I am so glad to have found you, DrHelen! I am a full-time caregiver to an elderly mother whose family history includes extreme religious perfectionism, control and anxiety. One adjective for it all is 'repressed', to say the least, and her PCP is clueless to it. I do counseling, have education/training in counseling psychology and integrative nutrition, and would love to get more info on managing repressed anxiety attacks as my expertise could use refreshing. Thanks.

I am convinced that my mom is depressed but she insistarted that she isn't, and I don't see her willingly visiting with a geriatric psychiatrist. How do I get her to open to this and ultimately move forward. I clearly see that she needs help but she does not see it.

My insurance said there were 54 Geriartric Psychiatrists in the state. Only 20 met the requirements most had CMEs in it or had a couple of clients who they were treated and those we visited should not have used it in their descriptive category. The true ones were way ahead of all the other there was no comparison. My husband has mixed dementia and thankfully we have connections and he's getting the proper care. Don't be afraid to ask questions about their background.

I hear you and am an aged care giver too - age 78 caring for a mother of 103 in assisted living and probably moving to an NH soon. I wish her well but I hope this is soon over - for both our sakes. She has late stage vascular dementia and her QOL right now is not good. It takes a toll on me physically, emotionally, socially, financially - in every sense I can think of. At my age she was travelling the globe, my grand mother died in her 70s and my grandfather in his 80s. My father died at 81 when mother was 65, so she was free to do as she wished, had great health and enough money to have options. She travelled into her early 90s. What a different life to mine. Hoping to get through this without too much damage to my health particularly.

Very interesting, and thank you so much for allowing me to make a comment (a rare opportunity). You say you want to "reach older adults and their caregivers" in a sentence above, but what yells out at me, WHAT ABOUT OLDER ADULTS WHO ARE CAREGIVERS, I am one of them and so are thousands more. We are such a very special group in terms of age, health, time, obligations and financial ability to pay for the needs of both the loved one and ourselves. Please don't leave us out.

Oh thank you for coming into my life at this time. My Mom is recently placed in long term care after a hospital stay for a severe UTI which has extreme impact on her mental status. She was first in the rehab unit for about a month, as she progressed her mental status greatly improved. She is a wheelchair pt. as a result of a stroke about a yr. prior which left her with a condition termed as retro-pultion which made it unsafe for her to walk independantly as she would suddenly just fall backwards. She was and still is very displeased that she must be wheelchair restricted. When they nursing home accepted her for long term care there, we never expected that their intention was to place her in the Star Ward, their term for the locked psych ward. We were shocked, Mom was initially beside herself and we insisted and beg that they move her out of there. She remained there for at least a week and a half, in that time she became very attached to her roommate a young pt. of 56 who is severely incapcitated, cannot speak or partake in conversations, walks non stop about the unit. Mom has taken on the roll of trying look after her and offer her verbal comments of support and so on. They had a room for Mom finally, but without any notice to us for discussion with Mom, one day, just went in and told her she was being taken out of that unit to a regular rm. in a regular ward. Mom was very displeased and told them she did not want to go. They proceeded in taking her out of there to said room where there was a pt. desperate for a rm/.mate and new friend. Mom pitched a fit the whole way, another pt. in the hall there said to her "don't even think your coming over here" and the pt. roommate immediately offered to switch beds with Mom if she preferred the bed near the window. Mom refused to stay there and told them to take her back to her room. When we were told of this event we could not believe it. We tried speaking with her as to why, and that we wanted the quality of her life there to be the best it could be. She continued to refuse. We were told by the Soc. Worker there that apparently Mom's wanting out of there was more about us taking her home with one of us, not out of that rm./unit. She continued there since, which is now about a month. There is absolutely no one in the unit for her to share communicative companionship with as they are all severely mentally incapacitated. We have asked the staff isn't there someone in there to pair her with to visit and pass the time. Unfortunately not. Mom recently has begun venturing out to the main DR activities and entertainment and enjoys it. She has now come around to realizing the unit she is in leaves her out of the regular population and isolated from making new friends and sharing and enjoying socializing with others; and wants to leave this unit. I should say that my Mom is 89 and doesn't even take blood pressure medication, she is quite healthy, she has very slight dementia and most of the elders in our family have passed away, all of her siblings, my Dad and all of her friends in the past few years. She became isolated of her own choosing prior to the stroke, as she was not willing to go to the senior center to socialize etc. She really counted on my sister and I and a cousin to fill her life and needs. So this has been a year of lots of changes, she disliked the Retirement Home we placed her in prior to the recent illness, she was there for about 9 mos. and complained and was displeased constantly. While it was a lovely setting, it was not managed/staffed very well with only 1 aide on per shift and 6 out of the 26 or so residents who needed hands on help/care for most everything. This facility is truly lovely, clean, clean, cheerful, the staff in every unit are compassionate, well trained, caring and attentive to the pt. residents. Worried that Mom will not be considered for a unit change by the administrative staff. Do you think it is reasonable that we make this request of them again?

