Question:
My mother aged 75 has been prescribed various medications for depression, anxiety. since her 20’s. She has now deteriorated to the point of threatening self harm and has seemingly decided she doesn’t want to be in the house she has lived in with my father for over 50 years. She has called an emergency ambulance and had herself admitted to hospital. They have had to admit her to a psychiatric ward which she has been in now for over 2 months. We seem no nearer to a solution as to how to help her, but a good diagnosis would be a good start! She had a poor relationship with her mother, who she feels abused her by hitting her as a little girl, she was evacuated during the war aged 8, she married at 17 to my father and had 6 children. She has never in my opinion been happy – could all her behaviour be the result of events in the early years? The doctors have told us she hasn’t got dementia or Alzheimers, it is thought to be a ‘personality disorder we just do not know how to cope with her
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Answer:
At age 75 there are at least two major issues with which your mother is coping. First, it sounds very much like she is experiencing Major Depression. It is not unusual for the elderly to experience this type of depression. You are describing symptoms typical of major depression such as: agitation, anxiety suicidal ideation, irritability and anger among others. With age comes the fact that people are dealing with many unresolved issues from the past and present. So, the answer to your question is yes, to some extent her behavior is the result of events from her childhood. There are losses of loved ones, memories of past injustices and dealing with the fact that children are grown and moved away. Unresolved marriage issues can resurface since couples have plenty of time to fight with one another. Retirement is not the great blessing we like to believe it is. The combination of inadequate savings and too much leisure time can be a nightmare for the elderly. Boredom and depression set with a fair amount of speed. If physical health is poor then the issues become magnified as the choices for solutions become narrowed. In addition, it is likely that her history of depression and anxiety are worsened by age and all of the issues stated in the paragraph above.
The second issue with which your mother is coping is the fact that she has a personality disorder. A personality disorder is characterized by the fact that people have life long and enduring patterns of behavior that interfere with work and relationships. There are many different types of personality disorders ranging from avoidant types due to social phobia all the way to paranoid and borderline disorders which are extremely explosive and disruptive in nature.
Like so much in life, personality disorders can become worse with age. With age come greater inflexibility, stubbornness and refusal to cooperate. Very often, the reasons for this rigidity have to do with the fact that the elderly person is fighting to maintain their autonomy and independence at all costs.
The combination of major depression combined with a personality disorder and growing inflexibility and stubbornness can make for just the type of situation you find yourself in with your mother.
In any case, while there are medications that help relieve anxiety and depression there is no medication for personality disorders. In addition, the success of psychotherapy with a person who is 75 years old and older depends a lot on how open they are to new ideas. My experience working in geriatric psychiatry for several years taught me that any type of psychotherapy has limited success with this age group. Even group therapy for the elderly is limited. The members of a therapy group comprised of elderly people tend to talk about the high cost of living, crime, and their children and so on. It may help allay some feelings of loneliness but it does not do much else.
I assume the doctors in the hospital have given your mother a complete medical examination. This is important because there are a number of physical conditions that can cause symptoms that look psychiatric but are not. For example, an under active thyroid can cause depression in a person of any age but particularly in the elderly. Adrenal issues and any number of other problems can bring about extremely depressive symptoms. Even a vitamin B deficiency can cause havoc.
Finally, any elderly person hospitalized for a period as long as two months can begin to deteriorate. They can become disoriented, confused, more depressed and even delusional.
So, how do adult children cope with an elderly mother (or father or both) who is in this situation?
What I wonder is whether or not the staff on the ward you mother is on has met with you and discussed options? Today, it is rare for hospitals to keep patients for as long as two months. Most hospitals today are very concerned about length of stay because insurance companies will not reimburse them for patients who stay beyond a limited period of time. Two months is way beyond the amount of time that is allowed by insurance companies. Even very suicidal patients will be moved to some type of nursing home or other safe and secure setting.
Also, it is difficult to believe that your mother is on a psychiatric ward of a hospital with the general psychiatric population. The reason I say this is that the elderly fall into a special category as do other groups such as adolescents. She really should be with a similar population of people who share similar issues. It can be frightening for your mother to be with the general population instead of with peers. This alone could add to a sense of disorientation.
One option might be for your parents to move in with one of you, her adult children. This is a very serious decision to make because it has implications for their grand children, assuming you are married and have children. It also has implications for your life style as it is very difficult to live with an elderly person who is cranky and mentally ill.
If it were possible for her to return home, to your father, or for both of them to live with you it would be essential for her receive regular psychiatric follow up on an out patient basis.
One other idea you could discuss with your family is having an outside psychiatrist who is a specialist in geriatric psychiatry, come to the hospital, see your mother for the purposes of doing an evaluation and giving his recommendations. Geriatric psychiatry is a specialty and does call for the expertise of doctors in that specific field.
Finally, there are social workers and nurses who specialize in the field of geriatrics. They can provide you and your family with many services, including the most appropriate resources in the community to help both your mother and father. This service includes dealing with issues of social security, medicare and other financial issues. They can also add further counseling for your mother and father as well as the rest of the family.
You are faced with a complex situation for which there are few satisfying solutions. This is a problem referred to as of being part of the “sandwich generation.The sandwich generation is made up of those people who have responsibilities for both their own children and for their declining parents.
You and your family need as much support, guidance and therapy as you can get to help you cope with your mother and with your own feelings of guilt, anxiety, worry and anger.
