Which Medical Specialty Should My Elderly Grandmother See?

Which department should I see?

Hello, doctor.
My grandmother is nearly 80 years old and has been suffering from depression since my grandfather passed away.
She has been taking medication for depression over the past few years, and her symptoms have included some signs resembling dementia.
However, tests at the hospital have ruled out Alzheimer's disease.
Recently, her overall health has been poor, and she has been experiencing constant hunger after meals, feeling extremely hungry throughout the day.
She finds it very difficult to sleep without eating, which is quite distressing for her.
I would like to ask which specialty she should see for this situation.
Thank you.

Hao Xiaojie, 20~29 year old female. Ask Date: 2023/07/22

Dr. Liu Hongxiang reply Family Medicine

Dear Miss Hao,
The main issue in your letter is that you have been feeling very hungry throughout the day after meals, to the point where you cannot sleep without eating, which is quite uncomfortable.
If there are no issues with diabetes or obesity, feeling hungry after meals is not uncommon.
Having a light snack or a late-night meal can be a good option.
Additionally, if your mental state is stable but the issue of hunger continues to trouble you, it may be advisable to consult a gastroenterologist for evaluation and treatment.
Wishing you good health and well-being.
Sincerely,
Dr.
Liu Hongxiang

Reply Date: 2023/07/22

More Info

Given your grandmother's complex medical history, it is essential to approach her care holistically, considering both her mental and physical health. Based on the symptoms you've described—depression, possible cognitive decline, and significant changes in appetite and sleep—there are several medical specialties that could be beneficial for her.

1. Geriatrics: This specialty focuses on the health care of older adults. Geriatricians are trained to manage multiple chronic conditions and understand the complexities of aging. They can provide comprehensive assessments that consider both physical and mental health, which is crucial for your grandmother's situation.

2. Psychiatry: Since your grandmother has a history of depression and is currently on medication for it, consulting a psychiatrist would be beneficial. A psychiatrist can evaluate her mental health more thoroughly, adjust her medications if necessary, and address any potential side effects that might be contributing to her symptoms, such as increased hunger or sleep disturbances.

3. Neurology: If there are concerns about cognitive decline or symptoms resembling dementia, a neurologist can conduct further evaluations. They can perform cognitive assessments and brain imaging if needed to rule out any neurological conditions that might be affecting her mental state.

4. Internal Medicine: An internist can help manage her overall health, including her nutritional status and any underlying medical conditions that could be contributing to her symptoms. They can also coordinate care between different specialists.

5. Nutritionist/Dietitian: Given her increased appetite and difficulty sleeping, consulting a nutritionist could help assess her dietary habits and ensure she is receiving adequate nutrition. They can provide guidance on meal planning that may help with her hunger and overall well-being.

Additional Considerations
- Comprehensive Evaluation: It would be beneficial for her to undergo a comprehensive geriatric assessment, which includes evaluating her physical health, mental health, functional abilities, and social circumstances. This assessment can help identify specific needs and tailor a care plan accordingly.

- Medication Review: Since she is on antidepressants, a review of her current medications by a healthcare professional is essential. Some medications can have side effects that impact appetite and sleep, and adjustments may be necessary.

- Support Systems: Consider involving social workers or case managers who specialize in elder care. They can help coordinate services and provide resources for caregivers, which can alleviate some of the stress on your family.

- Mental Health Support: Engaging in therapy or counseling could also be beneficial for your grandmother. Cognitive-behavioral therapy (CBT) has been shown to be effective for older adults with depression and can help her develop coping strategies.

In conclusion, your grandmother would benefit from seeing a geriatrician as the primary care provider, who can then refer her to psychiatry for her mental health concerns, neurology for cognitive assessments, and possibly a nutritionist for dietary guidance. This multidisciplinary approach will ensure that all aspects of her health are addressed, leading to a more comprehensive and effective care plan.

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