Sophie, What state do you live in? I am from the Boston area. Where there are plenty of Geritricians. When I took my mother at first they did was look at her medications and they slowly took her off medications that a regular Primary Care had given her. They also checked her blood work. There are many medical problems that can cause confusion. It sounds like your loved one is sun downing which usually starts around 4pm in the afternoon. I associate a Geritrician with a Pedtrician. They give medication in small does. There are two issues is your love one ambulatory or doesn't ambulate. You don't want to have medications that can cause a fall. It is very dangerous for a demented person to fall. They rarely come back as they where before. My mother was a sun downer but, pleasant. She was just in my face until she went to bed. I could not get anything done. I took her to see the Geritrician and she gave my mother Haldol 0.25mg and I could repeat the Haldol if needed. It did hold my mother and she would watch TV. I am not a big fan of Haldol but, if given at small doses it is fine. I hope this helps.
Mary Mawn-Hassani

I found a geriatric psychiatrist for my FIL last year and he tossed the doctor's name and number into the "pile of death" on his desk. The pile of death (or pile o'death since it's St. Patrick's Day today) is where information goes to die. He feels better knowing it's there and never does anything with it. What is he waiting for? Only he knows.

A few years ago my MIL, who has a neurodegenerative illness, had a knee replaced. Our family was against it but her doctor talked it up. She ended up in rehab for 6 weeks and when she came home, she was not the same. Soon her decline from her MSA sped up. She was deflated that her knee surgery backfired.
The expectations those in the medical-industrial complex have set are unrealistic.

The incentives in health care are perverse. Doctors aggressively treat old people with pills and surgeries because Medicare is their cash cow.

I think you need to talk about why so many Americans are unable to cope with aging. The medical-industrial complex has medicalized aging. No wonder so many old people and their caregivers are depressed when we treat aging like a disease.

How to deal with the evening-time anxiety and verbal and physical aggression.

Wow! I had no idea there are only 1,600 geriatric psychiatrists in the US. My pcp referred me to one in our small town, 2 months ago. The Dr. is female which is good for me, but I have a problem understanding her when she talks, because she is from India. Maybe it will get better over time. I hope so.

I find this info very interesting . My concern is where do I find this kind of help for my mom. This would be very beneficial for her as well as myself . I am also in need of a listing of geriatric dr's in Houston , Texas . I'm sure that that kind of doctor would be more in tuned to her needs. Thank you for your help thus far.

Where are you located?

Sadmomskid, please check out http://www.gmhfonline.org/gmhf/find.asp. I just did a quick search and see there is one geropsych in Denver, one in Lakewood, and 2 in Longmont. If she can't get in with those folks consider a general psychiatrist who has experience with older adults. Good luck and please don't give up.

