Psychosis and the Elderly Person

Psychosis and the Elderly Person

I used to be, until fairly recently, a Senior Sister for elderly people with complex needs. I have seen some terrible actions by GPs who have limited or no expertise with diagnosing and treating the elderly person. I recently answered a thread by a daughter whose mother had suddenly developed psychotic symptoms, and the doctor had badly misdiagnosed and treated this lady, leaving her at high risk of falls, malnutrition and dehydration. I have written this for anyone who finds they are in need of more knowledge in order to challenge or just talk to professionals on behalf of their relative.

Poor treatment can lead an elderly person to be put in a Home because of the label dementia being put on them, when this is not the case. Once that label is there, it is very hard for it to be removed, and all treatment from then on is with this label in mind. Anti psychotics are often prescribed, even though NICE guidelines say that this is largely unacceptable and can be dangerous to the elderly.

So if your relative suddenly starts to hear voices, noises and develop delusional thinking, investigations need to be made before any psychiatric label is given. So you will need to ask for, or look for:

• A urine test or chest to be checked, both for infection. Unbelievably these are the commonest causes of severe confusion in elderly people and are often missed or not checked first.
• A full scan of all blood works, by tests which cover all major functions in their body. Commonly poor kidney function, liver function, anaemia (which is common in elderly people), malnutrition and dehydration and many more things need to be checked. Many of these can lead to confusion in the elderly.
• Ask if the person can have a full assessment for a stroke. Many strokes in the elderly do not cause physical disability, but can cause temporary or permanent behaviour changes. Many little strokes can start a chain reaction leading to dementia. If checked early, then this may be prevented. A purely physical examination by the doctor is not sufficient. There should be a specialist x-ray done of the brain.
• Hearing and vision need to be thoroughly checked. I have known people labelled psychotic, when all that was wrong was they misheard or misinterpreted things in peripheral vision.
• Early stages of dementia need to be checked. Only a psycho-geriatrician or psychologist should diagnose this. However, many times other professionals feel they have the right to throw this label around.
• Recent grief can cause confusion in all of us, but for some reason, it is often not noted in the elderly because they often react differently from younger people.
• Hidden alcohol abuse. This is far more common than many relatives care to believe. This especially true in women.
• Recent severe trauma that is being hidden. It is more common than you may well care to believe that women who are elderly suffer sexual abuse. This can lead to PTSD but in the elderly, this is not expressed the same way as someone younger, and can look like confusion.
• Medication contra-indications not noticed by a doctor (common) and a build up of toxicity from medications.
• Infections elsewhere in the body. Cellulitis, which is an infection in the skin is very dangerous and can lead to blood poisoning. The elderly are apt to home treat this not realising how dangerous this is.
• Recent hospital admission for any reason can cause confusion on returning home. Many elderly people have a network of people who help them in the community, but when they are admitted, this may fall apart leaving the elderly person bewildered and depressed.
• Depression. Elderly people often do not react in the classic ways to depression and may see and hear things that are not there as a result. They may also develop delusions trying to account for this feeling. Depression is the single most misdiagnosed illness in the elderly and the commonest reason for the elderly to be labelled as having dementia and/or psychosis. If a person suddenly becomes confused, it is almost certainly not dementia.
• Loneliness. A very common condition in the elderly and can lead to hearing deceased relatives talking, believing false beliefs. I have seen many elderly people admitted with “dementia” which magically disappears once they are in the company of others!!
• Taken to live in a new part of the country. Relatives, often well meaning, take their relative to live near them so they can help them. Confusion is very common with this, and is diagnosed by a doctor who does not know this person as dementia and or psychosis.
• English as a second language. More and more people are coming from other countries to live here in their old age. Culture shock, isolation because of language problems, and loss of close friends and relatives can lead to severe loneliness and depression. Psychotic symptoms are common as a result, but these are temporary if the person is helped by their own culture.
• Different cultural norms of behaviour. I have nursed people who come from cultures where hearing voices is a shamanic event. In Western medicine, this is diagnosed as madness.
• A history of severe abuse from decades ago. I have looked after several people who were in the Concentration Camps in the second world war. As they become older, they remember these events more and more clearly. This can often lead to great fear and anxiety and ‘seeing’ the events as though real. Again this is sometimes diagnosed as psychosis when it is actually PTSD.
• Loss of sleep. Very, very common and can lead directly to apparent psychosis, which again magically disappears with sleep. However, sleeping pills are not always a good answer, as the person can get up in the night due to continence problems and fall because of over sedation. Also waking from a dream and believing the dream is reality.
• Psychiatric meds for anxiety or depression. These too can lead to the person becoming apparently psychotic, when it is the meds themselves causing this.
• Dehydration and malnutrition. Very, very common in the elderly. Both can cause severe psychotic symptoms due to lack of essential ingredients needed for the brain. Dehydration is common because elderly people do not drink enough in case of incontinence. Malnutrition can be present in an obese person as well as a thin person.
• Misreading of a lifetime difference in lifestyle. I have cared for men who were cross dressers who were labelled psychotic because they dressed as women, and had done so all their life.
• Relatives who wish their ‘loved one’ to enter a Home and make things up!! I have found this happen more often than we care to believe.
• Epilepsy which has developed after a mini stroke, which can look and sound like psychosis when they are recovering from the fit.
• Hidden psychosis they have had all their lives, but lived with without incident or medication which has just been noticed because they are old!!

These are the reasons that come to mind after 37 years of nursing. I may have missed some reasons which others can add to the list. As you can see, an elderly person who “suddenly” develops psychotic symptoms, needs a full and thorough investigation before any such diagnosis is given.

If the diagnosis is given, maybe due to organic psychosis (dementia), then you must be on alert to the medication given to them. Overdosing is very common by doctors who do not take into account the elderly person’s body inability to process the drug.

There are a lot of ways to care for a person who has psychotic symptoms and is elderly, which do not involve medication at all. Too often anti psychotic medication is given to stop a person making distressing sounds or behaviour, such as undressing, or screaming. Anti psychotics are NOT advised for the elderly as they can lead to premature death (eg Risperidone and Haloperidol has been banned for the elderly, yet is still prescribed!). If there is no other recourse but meds, then the dose must be extremely low as the elderly person will be grossly over sedated on a dose that a younger person could tolerate. Also it can increase the psychotic symptoms! It should also be reviewed monthly for its effects, something very few doctors are willing to do. As a relative, you must insist that this is done, no matter how annoyed the doc is with you. Regular blood tests need to be done to assess the drug levels in the body as in the elderly, they often build up and are not processed as in the young.

As a last mention, I would like to tell you a story of a lady who was brought to an assessment unit with “clear” psychosis. This lady had lived alone for years in her flat. One day she rang up the landlord to complain about the green mice which were running around. She wanted him to send a vermin controller around to get rid of them. He rang her relatives who came round to see her. She told them all about the green mice and was very angry when they told her this was in her mind as it was not possible. They said they were going to send a doctor to see her. She threw them out in anger.

The doctor came round but she refused him entry as he said he wanted to talk about her false belief in the green mice. Becoming more and more upset at the way she was being treated, she barricaded the door in fear they would take her away. The doctor called the police, who called a psychiatrist. He dutifully arrived and tried to talk to her that she needed this belief in green mice to be investigated and she needed help.

After a lot of shouting from her and ever more patronising comments from the psychiatrist, the police broke in and took her away to the unit to be assessed for psychosis. A week later her relatives went into her apartment to collect some clothes for her. As they were packing up some clothes, the niece suddenly screamed and her husband came to her side. She pointed to the floor, and there was a green mouse! They investigated closer and realised that the edges of the room had mould growing on it, and the mice had brushed up against it and caught the mould onto their fur and sure enough, they were green!!!

Always check the truth before jumping to conclusions. If she had been younger, no-one would have jumped immediately to the conclusion she was mad.

