Geriatric Psychiatry Direct

Geriatric psychiatry is the field of medicine dedicated to the diagnosis and management of mental health care in older adults. Seeking help from a specialist trained in the mental health care of older adults is nothing to be ashamed of.

Psychiatric disorders in older adults may be persistent disorders beginning earlier in life, and others may occur for the first time after age 50. In addition to depression and anxiety, substance abuse is not uncommon in the elderly. Neurological conditions such as stroke, Alzheimer’s and other neurocognitive disorders, may also contribute to neurobehavioral symptoms such as delusions, agitation and aggression. Even circadian rhythm changes, and inappropriate use of medications can further exacerbate these symptoms.

Anxiety

Bereavement

Depression

Sleep Disorders

Cognitive Disorders

Addiction

Psychotic Disorders

Bipolar Disorder

Depression affects more than 6.5 million of the 35 million Americans aged 65 years or older. A majority of older adults also have at least one medical illness placing them at risk for depression. This leads to worse health outcomes.

In older adults, depression may present with memory problems, sleep and appetite changes, slowed movements, and even delusions. Medical problems such as chemical, thyroid or blood count abnormalities, and vitamin deficiencies, can worsen these symptoms.

Older adults may also be grieving the loss of a loved one or going thru other transitions that may trigger depression. It is important to understand the biological and psychological aspects of depression in determining treatment.

https://www.nimh.nih.gov/health/publications/older-adults-and-depression/index.shtml

Moak, Gary. Beat Depression to Stay Healthy and Live Longer: A Guide for Older Adults and Their Families, Rowman and Littlefield, 2016.

Medical illness, disability, life transitions, and a fear of falling can lead to avoidance behaviors which worsens anxiety. Even if you had not previously thought of yourself as “anxious,” it is not an uncommon occurrence as you age. Additionally, you may experience worsening of other anxiety disorders such as obsessive-compulsive disorder and hoarding. Degeneration in the brain areas associated with the ability to modulate anxiety may contribute to the development of worsened anxiety. We understand how disabling anxiety can be and are ready to help.

Sleep changes are common in older adults and may be worsened by medical or psychiatric problems. As one ages, there is reduced sleep efficiency and quality of sleep, as well as reduced total sleep time. Medications and alcohol use also affect sleep duration and quality, placing older adults at risk for worsened cognition as well as falls. A comprehensive assessment involving education about sleep hygiene, as well as identification of potential pharmaceutical contributions to impaired sleep may be beneficial.

https://sleepfoundation.org/

Health care providers may often overlook substance overuse or abuse in older adults since impairments in functioning at work or social situations, or changes in cognition may appear within the normal limits of aging. Alcohol and other prescription medications are metabolized less efficiently in older adults, and substance use disorders require early recognition and ongoing treatment.

https://niaaa.nih.gov/alcohol-health/special-populations-co-occurring-disorders/older-adult

Patients with Parkinson’s Disease, Dementia with Lewy Bodies, or other neurocognitive disorders may also be described as “delusional” by their loved ones. Common examples include infidelity, belief that items have been stolen, or having visual hallucinations.

Certain medical issues may also cause “delirium” in which psychotic symptoms may occur. It is important to treat underlying medical causes of symptoms.

Additionally, older adults who were diagnosed with schizophrenia in young adulthood or adolescence have frequently been stabilized on medications which may need adjustment as the body changes to minimize or prevent side effects.

https://web.stanford.edu/group/usvh/stanford/misc/Schizophrenia%202.pdf

Although bipolar disorder is rarely initially diagnosed in older adults, the pharmacologic treatment of bipolar disorder as patients age often requires dose adjustments, particularly to avoid unnecessary side effects. Symptoms that may resemble mania in a younger adult may also be the signs of an underlying illness or dementia in an older adult and it is important to distinguish the two. Symptoms of mania frequently include rapid rate of speech, acting reckless, having a decreased need for sleep, or being uncharacteristically happy, affectionate, or irritable.

What is Geriatric Psychiatry?