My mom has been on a waiting list to see a geriatric psychiatrist for over 3 years now, even in a large metro area with many large medical centers. Her family practitioner does the best he can, has tried several meds and therapy, but he's in over his head, and she continues to suffer -- quite badly actually. My mom is 83 now, and wants to die. She will likely never receive the benefits of a specialist. Don't be old and depressed in Denver, you'll die before you ever get to see geriatric psychiatrist.

Dear Dr. Helen,
I worked at a long term geriatric facility in Boston, MA. I worked at this facility for 32 years. I spent my last 15 years working for Geriatric Research. I am familiar with PhD's who left and now work at The University of Michigan. I worked on many studies at the center and from working at the center. I was able to care for my mother at home. I was well aware of institutional living. I could not tolerate it. The saying is if you can't tolerate institutional living then take them home. I worked at a place that did great palliative care which was very important to me. I know there are many NH and they don't give good palliative care. This is the main reason I kept my mother at home. My mother was comfort care only and being her HCP, I wanted my siblings on board with me. It took two years. My mother lived with dementia for twelve years and two years later was diagnosised with MDS. We did use Procrit as ordered. This worked for 9 years, may be even less. I moved back to my mother house 8 years before she died. I did have a geriatrician working with her over all health. She told me the last thing you want to say is she has dementia. She did have a bloodwork up which was normal. She finally was diagnosed by Neuro-Psych. Her medicine was titrated and discontinued or left at a small dose. My mother suffered from a life time of Depression and severe anxiety. Dementia did a lot for her anxiety. It really left her but, we could never stop the Ativan. Her body wouldn't give it up. We tried twice and gave up. She had a small dose of Ativan 0.25mg 1x/day. We left the center and had a Geriatrician who was head of the department of geriatrics at a well know hospital in Boston. I had asked my mother for 25 years. What type of advance directive she wanted. I never got a response. I stopped working June 2010. I could see my mother failing, physically getting weaker. January 2011. She fell down the stairs. She cracked her head opened. I did call 911. I did have the paper that said my mother was comfort measures. Do not treat. DNR etc. I sent my husband to the hospital with my mother. I needed to track down my sisters and brother. Then I picked up my daughter and headed to the hospital. She had 2 pints of RBC's which shouldn't of happened. But, it did and there was nothing I could do about it. My sister was there and couldn't say no. My mother was admitted to the trauma unit for 5 days. She had sutures and staples in her head and broke her 7 rib. I did for years give her 1000mg of Vitamin D along with Calcium. I had worked on the Vitamin D study and saw the larger doses the elderly where give the less fractures they had. She also had osteoporosis which most of it healed except one inch on her spine. I also learned she had Vascular dementia. Even though the say it is 85% is a mixed dementia with Alzheimer's. I do believe it was Vascular dementia. The second day on the trauma unit. I decided to bring my mother home with Hospice. They came the following day to meet my mother and to talk to me. I had a couple of days to get ready. The dining room came down and the living room furniture was moved into the dining room. A hospital bed, oxygen etc was delivered. I bought a bed to be near her. Hospice came with their box of medication to be used as needed. The big deal was keeping her bowels moving. The months passed a behaviors happened. I used the medication as need. When she had pain I gave her Morphine and Ativan that worked well. July came and she really started to decline. She was dying from the MDS. My mother wanted to see her four children together. I called my family and her 4 children came and her two grandchildren. We all stood around her bed and she looked and smiled. She knew are names. I noticed the following days she was starting to let go had more pain. She was religious and told me her mother and father where in the house. Also, my father was there. My father died in 1978. She called him by his nickname. In the past she forgot him. She died on a Sunday. But, the Wednesday before I swore she had a heart attack, she grabbed her chest and throat. She was in pain. I gave her Morphine and she fell asleep. Thursday she looked at me. I knew my old mother was looking at me and and she said to me"Mary, I've had enough let me go". I knew this could happen with dementia. I felt like a ton weight was lifted off my shoulder, after 25 years my mother finally told me what she wanted. Friday, she had a rapid pulse and temp. Hospice came and said if it continued she wouldn't make it through the weekend. You have 12 years to say good bye. But, you are never ready for the moment. Saturday her pain increased and her morphine dose increased and Ativan every four hours. Saturday night I got into bed with my mother and just held her hand. I would have a couple syringes, no needle and we where increasing the Morphine and was giving it every hour. Sunday morning we increased her Morphine to 18 mg every hour. Which gave her complete comfort. She went into flash pulmonary edema. My sister and I increased her oxygen and we kept her airway cleared. This went on for an hour. 2p I gave her the last dose of Morphine. I could see her change. I told my siblings it would not be long. She had no moulding, nothing. At 2:20pm she passed. She looked at peace and her color did not change. She looked like angel. I was happy my mother and my father both died in their own home, surrounded by their children, and left feet first out of their home. I couldn't ask for anymore. I feel, if I had to do it again. I would do it the same way. My parents are at peace and together. My mother was 79 and died on July 17, 2011. I have made it through the grieving process. There is one thing I remembered. The first day I moved in, my mother had my bed and my daughter's bed made with are pajamas on our pillows. I cried like a baby. I knew the only person who would do this is your mother. I never forgot it. Mary Mawn-Hassani

