OCD in Elderly for Caregivers

By Cheryl Ellis, Staff Writer @ caregiver.com

Obsessive-compulsive disorder (OCD) is defined in part by the Merck Manual as “anxiety provoking thoughts and urges.” While the publication (a staple in the medical field for years) notes that symptoms are not often prominent in the elderly, caregivers may disagree.

Early stage Alzheimer’s patients may obsess about minor issues, such as the garbage being taken out. In some cases, it may become a “chicken or the egg” question as to which came first, the OCD or Alzheimer’s.
Since part of OCD involves performing repetitive tasks that balance the anxiety (using hand sanitizer repeatedly to avoid germs), it may not be immediately visible that there is an obsessive component to the elder’s thought process. Grandma may spend twenty minutes wiping out the bathroom sink after she has gone to the bathroom. Part of her extended cleaning out of the sink may be due to poor vision, or remembering something from a past not known by current family.

Elder folks who can identify “habits” begin to disassemble the cycle of worry that accompanies OCD. Dorothy, who is well into her seventies and a former nurse, mentions that she has several “habits” that have cropped up since her husband passed away. “I’ll just go right to the refrigerator in the middle of the night, not turning on the light. That’s a HABIT.” She’s noted others, such as waking up several times in the middle of the night. During family visits, she wakes hardly at all, and concludes she’s conditioned herself to associating being alone with needing to wake up.

A bright woman who applied much rational thought and association in her nursing career, she is still able to do so today. Dorothy emphasizes that recognizing a habit is one thing. “Doing something about it, well that’s another!”
It’s evident that the key to her dealing with these habits is making a connection; but more importantly, she has removed the anxiety component. Acceptance of these behaviors and the knowledge that she will break them when she chooses give her a sense of autonomy.

Caregivers can work toward helping their older family members retain a sense of self-control by remaining calm when “habit” strikes. When Grandma spends 20 minutes cleaning the sink, she can be asked “What makes you do such a good job?” This will open the door for her to make her own connection as to why. The caregiver may learn about the past (“My grandfather was in the military and we had to make sure it was clean and sparkling”). Or they may learn about a contemporary occurrence (“I heard my son say the place is a mess. I don’t want him to think I’m a burden”).

In either case, an artful question combined with a compliment may draw out information. It also allows caregivers to begin the process of reassurance which can decrease anxiety.

OCD is designated as an anxiety disorder, and any type of stress reduction technique that is agreeable to the person and caregiver can help tremendously. Aromatherapy, guided meditation, relaxing music and changes in diet (like reducing caffeine) are alternative methods of stress reduction that may have some impact.

Howard Hughes, famous eccentric billionaire, suffered from OCD. Those who have seen the movie “The Aviator” or who remember accounts from decades before have an idea of how bizarre this individual became. While most people live undocumented lives, we can look at the experiences of individuals in public power to relate to.

The Anxiety Disorders Association of America (http://www.adaa.org/) has a great deal of information to educate the layperson on anxiety in OCD, as well as other types of anxiety. Caregivers may find themselves developing a generalized anxiety disorder in response to the OCD disorder for those they are caring for.

Remember that when elders switch locations (moving in with a child, or to assisted living), they are going “out of the box” and stress factors increase. This increase in stress may turn Mom’s “habit” of cleaning when she is a little nervous into a full blown obsession over time. Work on the root cause, always.

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Compulsive hoarding or collecting may have developed from not having enough basic supplies during younger years. The cliché “salad days” may literally have meant that there were only vegetables from the garden to eat. A parent who always made sure there was plenty of food in the house may now not only have 65 cans of green beans (bought at scratch and dent warehouses), but stacks of newspaper coupons that are beyond the expiration date.

Instead of cleaning house in one fell swoop, try getting the elder to focus on the abundant stores they have, and how they can help others who are less fortunate. Some caregivers may have tremendous stress when it comes to dealing with the situation. At that point, calling in the “cavalry” of friends and associates who offer vague help is in order.

“I need you to help by going through Dad’s canned goods to find out which ones are expired or near expiration. Can you go with us to donate them to the local shelter?”

Any problems with compulsive hoarding require help. The Obsessive Compulsive Foundation has a website (http://www.ocfoundation.org/hoarding/) designed to guide caregivers. Support groups and other information can be found there. From that point, work on recruiting friends and family to help you with this issue. In the case of animal hoarding, the local Humane Society may be of help. Never, ever give any pet (hoarded or just a small excess) to anyone you do not know, or to any shelter that you do not know.

Even caregivers can have some obsessive compulsive traits develop with the day-to-day caregiving of an OCD elder. Look through information to see where you may have borderline events, too. By working through your own, smaller issues, you may silently be helping your loved one.

Raleigh Geriatric Care Management, http://www.rgcmgmt.com

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