Calypso



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114 comments to Psychosis and the Elderly Person

  • Michelle

    Hi. I ran across your forum as I was seeking guidance for my elderly in-laws. Both the mother and father are in their mid to late 70s. They have 6 children, two of whom are nurses. However, here’s the issues. My father-in-law has been diagnosed with Agent Orange from his military service. He has Parkinson’s disease, is almost totally blind. He has recently lost all ability to “feel” when he needs to urinate or have a bowel movement and because of many falls, he is now either confined to a wheel chair or bed.
    The mother has had a history (for most of her adult life) of manipulating her youngest son into staying with her. She never allowed him to have friends over as a child and teen. Every time he would get a job and try to become a responsible adult, she would make him believe that she was terribly sick and needed him to be home caring for her until he quit his job. If he mentioned looking for work, she would suddenly fall deathly ill or become irate with him.
    Now that she is older, she visits the doctor constantly with one infection after another. She is diabetic, but refuses to eat a healthy diet and will not take her shots on her own. I have to give them to her daily, in which she argues with me about how much she is to take and about whether or not she’s eaten yet. She refuses to check her sugar levels and has even lost her tester.
    For years now she’s wanted to move closer to her other children, but they’ve refused to care for them, citing that it’s the youngest child’s responsibility to care for their parents because he has no job and no life. He is now 40 and has never lived away from his parents for more than a couple of miles.
    The parents refuse any sort of hospice care and the doctors in our area are very quick to pass out meds with very little tests being done. Now, the mother claims to have dementia and is clueless about everything that we question her about. Yet, she has no problems remembering anything. It’s only when we’ve told her that a behavior, such as her manipulation tactics that’s she’s always used are unacceptable that she has problems “remembering” that she’s said or done anything. Her youngest son desperately wants to move out and start his life. The stress is too much for either of us to bear most days. But now that she has an opportunity to move, she refuses. Neither of us have any medical training as do the two nurse siblings, but no one else will care for them. Could she really have dementia,even though with her many doctor visits it’s never been diagnosed. Would she willingly tell people that she’s has it as if she’s proud of it. She really does make it sound as if she is boasting about the fact. Or is it all just for attention? As I suspect may be the case. The nurse daughters tell us that if dad was in a hospice that he’d be on the waiting list to die and nothing would or could be done for him. But, him we can deal with. We understand his issues. Mom’s not so much. Trying to save what little sanity we have left here. I should also mention that she has 21 siblings of her own, plus her 6 children. Her mother is still alive and although in a wheel chair is in better shape than she is. She is determined to keep disease ridden animals (strays) in her home, even though we tell her it’s not healthy. Her home smells of dog urine and feces that we have to clean. When we clean for her she gets upset. When we don’t, she gets upset. She’s constantly wanting things moved out of the house and back in again. She hoards all sorts of things and gets very upset when you try to explain to her that she has overdrawn her bank accounts buying the same things over and over, which she knows and remembers that she has. There is also another adult child who is mentally disabled and an epileptic that we care for along with the parents.

  • Questor

    There is a pattern, here: a relatively well carer/relative seeking information and guidance about an elderly person who is hardly coping and is distressed. What is not represented enough, I feel, is the oldie’s angle.

    I’m 84 and experiencing some of the physical, mental and mood problems described – although not so acutely (yet). I am concerned that I seem unable to get across how impaired I am, or how distressed, either to family or to medics. There is already a communnications barrier, which I sense in much of the above. You are making me feel frustrated and cross!

    Is there a way to get the sufferer’s view expressed here? I’ve heard people say “If I get as bad as that I’ll shoot myself!” They would’nt, of course. Much less would they want someone else to shoot them. But how many of us would be relieved not to wake up tomorrow? Towards the end of life, some of us – or, at any rate, I – do not value life, nor fear the end of it, as we once did. Could we hear more from those who are becoming dependent on what sort of “supporting” attitude they would prefer from the hale and zestful? Are fears and denial inhibiting their help? Are loved ones and medics exhasperating to US? Is communication being curtailed, to a degree, for fear of biting off too much or something?

    I now see how inadequate was my support for both my parents and for my favourite aunt and uncle during their decllines. But then, I couldn’t see things from their point of view. Too late, I’m beginning to.

    Thanks Calypso, for starting this and for your constructive contributions.

  • tula

    My older sister lives with our 85 year old mother. Since father died 2 years ago, our mother refuses to go to a bereavement group, refuses to go to a counselor (would rather use my sister and I as her emotional whipping post/s), refuses to go to the senior center to meet new people. She encourages my sister & I to do more things socially, yet when we try to get together she carries on, accuses my sister of making her look at the 4 walls, and discourages my sister from getting together with me for 6 hours, or any other friend of my sister. Lately, my sister tells me that our mother manages to fall and hit her head whenever my sister goes out socially. She never falls when my sister is there. Basically, I feel my mother is trying to keep my sister a prisoner in her home. Her mind is fairly intact. She still takes care of her finances and her memory is still there. But I’m wondering if she is really falling and hitting her head when my sister goes out, or if she is just saying that to manipulate my sister into staying home.

  • Beth

    Hello, hope you can help/ give more advice.
    My elderly grandad was diagnosed in October 2013 with terminal lung cancer.
    His health before diagnosis was pretty good, along with his physical and mental state.
    He had under gone a course of chemo and radiotherapy however the tumour has only slightly shrunk, unfortunately due to this and his age the doctors have recommended no further treatment such as chemo ect.
    This week he has undergone key hole surgery in his knee, although I’m not sure what the exact reason for surgery was- I wasn’t present I know it was done under a local anaesthetic.
    Since the operation he has been literally having conversations with himself- mostly before and during sleep. He knows and remembers the conversations yet can’t stop himself.
    He has also been having hallucinations again before and after sleep- he is fully aware of what he said when he is awake.
    We’ve spoken to the doctor and she was concerned that his codeine prescription was the cause but he has been off it at least a day and half and there is no change. What do you suggest? Thank you!!

  • thaddeus Buttmunch

    My Father came down with Shingles at 88. He not only has itchy lesions, but is Depressed, anorexic, very weak and bed bound. He was physically quite strong before this hit the fan in March. Some short term memory problems, and post prandial nausea after breakfast, but otherwise OK. He has not seen his ladyfriend for six months, and I am encouraging her to come over. His PMD has him on Lidoderm, Lyrica and Ritalin to pep him up. We are in Michigan. I wish I could find him some medical Marijuana (he doesn’t have a card).

    He is creeping me out with his constant talk of his Grave Monument. I lost it with him today. I want him to LIVE not Die, but told him I would do right by him. I’m all he Has!

  • CeeJay

    I adored your story regarding the woman with the green mice. I suspected that might be the outcome.

    The reason I happened on your site is the fact that my husband’s sister is currently staying with us after her husband of 46 years suddenly kicked her out of the house with no car and no money and no where really to go. She does have a physical disability called Dystonia, which is triggered by severe anxiety/panic attacks. She is also suffering from PTSD, as her husband attempted to “put her away” by controlling her meds – not giving her the right meds or possibly giving her the wrong meds.

    I love her to death, but she talks constantly! If she stops talking she falls asleep wherever she is. I am thinking this is a symptom of another disorder; it could also be due to the fact that she has sleep apnea and may not get the proper amount of sleep, so she talks to keep herself awake. She even will talk to herself if she believes a person in the room with her to be asleep!

    The dear has only been with us for a week now, but her brother and I are really getting more than a little frayed.

    Would you happen to have any thoughts on this? You may contact me at the email I posted.

    Thank you.

  • Mel

    The ambulance was called and my mom was taken to the Psychiatry ER. The social worker said that they were going to run tests on her (i.e. CT scan and blood work) and she was going to stay overnight.

    The next day social worker calls me and asks me if we would like to admit her to the hospital and I said how can we say yes or no if we don’t even know what’s going on. Next thing I know they admit her as an inpatient.

    I found myself in a desperate and convoluted situation regarding my mother’s scenario. This is a first time experience for my mother and my sisters and it seems like the hospital now has full control of her life and that was not the route that we were aiming for.

    They went ahead and did an emergency admission to the hospital Psych Unit. Both my mother and us (my sisters and I) are in shock with her being admitted there against her will. We did not know that they were going to place her in the Psych Ward floor – and she’s currently right now realizing where she is at and its devastating.

    The social worker working with her during the time that she was in the Psychiatry ER stated that they diagnosed her with Unspecified Psychosis and it seems they are focusing more on this more versus her memory loss. The same social worker said that her CT scan and blood work came back normal.

    During one of the visitation hour I attempted to introduce the proxy and I received resistance from the staff. One of the staff told me that she’s currently not capable of understanding the document and that she will or will be best after taking her medications – he then later tried to take back his words. That statement made me feel uncomfortable. And then her assigned Psychologist lost his cool and left the room.

    Her assigned team met with her (one psychologist, one psychiatrist and one social worker) and they explained to her why she was there and she did not take it well. She called me more than two times stating for us to get her out of there and how we could do this to her.

    Also, I had met with one of her Psychologist for an update and/or Q&A. He informed that she refused to take medication – they have prescribed her Risperidone (.25mg) and they plan on giving it to her once a day at night. I mentioned that my mom is a very natural, holistic individual – she has never taken Tylenol, NyQuil or any medications. This is going to be a great challenge and I was afraid of the course that they will take to make her take it. He informed me that they already submitted a request for medication over objection and will administer injections once approved by the judge.

    I am just very highly concern because it seems like her life is in their hands.

