Q: My 83 year old mother has been treated for Panic Disorders for approximately 40 years. She was diagnosed as Bipolar four years ago. I am her soul caregiver and recently she has become more confused, thinks my sister and I are in her apartment when she is alone, thinks her deceased husband is in her bed, has nightmares, many unfounded physical complaints, thinks the other residents in her facility hate her and wish she were dead, afraid to be alone but wants to be alone, needs to talk to me on the phone several times a day, sleeps a lot, poor appetite. I had learned a lot about Bipolar since she was diagnosed but wonder if it is dementia or a combination of both BP and dementia. She takes Klonopin and Paxil. It is impossible to get her into a psychiatrist because they won’t take medicare patients. I feel like my options are limited and need some direction with helping her. What would you suggest I do?

A: I suggest that you become very assertive and persistent and get her the help she needs. It most definitely could be dementia considering her age and the symptoms you are mentioning. I would find a good geriatric specialist willing to fully evaluate her. She could be over medicated, under medicated, on the wrong meds, etc. There could be physical or psychological aspects contributing to her problems. If she is in a nursing home facility they have to provide some mental health coverage and Medicare should cover this. In Ohio, most private practice psychiatrists accept Medicare so I’m not sure why you have had trouble in this regard. I’m also very skeptical of someone getting diagnosed with Bipolar Disorder at the age of 80. She would have had to demonstrate symptoms prior to this for it to be Bipolar. It would have had to have been overlooked or missed for years, or she really doesn’t have it. Sometimes severe depression can mimic Bipolar and can include psychotic symptoms. I understand your frustration and concern and hope that you will make some noise to get your mom the care she needs. Good luck and hang in there.