Introduction
The geriatric population includes elderly people older than 65 years of age. Geriatric psychiatrists deal with old age-related psychiatric disorders like depression, delirium (confused thinking and being less aware of one’s surroundings), dementia (a group of symptoms that affect one’s thinking, memory, and social abilities), personality disorders, mood disorders of later life, anxiety disorders, and so on. Geriatric psychiatry is a branch of medicine that focuses on diagnosing, evaluating, preventing, and treating mental and emotional disorders in the geriatric population.
How Did Geriatric Psychiatry Emerge?
Geriatric psychiatry is also called psychogeriatrics or psychiatry of old age. The first institution which showed interest in geriatrics was the Veterans Administration since aging veterans battled with various mental health conditions. The first Geriatric Research, Education, and Clinical Center (GRECC) was opened in 1976, and the first professorship of geriatrics was established at Cornell University in 1977.
The American Association for Geriatric Psychiatry (AAGP) was established in 1978, and the first geriatric psychiatry exams were started in 1991, and it was implemented that recertification every ten years was mandatory. The field of geriatric psychiatry has seen significant growth in the last 45 years, and numerous geriatric psychiatry fellowship programs focus on the mental well-being of the elderly.
Why Is There a Rising Need for Geriatric Psychiatrists?
On the one hand, there is a rising need for geriatric psychiatrists, but on the other hand, it is not a commonly sought-after career. According to a study conducted by Michigan University in 2018, the number of available geriatric psychiatrists is less than 2,000, meaning there are only 2.6 geriatric psychiatrists for every 100,000 adults aged 65 years and older. In a few states, there are no geriatric psychiatrists at all.
The elderly are susceptible to developing various psychiatric disorders, and geriatric psychiatrists who are extensively trained in this specialty have the skill to help the elderly deal with various late-life psychiatric syndromes like:
-
Anxiety.
-
Delirium.
-
Depression.
-
Mood disorders.
-
Personality disorders.
-
Sleep disturbances.
-
Substance and alcohol abuse.
Everyone is well aware of the fact that advanced age poses a high risk of developing certain mental health conditions, especially depression, dementia, and delirium. Old age is also one of the greatest known risk factors for Alzheimer’s disease (a gradually developing disease in which one’s memory and other important mental functions deteriorate). Geriatric psychiatry mainly addresses the following:
-
Psychological and biological aspects of normal aging.
-
Social and biological effects of psychiatric problems in the elderly.
-
Psychological effects of short and long-term physical health issues.
What Are the Causes of Geriatric Depression?
No single cause could be attributed to depression. Biological, social, genetic, and psychological factors play a role in geriatric depression. The following factors may be responsible for causing depression:
-
A family history of depression.
-
Reduced levels of major neurotransmitter chemicals in the brain like serotonin and norepinephrine.
-
Traumatic events in life like death of loved ones or abuse.
Other age-related factors could also result in depression among the elderly. These factors are as follows:
-
Isolation.
-
Facing mortality.
-
Immobility or limited mobility.
-
Financial constraints.
-
Retirement phase.
-
Long-term substance abuse.
-
Divorce or widowhood.
-
Long-term medical conditions.
-
Death of close ones.
What Are the Signs and Symptoms of Geriatric Depression?
The symptoms of geriatric depression are similar to the symptoms of depression experienced by people in other age groups. These include:
-
Sadness, irritability, and fatigue.
-
Crying episodes and feelings of worthlessness.
-
Poor concentration, apathy, withdrawal, and restlessness.
-
Extreme fear of a terminal illness or death.
-
Lack of confidence or poor self-esteem.
-
Mood swings, repetitive behaviors, agitation, or outbursts.
-
Worry and stress caused by the hardships of living with physical health conditions.
-
Suicidal thoughts.
-
Difficulty sleeping.
-
Body aches and pains.
-
Changes in appetite.
Depression is mostly the cause of physical pain in the elderly and is mostly not due to other health issues.
How to Diagnose Geriatric Depression?
Geriatric depression can be difficult to be diagnosed. A family doctor who regularly treats the elderly can easily make out if any mental changes are obvious in the elderly. Based on this or with the information provided by a close family member or a friend who observes them daily, the older adult may be referred to a mental health professional who will assess the symptoms, behavior, mood, daily activities, and family history of the older adult. A person who shows symptoms of depression for a minimum of two weeks is said to be diagnosed with depression.
How Can Geriatric Depression Be Treated?
No single treatment for depression will do wonders for an individual. Narrowing down the right treatment plan can take some time. Usually, the treatment encompasses a blend of medications, therapy, and lifestyle changes. The following medications are prescribed to treat depression:
-
Tricyclic antidepressants.
-
Selective serotonin reuptake inhibitors (SSRIs).
-
Selective serotonin-norepinephrine reuptake inhibitors (SNRIs).
-
Monoamine oxidase inhibitors (MAOIs).
The following lifestyle changes can be followed to deal with depression:
-
Discovering and engaging in a new hobby or interest.
-
Getting sufficient sleep daily.
-
Following a well-balanced diet.
-
Increasing physical activity or exercise.
-
Spending more time with friends and family.
Further, art therapy and psychotherapy can also help one deal with depression. Art therapy involves one to express their thoughts and feelings in a creative manner. Psychotherapy involves talking with a trained therapist in a private environment.
What Can Be Done to Encourage Many People to Pursue Geriatric Psychiatry?
The elderly require special and tender care since they are obsessed with many late-life psychiatric issues and other personal problems. The major difference between general adult psychiatrists and geriatric psychiatrists is the experience and comfort level that is offered in handling older adults with various co-morbid medical issues and on multiple medications. Geriatric psychiatry fellowships incorporate additional training in geriatric medicine and neurology.
More strategies can be initiated to encourage more people to join this field. Some strategies include incorporating special training in this specialty into undergraduate and graduate medical education and also introducing short-term fellowship courses.
Conclusion
Aging is unavoidable and is associated with normal biological and psychological changes. Certain physical and mental health conditions are common in the geriatric population, such as physical disabilities, long-term illnesses, comorbid conditions, and psychiatric syndromes. Just like people of other ages, the elderly also require special care and support to deal with their mental health issues. Geriatric psychiatry is one such branch of medicine that deals with the mental health conditions of the elderly, but sadly there are very few geriatric psychiatrists to assist the elderly. With proper strategies like the introduction of short-term fellowship courses and inculcation of this subspeciality in undergraduate and graduate medical education, one can hope to see many geriatric psychiatrists in the future to offer help to close and loved ones.
