My father is acting weird. What's regular old man crotchety behavior vs. pathological behavior?

October 6, 2012 8:38 AM

My father is getting up in years, and on a recent trip I noticed he's been acting differently. I don't have many elderly contacts so I'm unsure how much of this is normal old man behavior and how much is possible pathology.

Traits that are amplified but which he had before:
- morose disposition, now obsesses over past sad incidents
- social anxiety, doesn't want to leave the house or meet anyone in a new environment
- tells really long rambling stories to anyone who stands still (before, 3 min, now 15 mins)
- more interested in pets than people

New traits:
- Paranoia (recording conversations)
- Being extremely thoughtless / self-centered
- Going off on nostalgic driving trips without telling anyone
- Threatening suicide obliquely in arguments with his wife

His recall of recent events seems to be fine, and his ability to fix things and think through problems seems fine. He does not seem depressed all the time (can get out of bed, enjoy movies, etc.). He drinks a glass or two of wine at night but is not a heavy drinker. No heart problems yet. He takes valium for a muscle disorder.

I'm trying to get him to a psychiatrist or therapist who can diagnose things properly, but he's very defensive about it. I'm guessing he might just be depressed, or this could be early dementia without the forgetfulness, but would appreciate any other guesses if you've experienced something similar.

posted by anonymous to health & fitness (9 answers total)

Whatever this is it is not normal old man behavior.
posted by Blasdelb at 8:54 AM on October 6, 2012 [3 favorites]

Has he had an exam by a gp or internist lately? If not, make an appointment and go with him.
posted by Carol Anne at 8:54 AM on October 6, 2012

I'm going to take some guesses here, based on my experiences with my 85 yr old grandmother and my 95 yr old grandmother. Neither have a dementia/Alzheimers diagnosis though.

The 85 yr old lost her husband about 4 years ago to cancer (he went rather quickly, thank God). She's always been a negative nancy, but she also was always focused on taking care of him and her sons, to the point of hovering and nagging (and catastrophizing any little sniffle or cough). It's always been her nature, but when my grandfather died she had no one there to focus on and "take care" of. She's now gotten worse in terms of tracking a conversation and being forgetful, but I think that is depression related to losing her "purpose" in life (as well as now living alone, but next door to one son who keeps an eye on her). Depending on how long she lives it may head into a dementia related disorder, but right now her diagnosis by her PCP (there's no WAY she would go to a therapist!) is depression. He's prescribed an antidepressant to "help her sleep" but I'm not convinced she's taking it regularly.

The 95 yr old lost her husband at age 40, so there's been no recent deaths. However, she's been more paranoid over the past 5 years or so. She lives with my mom and stepdad, and when she cannot find a particular piece of clothing she is convinced my mom has stolen her clothes. I've noticed that if I "interrupt" her while she's in the process of looking for said clothing item (which I think she's looking for things she no longer owns) she doesn't get mad and act out about it. I have also noticed that if she's not engaged in something other than watching TV, she apparently starts thinking about God knows what in her head and that's where the paranoia will get worse or she'll be confused when we engage her in conversation. She sees a zillion doctors for various illnesses, and I think her issues are either related to the statins she takes for cholesterol (and has for years) or it's just because she has a 95 yr old brain. 90% of the time she's with it, but sometimes she's not.

So, questions to ask: Has there been any recent life changes? Is there an illness going on (bladder infections will lead to cognitive issues in the elderly because of the liver not filtering things efficiently)? Are there medication changes happening? Is he losing function of one of his senses (sight, hearing) and in denial over that by hyperfocusing on something else (or withdrawing from people)? Has something happened around the home or community (or world) that he's upset over and it's taking up more of his brain power to ruminate over?

If you can't get him to a therapist (which can sound very threatening to an elderly person who doesn't want to consider the possibility of dementia) can his PCP evaluate him? Can the PCP refer him to a gerontologist somehow for a full workup without upsetting him?

I think the new traits about going on nostalgic driving trips and being more self centered hint to something that's bothering him emotionally/mentally that he's trying to deal with. Is he facing morality somehow? Has some close friends recently passed away? Has something happened to remind him of the frailty of life? The social anxiety in the past may be an issue as well...has something happened to increase his level of anxiety? Any med changes that might be triggering anxiety? Thyroid changes? Hormone changes?