    • Stephanie

      I find this highly unusual. What happened that the ER was called in the first place? Any patient has full right to refuse treatment or medications.
      Does your mother have ANY regular doctor who could help you?

      I have often REFUSED treatment on my dad’s behalf.

      Are you in the United States? I hope this is resolved by now and your mother has named a POA.

      My dad ended up in the hospital and diagnosed with ALZHEIMERS just from taking cough medicine for 2 days. He cannot take anything like that without getting crazy and we never knew it because he never took anything. When he got into a nursing home situation they started giving him allergy meds, cough medication and it took us a few years to figure out why he was getting so sick and going to the hospital all the time. Turns out it was allergy and pain meds,,,, and then they diagnosed him with dementia.

      Crazy mess.

    • Micheline

      Hi,

      I read your story and I very much relate to it. I would like to know what happened to your mom, and what did you do. My aunt has been living by herself for 50 years. She is 87 years old now. Because she cant see anymore (she has macula degenerative) 2 weeks ago she hit her head and start seeing things, didn’t remember people, and was talking to spirits, (according to her) anyway, she stayed on the medical unit for a few days, until the psychiatric doctor told me that she was psychotic and probably has dementia. She hasn’t been good for sometimes, but i didn’t know that things would get worst.
      The doctor transferred her to the psychiatric unit and she has been there for a week. The social services refused my health proxy saying that doesn’t worth anything over there. I have been seeing her everyday, and she is very lucid and good. She requested that i bring a power of attorney because she didnt signed any document to me (i am the only family she has here in USA) and she wanted me to take care of her bills and things for her, because she doesn’t know what will happen to her. The hospital didnt allow her to sign anything.
      Everyone tells me that the best is to seek for her guardianship, which I will do, but it takes long time.
      I dont know what to do. She never took any medication, and now i dont even know what they are giving to her.
      How can a system do this to a person? She is pretty much inside a prison (psychiatric unit) cant talk on the phone, cant leave of course, we the family cant take her out and i am worry on where they are going to put her.
      She refused the medication, and they were going to take her to court, but i spoke with her and convinced her that would be better to take it or they would force it :(
      At this point, I am totally lost on what to do. i will talk to lawyers on monday but from what i heard, there is not much to do.
      I am very concerned on what will happened to her and what they will do to her.

      Thank you.

  • Julia

    Hi
    I am very interested to read all this. My 85yr old Mother started hearing voices coming from walls and cupboards about 4months ago. She believes them to belong to a builder working on an extension 3 doors away and says that he can hear her too and sometimes makes nasty comments. She also sometimes hears a woman and child with him. She says that they can channel sound through the skirting boards, plugs, pipes and wiring. She thinks they are using her gas and electricity.
    Despite talking to her neighbours that live on the side where the voices are coming from who assure her that they have heard nothing and have not had a man or child in their house, she insists it is a daily occurrence. I have stayed with her several times, but she either says that they know that I am there and won’t do it or that they are talking quietly and I can’t hear it. She also insists that the same man is responsible for washing away the concrete on her stone steps in the garden as she believes it is his job to go round in a water cart (which plays a tune)and wash the roofs and houses in her street. She has never seen this, but knows he has done it because she hears the tune and ground is wet.
    We lost my Dad last March and up to then she was his main carer and on the whole her memory was reasonable and because of her circumstances, she was quite active. Although her body declined after he died as her spine seems to have arched, mentally she seemed ok for the 1st six months. However, she is becoming really distressed now with these voices and I am at a loss of what to do as she flatly refuses to see a Doctor. I want to move her out of the house, but I am not sure now if this will help as she has lived their most of her life. However, she has agreed to see a Doctor if I move her and the voices continue.
    Can you give me some advice please?
    Julia

  • Andrea

    Your blog has confirmed what I began to realize happened to my mother. She was having balance problems in her late eighties and hitting her head more often than I realized. She lived in Michigan and I in Connecticut so telephones did not tell the whole story despite daily calls to her for the last couple of years. Neighbors kept telling me they had seen her about but didn’t want to invade her privacy. I brought up living with me in the East n she amazed me by jumping at the chance. As I was working full time, I flew in to set up sale of house with her and wonderful agent who began checking on her when she was in neighborhood. Did not expect the trauma she was going through. When we arrived to clean and pack her up, she had lost nearly 20 lbs, down to 80 lb, very confused, very depressed. Driving her East produced more trauma. She adjusted to living in new house but the solitary life threw her into another tumble. I hired a geriatric social worker, found a geriatric internist and then she fell out of the shower one morning when we were both getting ready for the day. We were recommended to have a neurological work up by emergency doctor. Automatic Alzheimer’s label. Didn’t feel right, but he was the MD. Neurologist prescribed aricept (sp) which had her her hallucinating, speaking her mother tongue, and seeing hallucinations. Social worker recommended getting her off the drug immediately and she settled down with in a day or two. Of course, doctor prescribed a months worth which was was over $400 and couldn’t be returned but that wasn’t his concern. She stayed home but I hired a companion for hours I was working so she would not be alone and I could keep working. Then a woman bought the house next door for cash. She would ring our door bell at 2 or 3 in morning drunk as a skunk to use our phone which threw my mother into horrible anxiety on top of everything. When she needed her cataracts done, she could not stay In the two story situation, so I checked her into a local assisted living respite situation for a month, two weeks for each surgery. There she met the love of her life, a brilliant 102 year old gentleman who brought her out of her fog. It seemed like the best thing at the when I booked a two room apartment with kitchenette for her and moved her furniture in. She was able to live in the semi independent section with her beloved cat although she did have assistance with drugs for her eyes, showering, and could use the dining center. She met her boyfriend for breakfast, lunch, and dinner at a table for two until he died at 104. I visited her daily and we went out for afternoon coffee or Trader Joes where she found babies to talk to as parents beamed. She read daily although crossword puzzles no longer interested her. Then after 3 1/2 years, the facility was locked down due a intestinal virus in area they were trying to avoid. When they reopened 6 days later, I visited Mom but she didn’t want to go out so we went up to the pub for pop where she bragged to her friends that she would be a great great grandmother in the next few months- which was true. I left a bit later as she was tired. The next morning I awoke to eight inches of snow and a phone call that Mom had died after her wake up call. Those 6 days of lock down and no visits had been hard on her. She basically stayed on couch with her cat and only moved to go to bathroom or bed. I called her several times a day and we spoke. Meals were brought in during that time to keep people away from each other as a precaution. Basically a clot developed in her ankle and broke loose after she started moving around. We were going to bring her home in the summer to live as I was retiring then. Didn’t make it. I don’t believe she had the diagnosed Alzheimer’s as she didn’t meet the profile but once the label is attached, it seems to change everything especially the way the person is treated and judged especially by doctors and in hospitals where she was constantly sent when she would fall asleep during snow storms and would not want to wake up–a problem I also suffer from but no one would listen. Family must check daily on treatment and conditions no matter how expensive or recommended a place is, and especially in hospitals as they drug the elderly so much and recommend nursing homes as only solution. Many a time I walked the drugs out of her and our geriatric social worker fought the hospitalist who wanted her in a nursing home so she could be released in my care and back to assisted living although I had to prove I had a companion to stay her 24/7 despite my daily visits and spending overnight with her until her geriatric MD cleared her. He was good that way. Got her in and cleared her within days every time. The more the facility sees you there, the more is taken care of–just like in a school. And family must stay as informed and involved as possible. The biggest thing I learned is not to believe what the directors, doctors, hospitalists,and nurses say without close examination. Aging can still be a mystery even to the experts. Labels are easy for the old just like for the young and we want to believe pills cure everything.

