit any other issues.

Could you please advise us on how we can help her and ourselves? Thank you.

Xiao Ying, 30~39 year old female. Ask Date: 2003/03/28

Dr. Qiu Ruixiang reply Psychiatry

Hello, Xiao Ying.
Based on the information provided, it is likely that your aunt is experiencing dementia with accompanying psychiatric symptoms.
The primary symptom of dementia is a significant decline in memory, which can sometimes be difficult for family members to notice, especially when the patient has additional psychiatric symptoms.
Currently, psychiatric medications may not improve cognitive function in elderly patients, but they can effectively alleviate psychiatric symptoms, including disruptions in sleep cycles, with over an 80% success rate.
This can help reduce the burden and distress on family caregivers.
It is recommended to seek psychiatric consultation as soon as possible.
My initial consultation hours are every Tuesday morning with Dr.
Qiu.

Reply Date: 2003/03/28

More Info

Auditory hallucinations in elderly patients, particularly those with complex medical histories, can be challenging to manage. Your aunt's case is particularly concerning given her age, recent medical history, and the nature of her hallucinations. Here, I will provide an overview of potential causes, management strategies, and recommendations for both your aunt and her caregivers.

Understanding Auditory Hallucinations
Auditory hallucinations are perceptions of sound without an external source, and they can occur for various reasons, especially in older adults. In your aunt's case, several factors may contribute to her hallucinations:
1. Neurological Changes: Aging can lead to changes in brain function, which may result in hallucinations. Conditions such as dementia, Parkinson's disease, or other neurodegenerative disorders can manifest as auditory hallucinations.

2. Psychiatric Disorders: Older adults may experience psychiatric conditions such as depression or psychosis, which can lead to hallucinations. The stress of her recent medical issues and hospitalization may have exacerbated these conditions.

3. Medication Side Effects: The use of sedatives or other medications, especially in the elderly, can lead to confusion and hallucinations. If she has been on sleep medications for an extended period, this could be a contributing factor.

4. Sensory Deprivation: Hearing loss, which is common in older adults, can lead to auditory hallucinations as the brain attempts to fill in gaps in sensory input.

5. Medical Conditions: Heart failure and other systemic illnesses can affect brain function and contribute to hallucinations.

Management Strategies
1. Comprehensive Evaluation: It is crucial to have a thorough evaluation by a healthcare professional, preferably a geriatrician or psychiatrist, who can assess her mental status, review her medications, and consider any underlying medical conditions that may be contributing to her symptoms.

2. Medication Review: A review of her current medications is essential. If she is taking sedatives or other drugs that could contribute to her hallucinations, a healthcare provider may consider adjusting her treatment plan.

3. Therapeutic Interventions: Cognitive-behavioral therapy (CBT) can be beneficial for managing hallucinations. This approach helps patients understand and cope with their experiences. Additionally, supportive therapy can provide emotional support for both your aunt and her caregivers.

4. Creating a Safe Environment: Ensure that her living environment is safe and comfortable. Reducing noise and distractions can help minimize her anxiety and the intensity of her hallucinations.

5. Routine and Structure: Establishing a daily routine can provide a sense of stability and predictability, which may help reduce her anxiety and the frequency of hallucinations.

6. Engagement and Social Interaction: Encourage social interaction and engagement in activities she enjoys. This can help distract her from her hallucinations and improve her overall mood.

Supporting Caregivers
Caring for someone with auditory hallucinations can be emotionally taxing. Here are some strategies for caregivers:
1. Education: Understanding the nature of auditory hallucinations can help caregivers respond more effectively. Knowing that these experiences are not uncommon in elderly patients can reduce feelings of frustration or helplessness.

2. Self-Care: Caregivers should prioritize their own well-being. Taking breaks, seeking support from friends or support groups, and engaging in self-care activities can help manage stress.

3. Communication: Maintain open lines of communication with healthcare providers. Regular updates on your aunt's condition and any changes in her behavior can help in adjusting her care plan as needed.

4. Patience and Empathy: Approach your aunt with patience and empathy. Acknowledge her feelings and experiences without judgment, which can help her feel supported.

Conclusion
Auditory hallucinations in elderly patients can stem from various causes, including neurological changes, psychiatric disorders, medication side effects, and sensory deprivation. A comprehensive evaluation by healthcare professionals is essential for determining the underlying causes and appropriate management strategies. By creating a supportive environment, engaging in therapeutic interventions, and ensuring caregiver well-being, you can help your aunt navigate this challenging experience.

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