[ photo by Tima Miroshnichenko ]

Importance of geriatric psychiatry. 

The majority of my patients are defined as “geriatric,” which is traditionally defined as being over the age of 65. Many of my patients have some sort of mental health disorder that affects their cognitive function.  I have frequently worked with family members whose loved ones have diagnoses that affect their cognitive health more so than their physical health. The majority of these loved ones have a diagnosis of dementia.

Dementia can be due to different causes and can include Alzheimer’s dementia, Lewy body dementia, frontotemporal dementia, and vascular dementia. These various forms of dementia are all due to different neuropathology and each have different initial presentations. Despite dementia being a more common condition affecting the (usually) geriatric population, there still has not yet been a cure found for this disease. There are a few medications on the market that can help with the cognitive symptoms with the person suffering from dementia, but these medications are not curative; they only help to reduce the symptoms of mild to moderate dementia. 

Complex interaction of mental health and dementia.

The majority of people I see with a diagnosis of dementia have a neurologist with whom they see regularly. The neurologist continues to treat and monitor the progression of dementia. In the past few years, however, I have encountered more and more people with a dementia diagnosis who are also established with a geriatric psychiatrist. In most cases, they ended up seeing the psychiatrist because of ongoing issues with anxiety, depression, and agitation. These all often go hand-in-hand with dementia, especially as the disease progresses.

I was able to speak with someone whose mother, let’s call her Diane, had Alzheimer’s dementia and had been hospitalized with worsening aggressive behaviors. Diane had been doing fairly well in a memory care unit, but then had a  urinary tract infection (UTI) that required hospitalization for treatment.  She was showing worsening agitation towards the staff at the hospital, and her memory care facility did not want her to return with these behaviors. Despite Diane’s UTI being properly treated and actually resolved, she was displaying severe enough aggressive behaviors that she had to be admitted to the geriatric psychiatry unit. It was here in this unit, however, that she was able to get treatment from a geriatric psychiatrist. 

What is a geriatric psychiatrist?

“What is a geriatric psychiatrist?” you may ask. This is a physician who completed a residency in psychiatry and then did an additional year-long fellowship that was specific to geriatric psychiatry. This fellowship provides specific training to the psychological issues that are more common in the elderly as well as the physiological differences in the elderly. As people age, the body becomes less efficient at clearing medications from the system, thus making the elderly population more susceptible to adverse effects of medications due to higher concentrations in the body. In addition, the elderly tend to be more fragile in terms of how their bodies respond to infections, both physically and mentally. The geriatric psychiatrist is trained in these nuances and can often provide medication regimens that are better suited for the geriatric patient than the patient who is 40 years old.

So, back to Diane. Her story is a bit more intense in that she actually required admission to an inpatient geriatric psychiatry unit. With this admission, though, she was able to be seen daily by her psychiatrist who was then able to make frequent adjustments to her medications to stabilize her from the agitation standpoint. She was then able to transition back to her assisted living facility with plans for follow up with her geriatric psychiatrist shortly after her discharge. 

I have encountered others who were having difficulty finding the right medication regimen to stabilize the effects of their specific dementia. Once established with a geriatric psychiatrist significant, positive changes in behaviors were noted. 

I understand it can be hard on the caregivers of aging parents to add yet another treating physician to the likely already long list of doctors. In the case of those that have dementia or specific psychiatric diagnosis, a little bit of prevention goes a long way. Establishing your loved one with a geriatric psychiatrist before a crisis might just shorten that crisis or even possibly help to avoid one altogether.

Do you feel your aging parent would benefit from seeing a geriatric psychiatrist? Unsure if it is the right next step for your loved one? Leave your question in the Comments section or contact me directly.

© 2021 Jessica Kluetz, DO