  • Judy

    My mother just turned 85 in January. She had an undiagnosed stroke in July 2013. After a month stint in a rehab facility, she came back to her home where I have been taking care of her. She was really progressing beyond everyone’s expectation. She was walking and dressing herself and I helped with bathing. She ate breakfast and dinner. We were progressing to where I was going to have a sleep study for her apnea and have a occupational therapist come in to help with some general hygiene issues. After she had her stroke she lost interest in the church that she has attended probably since the early 1960s. Also she lost interest in reading magazines and books that she used to enjoy reading. I really thought that the sleep apnea as a problem and was hopeful that she would get help for that. On Saturday, February 8, 2013, a old acquaintance from church called. I asked Mom if she wanted to talk this old female acquaintance. Mom took the call. I was in the bedroom with the baby monitor listening. I heard some brief comment from Mom but basically I just thought she was listening to this person. However, it was awfully quiet so I went in to check on Mom and the telephone was on the table with Mom looking straight ahead, and the person still talking on the phone. I took the phone, hung up and called the person back from the bedroom asking her what they had talked about. This women had said that she told Mom how much she and her late husband (my father) were thought of by the church members. After the discussion I went back in and asked Mom why she hadn’t hung the phone or said goodbye. No response. In short order I figured out Mom didn’t know who I was and a neighbor lady who came down after I called her, Mom didn’t know her either even though they had been friends for 20 years. It was soon ascertained that Mom didn’t even know herself. The ER visit that followed found no physical problems with Mom, no stroke or UTI. So home we went.. I suspected that the reaction that Mom had to the phone conversation was in regard to her husband, my father, who passed from cancer in 1987 time frame. I believe that mother never processed her utter grief from dad’s passing but was able to compartmentalize and keep at bay until the stroke which evidently stripped her of that ability. So the Monday after the incident, I asked Mom if this situation was related to dad’s death. That whatever it was we could get through it. I hugged her and said that she had to let go of dad and to celebrate his life by continuing on with hers. I literally could feel the energy leave her body as I sat her back down in the chair. Its been downhill ever since. I can’t seem to get the help to stabilize this situation and now its to the point she won’t take her meds or drink water, though she has eaten breakfast and dinner off and on. She seems to be going into and of these semi-conscious states, with different emotional energy representing themselves during these brief conscious moments. I honestly don’t know how to proceed. It would be one thing if she had an truly professional assessment of her condition but even though I’ve been screaming bloody murder little if no progress has been made to at least stabilize the situation. Does anyone have any idea how to proceed in order to stabilize my mother so we can move forward on an assessment and possible treatment options. I think she may have dementia caused by her stroke and PTSD but that is just a guess. Any ideas would be appreciated.

    • I have just read your entry, which is many months old, so your situation has probably changed. Had I seen this within days of your entry, I would have suggested (not as a professional, mind you) that you ask if it would be possible to treat your Mom for ptsd, or depression. What harm could that bring?

  • Rebecca

    My husband is dying Originally he was picked up for trespassing and resisting arrest by officer. They claim he was intoxicated and out of it. The dispatcher refused to cooperate when I said my husband needed medical attention right away he felt suicidal and wasn’t himself. She said she not a message center. I asked her to connect me with someone else. But she said with out consent by my spouse I couldn’t talk about his situation saying it’s HIPAA law. Refusing
    timely care my husband hurt himself seriously usiung things at the jail. By denying him timely care. David got worse. It was 2 days later when the psychiatrist arrived for assessment. She called me asking if I could take him to a psyhicatric facility, it’s all arranged. I drove 5 hours just to have treatment declined. He. needed to be on a legal HOLD. My husband went home few days later only to find something else to hurt himself with. The er put a hold on placing him right where he was rejected. Over the next month he has severely declined. Lost 30lbs and his mind. He is failing to thrive yet the ER keeps dumping where he’s dying.

    l
    l

  • Hi Calypso,
    I just happened to find this website at the right time. My father is 81 with a very very long list of health conditions but has one STRONG body.
    He is an insulin dependent diabetic (40+ years), Pancreatitis around 8 years ago, prostate cancer (last PSA 10), and enlarged prostate, 80 radiation seeds placed on the prostate 10 years ago, had quadruple bi-pass ten years ago, depression, hypertension, neuropathy in his hands and feet, kidney function 40%, hearing loss in one ear, recently diagnosed adrenal insufficient, and March 2013 had a TURP procedure. He was able to handle all of this until my mother passed away in March 2013. She did everything for him even while battling cancer herself. I had no idea how much she actually did until now that I’m the sole caregiver. The TURP procedure has been the most terrible for him. We have gone through probably 12 catheters since the procedure. Either the catheter would get plugged with flesh (from the procedure) and need to be flushed or he just couldn’t urinate. At one point, his bladder had actually started bleeding and clotting so much they had to irrigate it to get it to stop. That was the most terrifying thing and so very painful for him! I had watched the nurses irrigate his catheter so much that I was able to do it myself to relieve him of his pain. Now he is finally able to urinate on his own but not much control and when he goes, he goes allot! He is now considering the catheter indefinitely. But we have gone through numerous antibiotics due to several UTI’s as well. Which isn’t always good.
    So, he is extremely depressed and often tells me to take him outside to put him out of his misery… but he also has good days, they’re really good and he’s happy. He started falling at my parents house soon after my mom died. So much, I convinced him to move to a retirement facility. Still have independence but surrounded by people that watch him. A month later, he began falling there and becoming disoriented. Long story short… we ended up in the hospital, then to a nursing home for rehabilitation on walking and balance, and now to a wonderful assisted living facility. All was great and he was strong but suddenly 2 weeks ago, he started falling again. At least once a day. Fell flat on his face once, which was not like him. Complained of dizziness and just not feeling right. Remember he has neuropathy as well so he can’t really feel his feet. I know a huge part of this was the prostate medicine called Zytiga he was on. He was falling the last time he started taking it. So, I had it stopped to see how he did. It’s been 2 weeks and he’s a little better. But, yesterday the nurses found him wondering the hallways in just his open robe. Not knowing where his room was. I got there and he kept fidgeting with his feet. I asked what are you trying to do? He said, “Trying to get my damn socks on!” His socks were not even near him. I put his shoes on and 5 minutes later he’s in the closet frustrated cuz he can’t find his shoes. He was having strange hallucinations like that. Saying very strange things like what kind of shirt he wants and to not make a big deal. He’s not fancy. Not sure but I think he was talking about his funeral? I took him to the hospital. I thought he was dehydrated and maybe a UTI. Well that’s what it was but the Dr said both very small and not enough to make him be so disoriented. Gave him a 1/2 bag of fluid and an antibiotic. Today he was MUCH better but couldn’t remember yesterday too much. He had done this twice before with months inbetween each episode. One night he was found in his garage with the flashlight looking for a saw (instead of turning on the light). Another day, I walked into his restroom where he had been standing there naked fighting with his catheter saying, “It’s broken!!” There wasn’t anything wrong with it but I could see he had been sweating fighting with it for so long and exhausted. I just pretended that I fixed it. He was so relieved.
    I hate to call it dementia because he is fine most days walking around the place talking and laughing with everyone. Then I think it’s allot of grieving. He just balls thinking of my mom. He says he sees her at night, hears her talking to him. I don’t want the Dr’s to just give him another pill!! I never argue with him about anything that seems like nonsense only because I don’t know if it’s Alzheimers, Dementia, or what. I want him to still tell me everything, I think that’s important. I just don’t know what to do. He wants to be with my mom so very badly but then again he wants to stay with me but not as a burden. He just doesn’t have that one thing to take him away like my mom did. I’m sorry this is so long but obviously allot going on. Thank you for your time.

  • Angela

    Hello my grandmother is 76 yrs old. She has been having problems with mental illness for 20+ yrs. She thinks anything from she has bugs under her skin, to the drs put something in her to kill her, to aliens abducted her and put something in her to mess with her genes. She acts out everything to the extream. Her newest thing is now that shes in her late 70’s her skins wrinkled and flabby…. but to her, her flesh is falling off… im about to my point, i have 5 small boys to take care of and im trying my best to be patient but she refuses to take any type of medication to do with mental. Anything associated with the word she goes into a fit. I dont know what to do… i cant get her the help she needs and i cant continue to take care of her in her current state. Everyone else in our immediate family has already tried taking her on. But she next to impossible to deal with. All she ever talks about is how everyone wants her out the way, and no body cares, and eveyones out to get her, then you hear how she eat up with bugs and something is under her skin and shes dying. Shes extremely dramatic. Looks at everything with a worst case scenario outlook…. any advice before i end up in a straight jacket myself?

  • Lorna

    Hi my Aunty is 83 yo, she admitted to the hospital last dec 25 2013 to jan 2 2014. The problem with her is UTI, while in the process of antibiotic for her infection it happen that she keep on talking with sizzling looks like she talking with somebody. My Aunty is very choosy with the food so she always complain food is not good and doesn’t want to drink too that’s she dehydrated as well. Her daughter & husband passed away already for her life is no meaning already because of her very poor of eating..she always said she want to die bcoz she’s not happy anymore. Now we are here in the hospital bcoz of same problem poor appetite and recently she got a cataract on her eye and suddenly she cannot see anything and alway s complain dark. She admitted again last jan 6 at the same we want to do the eye cataract surgery so tgat she can see well and appreciate things..but now she doest want to take any medication to make her strong…she is also under the malnutrition so the operation cannot be done asap. I want to know if her condition of always to want to eat and take meds do we need to confront a psychiatrist? Bcoz to me her mind already focusing on negative side that’s she doesn’t want to eat and cooperate to have balance nutrition on her body so that surgery can be done asap…can you give us an advise where the best thing to do with her…psychiatric will help?