Supposing they expand their expertise to include the invisibly-disabled, still-in-the-workforce, 55-64 agers, in their outreach. And rebrand themselves as Life-cycle Therapists, using a cognitive, psychoactive drug-free (or drug-sparingly) approach.

Hello again caregivers! Thanks for the additional comments. We will be submitting a new post soon on wandering--look for it! Anne123, I would suggest that the caregivers in this situation continue to give their feedback about what they are seeing and experiencing to the PCP. Family input should be viewed as important and not to be ignored. Thanks for the welcome Kathleen2251932. Assandache7, a geriatric psychiatry evaluation would try to figure out what the underlying causes of your mom's sleep disturbance. There are many possible causes including depression (which is often accompanied by insomnia and anxiety), poor sleep caused by too little activity during the day, the urge to go to the bathroom which can wake people up, etc. Asking her of what she is fearful of happening with no one there would also be helpful (is she afraid that a medical event might happen and no one will respond?, etc). Could you get her a med alert button to push so that she would feel more confident that someone would respond. And so on.

Correction not 5 years. I meant 5 days.

To Standing Alone, I read your comment and I thought what happened to you was terrible. I worked in a nursing facility for 32 years. I have to tell you. Staff never have the right to raise there voices to patients, family members or anyone. I would go to the top and make a complaint. It is not up to you or your family to stay there every night. Then the other statement "you will have to hire help and pay for it." That is an inappropriate request. The last thing your mother having a bruise. Do you think she could of hit her arm? The first thing that comes to my mind was she was someone was a little to rough. We reported all new marks on a patient. I would consider looking for another NH. I really do not find bed alarms or chair alarms to affective. Only if you are right out side the door. It very common practice if a patient is a high risk of falling to have a sitter that the NH pays for to sit your mother. We had patients who where high risk and we would put them in a recliner and let them sleep in the dining room with the doors closed and the lights dimmed. The nursing assistants would sit in the dining room at night in between rounds and checking for wet pads and changing them. Residents who had Delirium. Where behind the desk 24/7. We never medicated them because it probably would make it worse. Time needs to pass. The only thing you can do is keep them safe. You need to start with the Nurse Manager if you get no results then I would go to Administration. If my mother had a severe injury. I would make a complaint with the State of Public Health. No NH likes to see them come. My mother died almost 3 years ago. I loved her dearly. She was take care of at home. Her hospital bed and I bought a bed so I would be right next to her. She was on hospice care. I remembered a time when she was in the hospital. Medicaid or Medicare has a rule. This is federal effecting every state. If an elderly person falls in the hospital and breaks their hip. The hospital will pay for it themselves. Because there was too many elderly falling and breaking their hips. Every elderly person had a sitter. Then with all the changes with decreased reimbursement from Medicare/Medicaid. The hospitals and NH have lost millions of dollars and they won't pay for sitters anymore. They depend on bed alarms and chair alarms. Thinks are changing we no longer posey people. We are a physical free restraints and use chemical restraints as need. My mother was admitted to a hospital. One of the hospitals in Boston where the Mecca of great hospitals are. The charge nurse told me they would use a chair/bed alarms would be used for her safety. One thing I could never tolerate was a patient falling. My mother moved quickly and I was very fearful of her falling and hurting herself. I am disabled and could never of tolerated staying over night. I looked at the charge nurse and I spoke very firmly and told the nurse. If my mother falls. I will sue this hospital for every penny it has! She got on the phone with her boss. When she got off the phone she walked over to me and said my mother would have a sitter 24hrs/day and she did for 5 years. I never had a problem advocating for my mother or family. I worked in the business long enough and I knew how to push buttons. I never regretted being my mother's advocate because she could not do it. I wish you the best. Both of my parents are gone and I feel it. I don't have the person or home who took care of me. It is a very empty feeling.

