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Ask the Mental Health Expert Archives 2001-2004

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Elderly Help

Q. What would be proper treatment for a 93-year-old woman who suffers from extreme anxiety about having been robbed 6 years ago? Since the robbery she has been hiding everything in her household from plain view--including food, clothing, hearing aids, teeth, eating utensils, check book, personal telephone book, etc. She wraps up everything in newspaper, hides it behind furniture, under beds, inside dishwasher and washer/dryer, oven, freezer, then forgets where she hid everything...

She uses lids from cat food cans with which to eat and to cut food. She swears everything has been stolen from her everyday, stays up late into the night moving everything to a different place, and this is on her mind constantly. She calls the police all the time to report the "thefts". She starts to argue with anyone who doesn't believe her. What would be a proper method of treatment?

A. This is a difficult and delicate situation, since the woman in question sounds like someone who will not easily agree to a complete neuropsychiatric evaluation--yet that is really what is needed. Before correct treatment can be suggested, correct diagnosis must take place. What you describe could be consistent with a dementing disorder, such as Alzheimer's Disease, in which delusions or other psychotic symptoms are frequently present.

The anxiety you describe may really be of psychotic proportions, as opposed to the non-psychotic type seen, for example, in post-traumatic stress disorder. (Someone who has actually been burglarized could easily develop PTSD, but would not be frankly delusional in an ongoing way, phoning the police, etc.). Very often, patients of the sort you describe wind up needing nursing home placement. However, it is possible that with thorough diagnosis and vigorous treatment, the symptoms might be manageable with visiting nursing assistance, regular psychiatric treatment, and perhaps some type of assisted living environment.

For example, if she has Alzheimer's disease (AD), medications such as donepezil (Aricept) may sometimes reduce agitation and even psychosis. In some cases, low doses of an antipsychotic medication (e.g., risperidone, olanzapine) may be helpful.

I would suggest that if the patient has a designated health care proxy--e.g., a son or daughter with power to make health care decisions when the patient is not competent--this individual be contacted regarding this woman's care and treatment. That proxy may be in a position either to initiate a home visit by the state division of "Elder Care Services"; or, if necessary, to initiate a commitment procedure that would permit a diagnostic hospitalization. (Of course, every effort should first be made to secure the woman's cooperation, but that doesn't sound very likely).

If there is no designated health care proxy, then contacting the state division of mental health or elder services is probably the first step. A home evaluation is often possible, depending on the state. The bottom line: the woman needs a thorough neuropsychiatric and medical evaluation before the correct treatment can be ascertained. Depending on how that goes, and her social support network, she may or may not require placement in a nursing home. My guess is that the latter is quite likely, however.

October 2002

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