  • Uni

    Hi, My dad is 90 years old and pretty healthy except for memory issues and my sister says, dementia. Since I’ve been caring for him for the last 2 years I’ve allowed him to go off his pills and go all natural. We get blood work and I research whatever natural foods, herbs, spices, will give him what he needs to bring up his levels, for instance, they had him on thyroid meds and he wanted to quit taking them. I let him. I learned that my sister had insisted, when she was caring for him, that he quit drinking milk and instead drink soy milk. Now I find that soy damages the thyroid. We are trying to undo the damage. Level is low and I’m trying to juice thyroid tonic for him.

    However, my concern is his reasoning and I want to get him to do some mental exercises like reading, but his eyes water and he won’t read daily or even weekly. Today he was singing along with the TV. Is that a mental exercise by any chance? I asked if he would try putting together a puzzle as a new year resolution for mental exercise but he was unenthusiastic. He was in an auto accident 2 years ago and lost all memory of all of us in his immediate family. He remembers his World War II stories though, as if he was just there last year. I’m trying to capture them all, but for now, I try aloe vera and every food and herb that helps to bring down inflammation, because I don’t believe it’s dementia, it could be inflammation in the brain couldn’t it? His lack of reasoning could be just from that accident, and I want to fix it. My dad was the wisest man I ever knew, always reasoning with sound judgement and I want that back. Now, he hardly even looks around when he’s looking for something, only straight ahead. I want to buy a tape or CD that he can listen to and repeat things, or something like that, a game or DVD that would take him through some reasoning exercises. Please is there anything out there like this? And if so, when can I buy it. Thank you so much for your help!

  • Kaylee

    I have a problem with my grandmother(79yrs old). For about 5 years now she has been constantly threatening to take her life. She landed up in hospital twice for taking too many sleeping tablets..

    I moved in with her on the 1st november 2013. For the month and 22 days I have stayed with her I have learnt that something is very wrong with her.

    She wakes me up at 12am, 1am, 2am, 3am,4am,5am bangs on my bedroom door, swears at me.

    If I go to work she phones me and says that if I come home from work ill find her dead because she wants to die.

    I came home from work another time to find her drugged up on sleeping pills,I knew it was the sleeping tablets!!

    She lies like this for +- 4 days and I don’t know how to deal with her manic episodes!!!

    She is causing me a great deal of stress.

    None of her children talk to her because they say she abused them when they were young. Her son lives in Dubai and will only visit when it suits him.

    I’m 22 and stuck in a house of horror!! She is mentally, emotionally abusive and she regularly picks up weapons to threaten me. She walks out in the street at night and regularly hallucinates crazy things!!

    I have made a plan to move out as she has made my short stay here intolerable.

    What can I do to make her get help? I’m alone on this! She is a danger to herself and others

    Thanks

  • Janine

    Hi please could you give some advice,my nan is 84 years old age,and of average health.but since Wednesday she has been saying some very weird things,like she’s pinched lots of money off a neighbour,which is untrue,saying she’s going to comit suicide,that’s she is so embarrassed off herself.She was very much the same on Thursday,so we called out the doctor who did various tests.friday she was the same,although after her sleeping for 2 hours we could not wake her what so ever,the doctor came again,he could not do anything,all the tests he had done came back clear,so she was taken to hospital with help of oxygen in the ambulance.
    She eventually came around saying she didn’t mean what she had said,hospital wanted to keep her in for further tests
    .she was talking about suicide and the stolen money again Saturday.Then whilst visiting today she was slumped in the hospital chair,staring into space,not talking.the hospital are not telling us what they think is wrong or what they are doing about it.i don’t even feel their looking after her properly,she was freezing cold,no pillow to support her head whilst in the chair.
    It is awful to she her go like this so quick,do you have any idea what it could be? Please x

  • Patricia

    My mother has had 3 surgeries in the past three months. Her knees and tendons. Since the surgery she ask all the time about her legs. Its weird, she can remember who was at her house yesterday and what she watched on television. But then she will look down at her legs-the left one still has a brace on it for a couple more weeks-and she will ask, “did I have something done to my legs”. its like she has blocked it out or something. She is in her mid seventies. My 81 year old dad is worried sick. its really hard to keep a brace on someone who cannot remember anything about surgery. She will make statements like, “well I just got up and walked in here this morning”, why cant I walk now. driving us all crazy, as we try to help her heal properly. She has never shown any signs of dementia. but we are about to lose our minds. I was reading another post about a lady seeming to be a little out of it. Same here. She will seem fine one minute and then she will repeat herself and say, “, what happened to my legs”. She is not very mobile yet, so we keep thinking it will get better. Any advice on what we should do? or just give it a little more time? Any help is appreciated.

  • Holly

    Hello. I just stumbled along your website here… My grandma is 94. We just moved into a new house 3weeks ago. about 7miles west. we lived in our other house 7 years. Ever since we moved into the new house she was kind of acting different she did not do the same things her routine was off… that is very understandable especially in the elderly. Last week she started acting funny and asking me weird questions like how can I open this pan, how to get cold water or how to turn off the stove things that she would never ask me normally. She also started to think that we were saying things about her when we weren’t, she even called her cousins in Maine to tell them that we are being very abusive to her and she wanted to move to Maine with them. She has lived with me and my parents the day I was born 25 years ago. Then on Saturday night she woke me up out of my sleep from the room next door saying help me help me her head was down and she was acting very strange she kept saying help me help me over and over again thing it won’t stop it won’t stop I’m dying help me. We called 911 . they took her. They did so many medical tests from couldn’t find anything wrong with her she does have kidney disease but her numbers have been stable for many years now. I went to visit her yesterday and all she was doing was staring up at the ceiling reaching for air in thing random nonsense when you ask her questions sometimes she could answer them. Other night she had ripped out all her IVs and was slapping the nurse sometimes she is good sometimes she isnt. I guess they said that she had a mini stroke or bunches mini strokes no one is really sure and of course they’re saying dementia and moving her to the dementia unit in the hospital for now until we can figure out what to do next. I feel so guilty because me and my parents sometimes lost patience with her and werent always nice and I feel like what if we pushed her to have this happen I just hate how she is and seeing someone in the state of mind is so horrible please help:/ i love her so much!

  • Emma

    Hi, just looking for some advice. My nan is 99 years old and living in her own home, independently up until about 3 months ago. She has problems with the heating pipes at her home which make a rumbling noise. Even though we have spoken to the neighbours she is still excessively worried she is causing a disturbance. A few months ago she started to hear a man’s voice shouting next door(no man lives next door and nobody else can hear the voice), complaining about the noise the pipes were making and he had not slept. This happens every night/morning. About 3 months ago she had a chest infection so family took it in turns to stay with her day and night as she was too weak to do anything for herself. However, after making a good physical recovery, mentally she has declined rapidly and now feels too vulnerable to stay at night on her own so for the past 3 months family have taken it in turns to stay with her. In addition to hearing the voices she has now become very depressed, low mood all the time, tearful, not interested in anything, poor concentration, poor sleep, worrying excessively, anxious, feeling like a burden. I have talked to her about getting the doctor to call but she is very reluctant. I don’t want to go against her wishes but she can’t go on like this, should I call the doctor out? Many thanks.

  • Vaughan

    Hello, My mother (80yrs old), over last 6 months has had hallucinations of cats, people dressed exotically building complex structures outside her house, children entering and leaving her house and other various delusional stories tied in with all this. Passed 6 different dementia tests, Charles Bonnet ruled out, Lewey Bodies ruled out, Parkinson’s ruled out an epilepsy ruled out. Had to be admitted to psychiatric unit 5 days ago. Is still as sharp as a pin with her memory, but yesterday Psychiatrist informed my sister, who worked with elderly for 22 years, that they think it is Dementia and want to move her to Dementia ward. Sister asked had they done a full Psych assessment, answered no, but will at her request do it!! This is scary. What is going on? Can they do this so quickly? Seems calmer in hospital. Surely she should be given a chance to come out of this before being labelled Dementia. Also if she can’t go back to her own house is this labeled Social Care (ie pay out of her own means) or is it under NHS care? We want what is best for mum at each stage of her life.

    • If there is no problem with her memory, I am very surprised at the dementia label. She needs a proper psychogeriatrician to assess her. Small strokes (TIAs – Transient Ischaemic Attacks), or any number of other things could be a cause. To put her on a dementia unit is quite a step, I agree with you. On there she will be with people of all levels of dementia, and that is not healthy, IMO.

      Demand a proper assessment. Also ask the question, if she is living quite happily with these hallucinations, is there any reason she needs to be on a ward? You can demand a “package of care” in the community, and they have to give it to you. They don’t like it as its expensive, so go and ask. I mean, seeing cats, children and odd people, isn’t the end of the world!