Norestforwary thanks for the idea but the first words out of her mouth is "What if something happens to me and you're not right here?" Plus when my sister stayed over she said "Oh good I like when you stay, I know someone's right here when I get up"...

Assandache: Just a thought. This may or may not be the cause. My mother in law has sleep apnea. While she is sleeping, she stops breathing for about 20 -30 seconds. Also, because of my MIL's heart problem, she sleeps on 2 pillows (2 pillows in one pillow case) . This seems to have helped her breathing.

Dr Helen, my 91 yr. old Mom with dementia awakes at 3-3:30 daily with a panic attack. I know the reason is because she doesn't want to be the only one awake.. She gets herself in a frenzy.

She sleeps alone in an in law apt. attached thru my kitchen on the first floor. My bedroom in on the second floor of attached home. My sister has stayed over night on her sofa and she has no anxiety symptoms when she's there.

Her Dr has tried both Ativan and Lexapro both make her to groggy which make her fear of falling and no one being with her worse..

I do not want to start sleeping on her couch nightly!!!

I'm wondering how a geriatric psychiatrist would help her deal with these symptons since she has dementia and has short term memory loss..I've suggested ways for her to relieve the symptoms but, every morning is a new morning!!

I am tired!! My husband is tired!!

"The next day I was berated by a male nurse for leaving my mother, even though I had the permission of the nurse who was watching her, had put on the bed alarm, and had put on restraints. I was told I could NEVER leave her alone again, if I could not be there then I WOULD HAVE TO HIRE SOMEONE TO COME AND STAY WITH HER!!! I was with her for 8 days straight, day and night and yet when I needed some sleep and medication to keep me from having a gran mal seizure, I WAS JUMPED ON BY HOSPITAL STAFF."

Seriously, HC? Had that happened to me, ears would have been ringing and people talking for weeks about all the heads they observed rolling down the hallways after I bit them off...

Hello and welcome. You are a Psychiatrist and also a Neuropsychiatst. Neuropsych who is the appropriate doctor to actually diagnosis dementia. This is after a Geriatrician has ruled out everything medically. I believe my Research Dept has worked with your Research Dept. I worked in a Jewish facility in Boston, MA. Welcome!

What about when an elderly man would seemingly "intimidate" his doctor into backing off when it was suggested he see a psychiatrist? And then the elderly man continues to intermittently exhibit ugly rages (only in private, of course), placing enormous stress on family caregivers? When a situation like this doesn't change for a number of years, there will definitely be negative health effects in the caregivers. Courage is needed, among the caregivers, and among the physicians.

One thing I found missing which would help for respite care and well being of the caregiver is a lack of an Adult Day Care where my mother in law lives. The closest one is an hour away. Thanks!

