What is Geriatric Psychiatry? When is it Necessary?

Geriatric psychiatry deals with both biological and psychological factors in aging adults. It explores acute and chronic physical illnesses as well as the psychiatric conditions that may affect us as we get older.

These professionals focus on prevention, evaluation, diagnosis, and treatment for mental and emotional disorders. They also advocate for the improvement of psychiatric care for elderly patients.
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Normal Aging

​Understanding what is part of the normal aging process can be difficult and recognizing the changes in cognitive functions and personality is delicate.  As we age, there are expected changes in our vision. 
Sleep patterns change and fluctuate. There is a decline in motor skills and multi-tasking is more difficult. Vocabulary will change.  All of these are normal. However, if core personality traits change or cognitive functioning deteriorates, there could be concern for a mental illness including depression.
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Assessment for Geriatric Psychiatry

When assessing the status of an older person, either by a family member or by medical personnel, it is important to allow sufficient time for the patient to absorb the details of the questions and to consult with family members.  It is easy to dismiss some of the complaints as exaggerated or ordinary. 

Respectful and thoughtful listening skills are critical. While an accommodation for sensory impairment should be considered, not all older people are hard of hearing and you should speak in a normal tone of voice unless requested to speak louder.
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Pharmacology

As a concerned family member or as part of the medical team, it is critical to review prescriptions and over-the-counter medications.  This has a two-fold importance:  to be sure the prescribed medication is taken as ordered and to review for any interactions.  

Older adults often visit more than one medical professional.  Most older adults are quite capable of managing their medical care and are conscientious about complying with the medication instructions. However, when multiple prescriptions are involved, medical staff should carefully review all of them. Overprescribing is rampant for older adults who are more vulnerable for adverse effects.

As one ages, the liver becomes less able to break down medications and toxins.  Side effects can become more common if medications are not initiated and titrated slowly.  Lower doses may be utilized compared to younger adults.

At some point, cognitive abilities will fail and it will be necessary for someone else to take responsibility for the medications.
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Depression

It is estimated that at least 25% of older adults suffer from some form of depression or symptoms that will impair their social or emotional functions. Depression can increase the risk for health complications including longer hospitalizations, poorer recovery rates, and other issues.  
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Dementia 

The chance of dementia increases with age: 

• 5% of all adults over 65
• 30% in adults in the mid 80s
• over 50% for adults in their 90s. 

While Alzheimer's is the most common form, there are other types of dementia to be screened for.
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Symptoms like depression, anxiety, and insomnia are often overlooked as changes in cognitive abilities. Wandering will occur in over 90% of patients diagnosed with dementia and is the primary concern for their caregivers.  With supportive guidance to the patients and families, this condition can be dealt with reasonably and safely.  Of primary concern is safe judgment and appropriate living arrangements.

If you know someone who may need some help, don't delay, book an appointment today. 
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