      I am struck that she is calmer in hospital. That could mean that something in her environment at home is triggering her. It could be worth looking around. I take it she is widowed, bu the elderly don’t always “get over” grief at all, so that’s another area to look at.

      You have to ask, are the psychiatrists erring on the side of caution to cover their own backs, or are they putting her needs first? The former is oftent he case.

      Please come on the forum and look at our dementia forum and talk on there.

  • Cathy

    Please Help…. August 20, 2013 my 72 year old mother went into the hospital for bilateral knee replacements. Surgery seemed to go fine. However, she started to hallucinate and get angry with us. They did find that she had a UTI and started her on antibiotics. She was confused as to where she was and accused us of “putting her away”. we finally found out that she was allergic to morphine. They changed the pain killer and the hallucinations went away. She had to have a second surgery nine days later as one of her knees buckled due to a torn patella tendon. We brought her home 4 days later. using a lift, wheelchair, and slide board we have been making. The other knee has done the same thing. Surgery on that tendon is scheduled for October 22 nd. I’m really concerned with the anesthesia. Last time the doctors kept treating us like we were crazy and asking us if she had ever done this before. She has never had memory problems or short term memory loss. There are days she still seems out of it. Could anesthesia be the culprit? I don’t know what to do or who to ask.

    • Hiya

      I would keep maintaining that there is no sign of dementia to the doctors. Anyone confused and elderly and they jump to conclusions sometimes. Anaesthesia that often for you or me might make us confused and a bit off. Someone who may not be in the best of bealth to start with, yes it could well be that. But I will say that modern anaesthetics are very good and not nrealy as much of a whammy on the system as they used to be.

      I would keep mentioning that she is allergic to morphine though. Its amazing how these things can get lost and one doctor doesn’t know what another has found. What worries me is when the anaesthetist talks only to your mother and may not get the full picture.

      Even though she has had some antibiotics, I would insist they check the urine after the course has finished, if she gets confused. Sometimes the infection hasn’t quite gone and a few days later it reappears. They may want to wait a few days before re testing as the antibiotics in the system will muddy the picture.

      I learnt the hard way that it pays to make a total nuisance of yourself, put on a thick skin and don’t let looks or anything put you off feeling totally sure about all the answers. My husband was in for 3 and half months and I was very uneasy about certain things, but only when everything went wrong did I find my voice, if you see what I mean.

      I suspect that all these ops may have something to do with her “being out of it”, and any meds they may have changed or taken her off whilst having the ops. I wouldn’t worry too much yet, and give her tie to recuperate. She may well bounce back in the longer term. I hope that may help.

  • shannon

    I was so thankful to find this website and nearly cried when I read your introduction because I’m so afraid that we are falling into the same dangerous situation with my grandmother and her GP.
    My grandmother will be a healthy 100 in three weeks. She has lived by herself until about a month ago when she moved into her new basement apartment in my parents new house. Other than talking about the weather and asking certain things over and over, she really doesn’t have an issue with memory. But in the past two weeks, she has started waking up during the night, appearing to have a bad dream, one hand tightly holding her other wrist, thinking that it’s something “getting” her. It happens two and three times each night. She has to be brought out of this sleep or trance and be shown that it is indeed her own hand that is “getting” her. We even found her standing at her dresser beating her hand on it (with the other one) trying to kill it. She takes the lowest dose of Xanax every night, and has for 15 years since my grandfather died.
    So we called her GP a few days ago and described what she was doing and he called her in a prescription for Ativan and said to discontinue the Xanax. She’s been on the Ativan for two nights. The first night, she fell going to the bathroom and hit her head and bruised her ribs. Only had one bad dream early in the night. The second night, my dad slept in the room with her and she seemed to dream or hallucinate off and on, all night long. Telling people to stop hurting her, etc but never cried out in horror like she did before.
    I guess I my question is, what could cause this sudden night terror? You have explained some things to have checked. Thank you for an informative article.
    Does anything stand out to you in this case? We are desparate. My parents need sleep. My grandmother is scared. :(
    Many thanks, Shannon

    • Hello Shannon, nice to hear from you. She has just moved a month ago, so it could be the move which is scaring her. She isn’t surrounded by her usual things in so far as they are not witin her bouse. Having lived alone for so long, you have no idea if she actually had been having these things before. She could have been.

      Night terrors are awful for anyone, but I would doubt it is psychosis. Being 100 ( amazing) she will almost certainly have frail kidneys etc and would suggest they get checked out first. But honestly, if it was that she would show signs in the daytime too and you say she isn’t. That leads me to suspect it is psychological and possibly about the move. Elderly really don’t cope well with this.

      i know you probably have thought about this, but can a nice soak in the bath, milky drink and soothing music help? Obvious, but we sometimes miss the obvious. I am reluctant to suggest medication in someone so frail, and as you saw yourself, a new sedation can make someone fall in the night. All sedation can do that.

      It might be worth asking the GP to have an interview with you or your parents as well as your grandmother, with a psychogeriatrician. ou may have to insist, as there aren’t many of them and they usually won’t refer someone easily. But tough, your grandmother deserves the best!! He may be able to come up with something to help. Push for it. And if she falls again, call the GP back. You will need others there for the interview, as she may not remember much.

      What does your grandmother say about all this? Does she have an views on it? Maybe she will tell you that she has had this for years. Even though her husband has died, it could be terrors over being alone too.

      But the psychogeriatrician is your first port of all I think. As I said before, if it was psychosis, it would manifest in the day time too.

      Best of luck. xxxx

  • Barbara

    I am having terrible problems with my mother. She has been suffering from some type of dementia but it has worsened very rapidly in the last few months. She will be 88 tomorrow. She was being treated with Namenda and an anti-depressant (don’t know which one) and she had become at least more reasonable with my Dad. But then she had some episodes where he could not wake her up and she ended up in the ER. So the medications were stopped. They did every test and scan in the book (including CAT scans and an EEG) and found nothing whatsoever physically wrong with her. But after a day or two in the hospital she is completely delusional, seeing all sorts of things and almost no connection to reality at all. She is eating better, which is kind of odd, but good. But she is also being combative with the nurses and yells at my poor father (and me) to be quiet and leave the room. He cannot care for her at home like this, and they are talking about putting her in a geriatric psych ward to see if they can get some type of relief with medication. What on earth has caused these hallucinations and what can we do to help her? She seems to suffering mentally, even in her sleep she has nightmares and is agitated. This is so very hard on all of us, including her (or mostly her).

    • I am so sorry to have taken so long to reply. I hope you might see this. Personally, I would insist on getting a psycho geriatrician involved and a full assessment from them. But I don’t like it if they just put her on more meds. If she has been diagnosed with dementia, then you could look on the web page ( like this one, only another label) I have written on dementia on this web page too. It might give you some pointers in what could be done.

      I think that might help more than me rabbiting on here. If not get back to me.

  • Jen

    My mother-in-law is 83 years old and currently lives in the locked unit of a nursing home. 7 years ago she was living independently when she began hearing voices and having paranoid delusions. She stopped eating and taking medications, began to sleep on the floor, stopped letting people into her home, etc., at which point she was diagnosed with delusional disorder and institutionalized. She was placed on antipsychotics and sedatives (in addition to her meds for diabetes and high cholesterol), and the delusions remained. She was progressively moved through increased “levels of care”, although her condition remained largely unchanged. About 6 months ago she had a severe case of pnuemonia, and subsequently appears to have suffered a stroke (speaking and swallowing difficulties, one-sided weakness). All of her medications were discontinued due to the swallowing difficulties. Subsequently, all delusions have disappeared and, for the first time in 7 years, she appears to be completely normal mentally. Are there any cases of strokes reversing psychiatric symptoms such as this? Your insight would be much appreciated!. Thanks.

    • I am so sorry to have taken so long to reply, I hope you do get to read this.

      I would think its taking her off all those drugs! The elderly don’t do well on drugs and I hate to see them on them. As you said, they didn’t work either. I have no idea if a stroke can “cure” anything like that, but I suspect that is a red herring.

      Anti psychotics are very powerful and have loads of side effects. They have been largely stopped as they can increase the rate of strokes and heart failure in the elderly.

      I get so despondent when I hear of people being loaded up with drugs rather than listening and dealing with them in a thought out way more. I wish you all the best and hope it remains like this for you and for her.

  • Tim Ensign

    Hoping someone can help, this is not a joke and I am reaching out for some advice here . My 80yr old father has recently started telling us he is hearing a voices that tells him not to drink or eat anything, if he does it will cause him to die because he has no stomach??? he has been telling us other random stories like this as well. He has no memory loss and I believe the situation is aggravated when it is quiet or he is trying to sleep , he gets very restless and fidgety.

