Psychiatry and the elderly, what to expect
Dealing with a loved one’s cognitive decline can be challenging. From forgetfulness to depression and everything in between, the changes in the person’s outlook can almost feel like you are dealing with a different person. Goodness Me looks at old age psychiatry (a.k.a. psychogeriatrics or geriatric psychiatry), what to expect in ageing relatives and where to seek help.
Old age psychiatry arose in the 1970s as a sub-specialty in Britain, largely driven by the ageing population and improvements in health care that saw people living longer.
Epworth psychiatrist Professor David Ames says since then there has been a lot of work done to understand the two main conditions of aged psychiatry: dementia caused by Alzheimer’s Disease, and depression.
“With our ageing population and smaller families, as a percentage of the population we are seeing increasing numbers of people touched by the experience of caring for someone with Alzheimer’s,” David says.
He says the brain is a complicated organ, and often the first symptom of Alzheimer’s Disease in older people is forgetfulness.
“This is not just forgetting where the keys are, but means when someone starts forgetting to pick their grandkids up from school for example – something they have done regularly in the past but now forget. Language loss where the person regularly forgets words they previously used often is also an early warning sign.”
He says another common indicator is losing motivation to do things they have previously enjoyed, such as playing golf, bridge or cooking.
“Alzheimer’s affects the frontal lobes and diminished activity seems to be a strong indicator of cognitive decline.
“Another common symptom is the loss of spatial relationships, such as the ability to find your way to places you don’t go regularly.”
Educating caregivers on the social management of Alzheimer’s is proving to be one of the most successful strategies for allowing people to stay in their homes longer.
Alzheimer’s Australia runs courses for carers and patients living with memory loss.
“There are both practical issues to deal with as well as grief for the caregivers over the changes in the loved one’s mental health,” David says.
Practical issues include things such as establishing an enduring power or attorney, thinking about the older person’s residential set up and seeing that there is a Will in place are just a few of the outcomes of the course that can help empower carers.
He says some people also need to seek individual assessments with psychiatrists, geriatricians or neurologists to look at whether medication can help slow the decline.
“The standard medications can buy between 3 to 18 months in slowing the rate of cognitive decline in more than 50 per cent of patients. However, in about 15 per cent of people, the side effects of the medication in terms of nausea or diarrhoea means medication is not be worth the trade off.”
Depression in the elderly
In the majority of cases, depression presents itself in the elderly where people have been depressed in earlier life.
“Only about one third of people presenting with depression have developed it for the first time in later life, and usually that has been brought on by an eventsuch as a stroke, a bereavement or becoming immobile,” David says.
He says the same medication is often used to treat depression, but in lower doses than in younger people as older people tend to have a slower metabolism.
“Depression can get better and is likely to get better with medication. It is important to note that depression in the elderly is not normal. Having a low mood, losing interest and sleep disturbance are all treatable.”
David says that there are only about 1–2 per cent of older people living in the community that have major depressive disorders. He says you need to seek help from a psychiatrist when there have been one or more episodes that require you to call on others for assistance.
“The evidence is that we can get people well and keep them well, so that they have less of a tendency to relapse.
“Getting help early can make a big difference in your outlook. How a patient presents initially will often be an indicator of the level of decline. