Mental Health Issues in the Elderly: A Case Study

Mental disorders

Hello, doctor! My mother passed away in July 2010.
My father, who is now 75 years old, lives alone in a three-story house (the children live elsewhere).
He has health issues, including hypertension and hearing loss, and he takes medication three times a day.
In October 2010, he underwent a coronary angioplasty with stenting.
I am concerned that he may have mental health issues (I suspect this) because he believes that during his hospital stay in the intensive care unit, the nurses were mean to him and wanted to harm him.
He also claims to have seen strange supernatural phenomena in the hospital room.
Our family thinks these claims are absurd and unbelievable.

A few months after returning home, especially recently, his condition has worsened.
He says that his blankets and pillows are hiding many bad things (like heads and blood), and even after getting new bedding, he continues to express the same concerns.
Additionally, he reports seeing a Black man and a blonde woman having intercourse and refuses to enter the house, claiming there are many bad things inside.
He is afraid to sleep.
We believe the situation is serious, and last week my brother took him to see a psychiatrist, who suggested that he might have dementia.

Based on the symptoms I have described, what illness might my father have, and how should it be treated? Please let me know, thank you!

Xin, 40~49 year old female. Ask Date: 2011/03/18

Dr. Ouyang Wenzhen reply Geriatrics

Dear Sir/Madam,
Thank you for using Taiwan e-Hospital! In your inquiry on Friday, March 18th, at 21:59, you mentioned that your father is 75 years old, lives alone, and is suspected to have "the nurses in the intensive care unit being harsh to him and wanting to kill him" (which is likely a case of persecutory delusion) and visual hallucinations, such as "seeing strange supernatural phenomena in the ward," "finding many bad things (like heads, blood, etc.) hidden in the pillow even after changing to a new comforter," and "seeing a Black man and a blonde woman having sex." His condition has worsened since returning home, and the physician has suspected "dementia." You would like to know about your father's possible conditions and subsequent treatments.
1.
Regarding your father's possible condition: Although the information you provided is not comprehensive, if your father had noticeable and long-term memory issues (lasting more than 6 months) before being admitted to the intensive care unit, he may indeed have dementia.
However, it is important to note that he could also be experiencing delirium due to physical illnesses such as stroke, dehydration/electrolyte imbalance, or infection, either in the intensive care unit or currently.
Elderly individuals with dementia are more susceptible to delirium.
It is also possible that he is experiencing behavioral psychiatric symptoms associated with dementia.
According to literature, at least two-thirds of dementia patients exhibit at least one psychiatric symptom or behavioral issue concurrently.
If your father's memory was very good prior to the onset of the aforementioned hallucinations or persecutory delusions, he may have late-onset schizophrenia, although this diagnosis is less likely than the previously mentioned dementia or delirium.
2.
Regarding your father's subsequent treatment: It is advisable to consult a psychiatrist (preferably one specializing in geriatric psychiatry or dementia) or a neurologist (who specializes in dementia treatment).
He needs to undergo blood tests and brain imaging studies (such as CT scans and MRIs) as soon as possible to determine the underlying causes of his dementia or delirium.
If any physical conditions are identified, appropriate medication adjustments should be made.
Regardless of the underlying cause, your father will also require antipsychotic medication, which should be gradually increased to help reduce/control or eliminate the delusions or hallucinations.
Additionally, if there is a risk of harm to himself or others, hospitalization is recommended, either in a psychiatric or internal medicine setting.
If your father is not agitated and poses no risk of harm to himself or others, day hospitalization or day care is suggested, along with medication and other non-pharmacological treatments—such as increasing his social interactions.
Finally, if your father is in the Greater Tainan area, the Gynan Psychiatric Department and Dementia Day Care at the Chia-Nan Hospital of the Department of Health are more than willing to assist you.
If you are in other counties or cities, you can search online for the "Taiwan Geriatric Psychiatry Association" to find current geriatric psychiatric specialists or the Taiwan Dementia Association (TADA) and the Taiwan Clinical Dementia Society (TDS) for recommended dementia physicians and service organizations.
Wishing you all the best and good health.
Sincerely,
Ouyang Wenzhen
Chia-Nan Hospital, Department of Health
March 20, 2011

Reply Date: 2011/03/18

More Info

Based on the information you've provided about your father's condition, it appears that he may be experiencing symptoms consistent with a combination of mental health issues, possibly including delirium, dementia, and possibly even a psychotic disorder. Given his age, medical history, and recent hospitalization, these symptoms warrant careful evaluation and management.

Understanding the Symptoms
1. Delirium: This is an acute state of confusion that can occur in older adults, especially after hospitalization or surgery. It can be triggered by various factors such as medications, infections, or changes in environment. Symptoms may include disorientation, hallucinations, and altered perception of reality, which aligns with your father's experiences of seeing "strange phenomena" and feeling threatened by nurses during his hospital stay.

2. Dementia: This is a progressive cognitive decline that affects memory, thinking, and social abilities. Your father's reported beliefs about "bad things" being in his bedding and his fear of going inside the house could indicate a decline in cognitive function. Dementia can also lead to paranoia and hallucinations, particularly in its later stages.

3. Psychotic Disorders: The hallucinations and delusions (such as believing that there are "bad things" in his bedding) could also suggest a psychotic disorder. This is not uncommon in older adults, especially those with underlying cognitive impairments.

Recommended Actions
1. Comprehensive Evaluation: It is crucial for your father to undergo a thorough evaluation by a geriatric psychiatrist or a neurologist. This evaluation should include a detailed medical history, cognitive testing, and possibly brain imaging (like an MRI or CT scan) to rule out any structural causes for his symptoms.

2. Medication Review: Since your father is on multiple medications for his hypertension and other health issues, a review of these medications is essential. Some medications can have side effects that exacerbate confusion or lead to hallucinations, especially in older adults.

3. Supportive Care: Given that your father is living alone and experiencing these distressing symptoms, it may be beneficial to consider additional support. This could include:
- In-home care: Hiring a caregiver to assist him with daily activities and provide companionship.

- Community resources: Engaging with local senior services or mental health organizations that can provide support and resources for both your father and your family.

4. Family Involvement: It’s important for family members to remain involved in your father's care. Regular visits can help monitor his condition and provide emotional support. Encourage open communication about his feelings and fears, as this can help him feel less isolated.

5. Safety Considerations: Given his fears and hallucinations, ensuring that your father's living environment is safe is paramount. This may involve removing any items that could be harmful and ensuring that he has access to emergency contacts.

Conclusion
Your father's symptoms are concerning and indicate that he may be experiencing significant mental health issues that require professional intervention. Early diagnosis and treatment can greatly improve his quality of life and help manage his symptoms. It’s crucial to approach this situation with compassion and understanding, as he may be feeling frightened and confused by his experiences. Engaging healthcare professionals who specialize in geriatric care will be essential in navigating this challenging time.

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