    Please Help,

    Tim Ensign

    • Calypso

      This is tricky for me to answer on a forum, but I will try. The thing which jumps out is that this happens more when he alone and very tired. In the elderly, things can have dramatic effects when a little is wrong. I would suggest that you ensure that all the blood tests I mentioned in the article get donw. Elderly often have poor functions at the best of times, so any kidney problems means that toxins circulate in the blood stream causing thought changes.

      As with the person below, if nothing physical is the cause, then insisting on a psycho geriatrician to assess him, is a very good starting place. Also remember the elderly don’t often show depression the same way as we do. If you try and interpret what he is saying, it could be that he feels he is dying perhaps.

      Remember, if he isn’t drinking enough then dehydration is an issue. It could be that he has chronic dehydration. If you take his hand and gently pinch together the skin, if it doesn’t bounce back immediately, then that is a sign of dehydration.

      So basically, if all the physical things are normal for his age, demand a psycho geriatrition for a full assessment, and say its urgent given the nature of your father’s delusion. I hope that helped.

  • Michael

    My father is 87, and had an intestinal blockage which required surgery. Fortunately, his intestines had become twisted so the surgery wasn’t as invasive as we first feared. For an 87 year old man, the surgery did take a lot out of him.
    He has been recovering well, his bowls are working fine and by all other measures; recovering. He has had significant pain, but now it is being managed. We have hit a road block with him, he is wanting to die. Although he has been showing signs of recovery, this attitude will likely kill him. The last time he ate it caused him great problems, so his stomach had to be pumped to remove the contents. The doctors say there is no reason now why he cannot eat, but he refuses to.
    What can we do?

    • Calypso

      I am so sorry to take so long to reply to you and I hope you have managed to resolve this problem. Has you father been put on anti depressants? Being away from home, going through major surgery, to him, can make your dad feel all too mortal. Plus would add that anaesthetic can be highly depressing to an older man.

      I would advocate getting a psycho-geriatrician to talk to him and come up with reasons he may be feeling this way. You may have to insist on this, but as you say, your father’s life is at stake here. Sometimes you have to wait a little time for this to happen, but keep insisting.

  • Carol

    My mother is 96 years old and lives by herself with two live-in care-givers. Last November she started singing do-re-mi, mi-re-do on and off during the day. Thus she was prescribed PMS-Quentiapine, Paratin, APQ-Memantine & Nalion, by a psychiatrist. After she stopped singing, she started making noise most of the day. So I called a geriatric doctor who recommended weaning her slowly from these medications. When she stopped taking APQ-Memantine, there was no ill effects. But when we decreased the dosage of PMS-Quentiapine from 25mg to half, the level of her noise-making has increased.

    It seemed that she has no control of her tongue. Her mouth is always open with her pushing her tongue to the left side of the cheek.

    What’s the cause of her making noises during most of her waking hours? She doesn’t really talk any more. If you ask her a simple question, she’d answer in a slurry way. She sometimes recognizes me and other times doesn’t.

    • Calypso

      Hello, and thanks for the post. I am a little surprised at the quetiapine, but on the dose you mention, it is a very low dose. Its a major tranquiliser, but used in these doses as a mild sedation. I am surprised that she was taken off the Memantine as this is for people with mild dementia, to help them with memory problems. But I am not a doctor, so don’t quote me.

      When someone has dementia, you have to go where they are. So if she is making noises, can she tell you anything about why? I suspect not though. Was she musical at all in the past? Music is very powerful in helping people with memory problems. But there is a tendency to get the era of music wrong. Its about playing anything she used to like, not just of her era. Sing with her and use gentle touch and smiles. People who may have dementia, respond very well to body language being positive.

      You could also try memory boxes. We used to make boxes with things which would have been important to the person and occasionally, taking them out. If there could be different textures, as well as visual and possibly smells – for instance, when I get older, I want Chanel No 5 (LOL). But talk and smile, and make sure she can hear you. Talking of hearing – has anyone checked that she doesn’t have blocked ears with wax? Its another mild possibility that she cannot hear well.

      We used to teach that all Motion is Emotion. So she is trying to communicate something in her world. You have to try to reach out to her, she can’t reach you. Asking a lot of questions usually confuses people, so try singing the doh re me back to her, to show you have heard her. Lots of touch, if she doesn’t mind, smiles and tastes. The five senses can reach people better.

      The mouth movements are a little worrying – they can be a side effect from drugs at times – its worth asking the doctor.

      I wish I could help more. xxx

      • Calypso

        Oh I meant to add, head massages and hand massages can have a very strong effect to help with calming the person. Get onto the Alzheimer’s Society for lots of info on helping her. They are very good.

  • KayV

    Hi. Reading this has really opened my eyes. My nan has recently (within the last 2-3 months) gone severely down hill. She is seeing things (such as her walking stick dancing, air freshners kissing, children following people around the house), doing things (such as putting her cutlery in the kettle, making cup-a-soup with milk for breakfast, losing house keys, hiding things) and also making things up (says she has been out in the night walking the streets when this is not even possible as she can’t walk more than a few steps unaided). She had a brain scan last week, and we are due to get the results on friday. she has previously been treated for water and chest infections, but netiher lot of antibiotics seems to of helped, maybe slightly, but she just goes straight downhill again afterwards. She is currently under a lung cancer specialist, and the fear is that it may have spread to her brain (hence the scan last week).. But reading this has given me a tiny bit more hope that it may be something different. Only time will tell obviously, but its good to have a bit of hope x

    • Calypso

      I can only hope the scan is OK. I am sorry you are having such a bad time. I can’t suggest much because the brain scan is the key here. If its not secondaries, don’t let them stop there. You say she doesn’t respond to antibiotics well, so can they get a sample to see if she has a bug which is immune to most antibiotics? I hope its not that, but MRSA does occur in urine.

      All said, I really hope things work out for you and your nan. xxx

  • john fitzpatrick

    hi , have you any advice my father of 74 as become paranoid for about 10 weeks, thinking my mum as been trying to make him mad and that she is playing mind games,
    my mum is a lovely woman and doing nothing of the sort, we managed to get my dad to see someone and at one point we took him to a&e, we had all kind of test but he’s physically fine,
    he seemed to be ok for about 2 weeks and now he’s now decided he wants to leave my mum, but he doesn’t know the reason why as he still loves here, it is very confusing
    we know hes not himself but not sure what to do, my mum is devastated

    • Hiya and so sorry to take so long to reply to you. It could be that your father is getting TIAs – Transient Ischaemic Attacks. These are tiny blockages in the brain which clear very quickly, but can lead to a stroke eventually. I am sorry if that is blunt, its just an idea – obviously I can’t diagnose from here.

      Has he been assessed for depression? That is another possibility. Sometimes elderly people feel they are no longer worth anything, that they are dragging another person down, and so do things like this. Elderly rarely show depression like younger people do.

      These are just two ideas, but its something a trained psychogeriatrician might be able to get answers. You can ask to see one. Occasionally, a person will talk more easily when alone and can talk about their issues. I would suggest you don’t give up yet. Physical tests only take you so far, it could mean another route needs to be opened up.

      I hope that helps and I hope that its not too late to answer you.

  • frances

    Thanks for the helpful and informative posts which I find very reassuring. Am taking 90+ year old mother to the doctor tomorrow as she is hearing voices which she insists are real. She lives alone and can converse normally about everything else but has poor short term , memory and becomes confused if she stays with family members. We suspect part of the cause may be loneliness but fear she may lose the plot altogether if we move her as she has lived in the same area all her life and in her current house for 68 years. After reading these posts I feel more confident about talking to the doctor who I’ve never met and will make sure my mother is not given drugs without being assess.
    Thanks

    • I think it is normal to talk to people who may or may not be there in a way. I think if your mother is OK in every other way then leave her to it. If your mother is happy with her voices, don’t let the doc put her on anything!
      Some doctors are obsessed with giving out meds!!

      As for moving her, you can insist on a “community package” for her. They don’t like it because it costs more money – but hey, fight them on that. You may find it easier if you can get a social worker on board. Again, don’t take no for an answer. It is really hard to know what is out there so maybe think about giving Age Concern a ring?

  • Alexi

    Thanks for your article. Very useful.

    I hope you don’t mind me asking on here, but I am writing a fictional piece on an elderly person who has recently been widowed. I just wondered if you could say in your opinion if it was very unlikely that he would talk to her on an unplugged phone, refusing to believe that she was gone and hearing her voice on the line? My grandfather talked to my grandmother who passed away as though she were in the room, but we were never sure if he really believed she was there… I don’t want to misrepresent anyone as I think there is probably enough of that on TV already!