Good evening! Thank you for the additional comments. We are reading all of them. A lot of you are facing tough problems, but your insights, humor, and grace under pressure comes through. Knowledge is a two-way street and you are providing us with information that is "real world" and is going to help us shape the interventions we are developing for caregivers. BunnyIL your dad's symptoms are concerning and hallucinations are more common in older people with sensory impairments like visual loss. Glad you are getting it checked out! Holycow, I am sorry to hear about all you have been through. Hospitalizations can be really tough on older adults (and their caregivers!). Many hospitals are not well set up for the care of people with dementia. We hope that changes (soon). Jeffrey20832, your comments are incredibly helpful as we think about our developing interventions. At some point later in the course of dementia (where is not always quite clear), our approach needs to shift to one of palliation. Maryhope49, caregiver overload/strain/burden is linked with stress/anxiety and depression all of which impact attention and memory. Making time to take care of your own health (including making sure that other memory issues aren't occurring) is important.

Our geriatric shrink is an angel from heaven. So many insights in what is going on with my Hubs. Love her to death Looking forward to the new partnership.

I've been taking care of my Dad with Alzheimer. Recently I've been forgetting everything, don't know what I'm looking for, going out to town and don't know where I'm going. Last night I was besides my Dad's bed and fell on the floor, don't remember what happened. This worrying me.

Dr. Helen - it will be helpful to get your input to and from the caregiver community. The one concern that I have is the caution that I believe some geriatric psychiatrists have in offering medication for anxiety and behavior issues in Alzheimer's versus the limited number of caregivers able to manage such patients. I understand the caution but the limited number of caregivers makes it difficult for such a strategy to work, especially in today's economy, which drives so many to try to find any employment. My mother is currently visiting an adult day center three days a week, but they are having difficulty dealing with her afternoon anxiety. She is only on Exelon Patch mornings and Mirtazapine (Remeron) 22 mg - one 15 mg pill and one half pill at night before bed. We also have Clonazepam for occasional anxiety, but that does nothing for the day center when they give her a Clonazepam at around 12 noon for her afternoon anxiety, which is becoming an earlier and earlier "sundowners." Now we have been seeing a geriatric psychiatrist for 6 months to help us. The first one gave us "smart food" vitamins and told us there was nothing he could do. Wrong answer. So we started seeing another 4 months ago. Geriatric psychiatrist number wanted to wean her off Namenda (done), and get her Remeron (done), which she believes Remeron is a safer drug. OK. Great. Problem is now I have the day center sending me emails complaining about her anxiety levels in the afternoon. And the day center only has so many volunteers able to give her one-on-one attention, because after all, it is a shared day center (like every other AL and NH) not a personal individual care treatment center. So I am really grateful for the slow and cautious approach of the new geriatric psychiatrist, and at least she is not giving her vitamin pills. But my mom is at Stage 6 with her last MMES at 10 (2 months ago). I need more medication help to manage her anxiety, mood swings, delusions, etc., and occasional angry / violent outburst. She sees doctors regularly and geriatric psychiatrist. My sense is the geriatric psychiatrist does not think we need to prescribe Seroquel, Depakote, etc. yet. - OK but when the day center is complaining to me in writing (a really bad sign, remember they refuse to have her there), when is a GOOD time to reconsider her medication? Now this problem with mother - this is a small portion of the societal problem - this is going to become A LOT worse as more baby boomers age, and the Alzheimer's researchers accomplish nothing. The reality is we are not going to have enough caregivers to allow the AZ patients to act out all of their anxiety, delusions, etc. without medication. The media wants to portray Alzheimer's Disease as just a "memory" issue, and totally ignores the behavior issues associated with such brain damage by this horrible disease. But this problem is going to get worse and worse. We need our geriatric psychiatrists to help us manage these poor sick individuals who cannot help themselves and their behaviors. Yes we can soothe, entertain, distract, give repetitive things to do, etc., and we do - but that will still only go so far. We need another look at how on medical ways to help manage AZ patients. There simply are not enough caregivers, despite the heroic efforts of so many families, volunteers, and paid caregivers.