Abnormal Behavior in Elderly: When to Seek Emergency Care

Abnormal behavior in the elderly?

My father is 86 years old.
He has fallen twice this year, and after an emergency room visit, he was diagnosed with a gastric ulcer.
Due to poor bladder function, he currently has a urinary catheter.
He has regular follow-up appointments with both urology and gastroenterology every month.
Since returning from the hospital, he spends most of his time sleeping.
His diet is normal, and he uses a walker to move around.
However, for the past week, he has been getting up every one to two hours during the night to use the bathroom, but most of the time he returns to bed without having a bowel movement.
When I ask him if he feels uncomfortable, he says no.
Previously, he had a couple of incidents where he had bowel accidents after taking a stool softener prescribed by the gastroenterologist, which led to him frequently needing to use the restroom after starting to take Lactulose syrup.
I suggested he wear adult diapers, but he refused.
In January, he exhibited abnormal behavior with delirium, which led to his first emergency room visit, so I suspect this might be a similar abnormal behavior.
However, this time I can communicate with him normally; he just cannot control the urge to have a bowel movement every two hours.
Should I take him to the emergency room, or which department should I consult? Please help clarify this for me.

Wang Huimei, 40~49 year old female. Ask Date: 2016/03/06

Dr. Wang Xiumei reply Psychiatry

If you feel the need to have a bowel movement every two hours, it is advisable to consult a gastroenterologist to investigate the reasons for this change in bowel habits, particularly to rule out any diseases related to the colon.
If the gastrointestinal tract is found to be normal and the individual also exhibits signs of cognitive decline with compulsive repetitive bowel movements, it is recommended to seek evaluation and treatment from a geriatric psychiatrist.

Reply Date: 2016/03/06

More Info

When dealing with abnormal behavior in elderly individuals, especially those with complex medical histories like your father, it is crucial to approach the situation with a clear understanding of the potential underlying causes and the appropriate steps to take. Your father's recent medical issues, including his falls, the discovery of a gastric ulcer, and his urinary catheterization, indicate that he is experiencing significant health challenges. The fact that he has been sleeping a lot and is now frequently needing to use the bathroom, even if he is not producing much, raises several concerns.

Firstly, the frequent need to use the bathroom could be a sign of several issues. It might be related to his bladder function, especially since you mentioned he has a catheter. It could also be a side effect of medications he is taking, particularly if he is on laxatives or other gastrointestinal medications. Additionally, his previous episode of delirium (or "acute confusional state") could suggest that he is at risk for further cognitive disturbances, which can manifest in various ways, including changes in behavior and increased confusion.

Given that he is able to communicate normally with you, it is a positive sign, but the frequency of his bathroom visits and the fact that he is not producing much output could indicate a need for medical evaluation. It is essential to consider whether he is experiencing any discomfort or pain that he may not be expressing clearly. The fact that he has had episodes of abnormal behavior in the past makes it even more critical to monitor his current state closely.

In terms of whether to seek emergency care, it would be prudent to consult with his primary care physician or the specialists he is currently seeing (urology and gastroenterology) before heading to the emergency room. They can provide guidance on whether his symptoms warrant immediate attention or if they can be managed through an outpatient visit. If you notice any sudden changes in his mental status, such as confusion, agitation, or an inability to communicate effectively, then it would be advisable to seek emergency care.

Additionally, if he exhibits any signs of distress, such as pain during urination, abdominal pain, or if he becomes increasingly lethargic or unresponsive, these would be clear indicators that he needs to be evaluated in an emergency setting.
In summary, while your father's current behavior may not immediately necessitate an emergency room visit, it is essential to keep a close watch on his symptoms and communicate with his healthcare providers. They can help determine the best course of action, whether that involves adjusting medications, further testing, or possibly a referral to a specialist if his symptoms persist or worsen. Always trust your instincts as a caregiver; if you feel that something is off, it is better to err on the side of caution and seek medical advice.

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