    Thank you

    Alexi

    • Hiya
      Sorry to take so long to get back to you. It would be totally normal for a widowed person to do that with a phone. I am 56 and lost my husband last December and I send him texts every now and then. I want to have a way to talk with him.

      It really doesn’t matter if they think the person is there or not. Grief can take a very long time and with elderly people, it may never go.

  • Just to say that I am sorry I have not answered any of these messages. I have been away and also forgot to check on here. Thank you for you kind replies. To the lady whose mother is on all those drugs, SHOUT very loudly to get some help and get her off them!!!

  • rene maia

    Hi, i have read your post with interest. My dad recently had a fall (hit his chin and head) and then contracted cellulitis. He was treated with various antibiotics which did not work and was eventually admitted to hospital where the treatment worked. Since his return he has not recovered. The cellulitus has gone although he says he can feel the bugs moving around, but he gets very confused, does not know who anyone is, which is very upsetting for my stepmom, does not eat and what he does eat he brings up and sleeps all the time. He has got weaker and weaker and again fell after trying to go to the kitchen at 4 in the morning. He has been readmitted and they have now inserted a catheter (under sedation) to feed him and medicate him. They say the confusion was a result of dehydration and no food but no improvement seems to have been made mentally and physically. He has now been in hospital for a week, but is just as confused and still sleeps all the time. A bit of history. My dad and stepmom left South Africa, lived with me in Portugal for 6 months, then moved to Australia to be with their son. However they were not able to stay there permanently and moved to Bali which is the closest they could settle near my brother. It has been a lonely existence for them these past few years but only since the fall and the cellulitis has this has he become so confused, weak and sleeping all the time. Doctors have done blood tests, x rays etc and can find nothing wrong. Any help or suggestions would be most appreciated. thank you

    • You probably won’t get this as I have only just seen it after a long time away. But just to say that confusion can be depression too. Elderly people do not show depression the same way that younger people do.

      I would also say that there may be some dementia, but I cannot diagnose on a forum obviously, but we do know that once someone has their centre, the place they live and the daily routine taken away, a level of dementia may show up more. People in this situation can still get back a lot of what they have lost with the correct help from the community medical team.

      However, don’t jump to that just yet. I presume that they have tested everything like kidney function, liver function, sodium, all the different types of tests for anaemia etc etc. You have to watch that all of this is done. However, there is one other possibility, and that is that the cellulitis is cured but there is an inflammatory response still going on. What I mean is that people can have an inflammation even after the infection has gone.

      Sorry I can’t be more help. xxx

  • lynn white

    Found this really interesting and I have also found it encouraging.my fathers has just moved into sheltered account after living with me and my partner for the past 8 years.it was getting increasingly difficult for him to climb the stairs and as i have to work 10 hours a day has been a very worrying time.after moving within a couple of days he has become very confused at times to the point were I’ve brought doc in who had him admitted to hospital.brain scan shows short time memory loss but hosp still haven’t checked for urine infection after numerous requests from me.I had noticed a very strong urine smell when emptying his commode.there now discharging him with him still confused most of the time and he seems angry with the world.we have as a family discussed a care home but after reading this article are going to sort a carer out for times during the day and see i this confusion settles down.he’s 81 with limited ability and doesn’t want to go into a home.very difficult to know what to do and is causing us all great upset.

  • hello my father inlaw as recentley found out he was placed under such an act. this was purley to get control of his money by the power of atorny.now the family question fraud by her. the police are involved. and we need our dad to get this order removed.its difficult. but our doctor says, no he has short term memory loss.she took advantage because dad was not wearing his hearing aids. and had recentley gone through hip replacement.we know she has creamed him. kept him short of money. how do you deal woth this kind of bad power of atorney. we have waited since christmas.for police action. poor dad has not got nothing.he had to ask her for every penny he spent. then learnt he had been placed under the act.please direct me on what to do as dad is freating in a care home. after a fall.he is in sound mind the nurses know and security in place. but the case is dragging on and dad has no chioce. i have today gone to an independant solicitor.

  • chris

    my mother has bad tinitus and constantly hears loud noises of all types , this then developed into hearing voices through the wall and she was sure she is being persecuted by someone , but for the last two weeks things got much worse , she started talking to a few imaginary people and is convinced she is getting married , she waits at the window for this person and the imaginary preist ,she is in her eighties and insists on going out on her own , she lives with a relative who lets her out in the daytime but my mother now wants to go out at night because she’s convinced that her imaginary husband to be is waiting for her at the church , it breaks my heart to witness all this . she has just had a urine test for a possible infection .

  • stef

    I am a third year mental health student so far mainly specialised with the elderly and the above topic. I find your piece very interesting. I am currently researching into a recent situation and would be greatful for any feedback. The situation is an elderly patient with a less severe cognitive impairement experiencing psychotic symptoms however this client is extremely hard of hearing with no use of a hearing aid. The communication barrier is significant.

    Many thansks Stef

  • MICHAEL

    Thanks for the above. My mother is in hospital very confused. It happened out of the blues on Wednesday night. She became delirious.A uti has been ruled out and she had a ct scan which was negative.

    • sheilahe seeing and hearing things, and getting angry at us, and thinking she was at home, ect....

      You don’t have to have an infection in order for her to become delirious. My mother has had this happen 2 times and she is coming home tomorrow from another hospital stay. After this happend before with all the confusion and hearing things and seeing things that are not there,thinking I was a nurse…etc…when she was released from the hospital and on her way home, the minute we turnd on to her street, everything started to come back to her, it was so amazing to us, because we thought that she would be like this from now on, The hospital and her doctor said it was alzheimers, so we even went to a place that helps us with what we were going to need to take care of her! The sooner a person can be back in their elements, the better for them. That even goes for rehab. If you can have physical therapy come to the house, then do it! It will do wonders for the paitient too!

    • sheila

      Also wanted to add that she is really confused again, and my sister and I just go along with what she is saying, other wise she gets upset.

  • Helene

    My mother-in-law is 91 and in a nursing home. She recently had a urinary tract infection as well as low sodium count. She went into delusions and was put on an Ativan ointment. It was finally discovered that she had the infection after a culture test had come back positive. Her infection was cured but they continued the Ativan because they said she had anxiety. Her delusions took on a different tone but got worst. A drug named Depacote was added after she had a especially bad episode which had her screaming. At that point they gave her Haldol which they continued giving her,I believe, for a couple of days. Now they have added Resperdal along with the Depacote but have stopped the Ativan. I believe that there was no point after her infection was cured did they take her off the Ativan for a period of time.
    My concern is that she may not have to be on those drugs. She had no delusional episodes until the urinary tract infection. I have read that Ativan can be a cause of delusions and believe that it might have been the culprit behind her continued her episodes after the infection was cured. I am concerned because I am afraid that she will lose what quality of life she does have.

  • angela

    As a doctor in old-age psychiatry, I have to say this is an excellent article on how to help an elderly person who has apparently developed psychotic symptoms. It is essential that they are reviewed sensibly and systematically rather than assumed to be this or that stereotype of old age! Relatives and close friends should not be afraid to politely question any doctors who appear to jump to conclusions and reach for the prescription pad.

    Thanks Calypso.

    • Admin

      Thanks Angela for your comment. We do hope that you will get involved in our forum.

    • Tempie

      Our neighbor, age 75 has been getting more and more confused for 8 months now. at first it was just talk about his invisible friends, and accusing other neighbors of killing his cats, (all are alive and accounted for). Now it’s much worse. the other night, at 1 am we hear him out side yelling for help in one breath, the saying, “dont you come over here” in the next. we found him next to our car, on his knees, claiming his wife pissed him off,(divorced 20 plus years), claiming the FBI had the neighborhood on lock down. My hubby got him inside. soon we hear his truck start up, we go out to see what he is doing, he says, “I gotta get off the edge of this cliff!”. once again, we get him inside, got to bed, and are soon woke up by the police, looking for the man. His truck is wrecked in the neighbors yard, and he is missing in freezing temps. The police find him, in the drivers seat of a neighbors truck. no explanation as to why. medics are called, he refuses help. next day, he asked the neighbor to help get the kids out of his back seat, (no kids) He is even yelling at them to hold still. He then accused us of wrecking his truck, accused a friend of peeing on his floor, Pointed out a kitten on the floor, (not there). So he says he went to the Dr today and told them he was having “memory trouble” and they gave him a smart Patch and told him to get a hobby. This worries me because, it’s not his memory, it’s confusion and seeing things! He could have hurt himself or someone else if the truck had ended up in the neighbors house that night!Do I sneak a peak at his meds, get the name of the Dr. and call him? Or do I just mind my own? I doubt this man was honest about what is going on. “memory problems” to me seems to minimize things!

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