Which Medical Specialty Should My Elderly Grandmother See?

Which department should I visit?

Hello, doctor.
My grandmother is nearly 80 years old and has been suffering from depression since my grandfather passed away.
She has been taking antidepressant medication for the past few years, and her symptoms have progressed to resemble those of dementia, although tests at the hospital have ruled out Alzheimer's disease.
Her overall health has been poor, and recently she has been experiencing constant hunger after meals, feeling extremely hungry throughout the day, and unable to sleep without eating, which is very distressing for her.
Could you please advise which specialty she should see? Thank you.

Hao Xiaojie, 20~29 year old female. Ask Date: 2023/07/23

Dr. Liu Hongxiang reply Family Medicine

Dear Miss Hao,
The main issue in your letter is that you have been feeling very hungry after meals, to the point where you feel hungry all day long, and it becomes difficult to 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 small snack or a late-night meal can be a good option.
Additionally, if your mental state is stable and the hunger issue continues to trouble you, it may be advisable to consult a gastroenterologist for evaluation and treatment.
Wishing you physical and mental well-being.
Sincerely,
Dr.
Liu Hongxiang

Reply Date: 2023/07/23

More Info

Given your grandmother's complex medical history, it is essential to approach her situation with a multidisciplinary perspective. Based on the symptoms you've described, including her depression, potential cognitive decline, and recent changes in appetite and sleep, several medical specialties could be beneficial for her care.

1. Geriatrics: This specialty focuses on the health care of elderly people. Geriatricians are trained to manage multiple chronic conditions and understand the complexities of aging. They can assess her overall health, including her mental and physical well-being, and coordinate care among various specialists.

2. Psychiatry: Since your grandmother has a history of depression, consulting a psychiatrist could be crucial. A psychiatrist can evaluate her mental health status, adjust her medications if necessary, and provide therapy options. Given that depression can manifest with cognitive symptoms, it’s important to ensure her mental health is being adequately addressed.

3. Neurology: If there are concerns about cognitive decline or dementia-like symptoms, a neurologist can conduct further evaluations. They can perform cognitive assessments and brain imaging to rule out any neurological conditions that may be contributing to her symptoms.

4. Nutrition/Dietetics: Given her recent changes in appetite and the feeling of constant hunger, a registered dietitian can help assess her nutritional needs and develop a meal plan that addresses her hunger while considering her overall health, including any medications she may be taking.

5. Internal Medicine: An internist can provide comprehensive care, managing her chronic conditions such as any cardiovascular issues, diabetes, or other systemic health concerns. They can also coordinate with other specialists to ensure all aspects of her health are being addressed.

Recommendations for Next Steps:
- Comprehensive Evaluation: Schedule an appointment with a geriatrician who can perform a thorough evaluation of her physical and mental health. This will help identify any underlying issues that may be contributing to her symptoms.

- Mental Health Assessment: If she is currently seeing a psychiatrist, it may be beneficial to discuss her recent symptoms with them. If not, consider making an appointment with a psychiatrist to evaluate her depression and cognitive symptoms.

- Nutritional Consultation: A dietitian can help address her feelings of hunger and ensure she is receiving adequate nutrition, which is vital for both her physical and mental health.

- Regular Follow-ups: Ensure that she has regular follow-ups with her healthcare providers to monitor her condition and adjust treatments as necessary.

Additional Considerations:
- Support Systems: Engage family members or caregivers to provide emotional support and assistance with daily activities. This can help alleviate some of the stress she may be experiencing.

- Mental Health Support: Consider group therapy or support groups for elderly individuals dealing with loss and depression. This can provide her with a sense of community and understanding.

- Monitoring Symptoms: Keep a journal of her symptoms, including changes in mood, appetite, and sleep patterns. This information can be invaluable for her healthcare providers in tailoring her treatment plan.

In conclusion, your grandmother's situation requires a comprehensive approach involving multiple specialties to ensure her mental and physical health is adequately addressed. By seeking care from geriatricians, psychiatrists, neurologists, and dietitians, you can help her navigate this challenging time and improve her quality of life.

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