Sorry I asked more questions than gave answers to! But I think some of these questions might help trigger a memory in your head (or his wife's head) about when things started to change.

Good luck! I know from experience how hard it is to watch something like this when you can't "fix" it.
posted by MultiFaceted at 9:07 AM on October 6, 2012 [3 favorites]

MultiFaceted makes good points; some PCPs are better at dementia evaluations than others, but may be able to persuade your father to accept a gerontologist referral more easily than he would take the same suggestion from you.

Social isolation is a huge issue for people as they age, especially as their former support system and peer network fade away (death, illness, their own isolation). The appearance of passive suicidal ideation is a big red flag for me; whether he's doing it to "punish" her or for some other reason, that is a new behavior that his PCP absolutely needs to know about, and would likely cause a referral to a gerontological therapist or psychiatrist. Do you and his wife have your dad's permission to speak to his doctors? Getting him to agree to that will save you both some trouble down the road, especially if his attitude and behaviors continue to decline.

Also, do his symptoms worsen in the evenings? This may be indicative of sundowners syndrome; though it doesn't automatically equal onset of dementia or Alzheimer's, it is a bit of clinical evidence that can help his docs figure out what's going on.
posted by catlet at 9:42 AM on October 6, 2012

He takes valium for a muscle disorder.

You should review all his medications and check to see if he is taking everything appropriatedly and correctly. Check to see which antidepressants he's on and maybe go to his regular doctor with him and make sure he's taking the right things.

Sometimes people keep taking stuff they don't need and end up over medicating themselves causing confusion and other mental symptoms.

You say he has a muscle disorder--is that a separate disease-- or an arthritis-related problem? Some muscle/nervous disorders also cause mental disturbances.
posted by AuntieRuth at 9:53 AM on October 6, 2012 [1 favorite]

This sounds similar to the beginnings of my late father's vascular dementia. If I were you, I would go with him to see his PCP, not a psychologist or psychiatrist. What you might consider is calling the doc first to tell him what you're concerned about so that he can evaluate these things during the visit. And go over with the doctor and your father what drugs the latter is taking and whether they're still needed (fewer drugs is often better with older people).

You mention that your father is married. What's his wife's perspective on his behavior? Is she noticing anything else unusual? If you can get her help in getting him to the doctor, it might be a good idea. And also, if you can, feel her out on how he's coping with things; if he's the one who pays the bills, is he keeping up with it? If she says yes, does she know this for a fact or is she just assuming he is? How's he doing on hygiene? Sometimes things can get out of control quickly in the home of someone who's depressed or ill and you don't want to let the situation get too bad. And if things are slipping, this is important info for you and the doctor to know.

Best of luck to you. Believe me, I know how hard dealing with elderly parents can be. Feel free to memail if you would like to.
posted by WorkingMyWayHome at 11:16 AM on October 6, 2012

Valium is often prescribed for muscle spasms, which are often an aspect of Parkinson's.

Parkinson's could be responsible the increased length of the tales and obsessing over past incidents (perseveration), as well as the moroseness (depression), and social anxiety (exaggerated interest in pets could a facet of social anxiety).

The standard treatment for Parkinson's, L-DOPA, could be causing the paranoia, and, through an increase in impulsivity maybe those driving trips. People on L-DOPA have increased rates of problem gambling, too, so I would look at his finances if I could and try to get a sense of where he's going on his trips.
posted by jamjam at 11:21 AM on October 6, 2012

I have seen things like this attributed to, and relived by treating: vitamin d deficiency; vitamin b deficiencies; lack of oxygen (solved by pacemaker); dementia. So, yeah, doctor.
posted by dpx.mfx at 2:40 PM on October 6, 2012

Another possibility is hearing loss. Being unable to hear and understand what others are saying could certainly account for increased social isolation, anxiety, and preference for pets over people. It could also contribute to increased paranoia, and to telling longer stories and seeming self-centered, due to missing the little conversational clues that others are giving. When your hearing is impaired, but not so suddenly or obviously that everyone notices, interacting with others gets very strange.
posted by Corvid at 8:26 PM on October 7, 2012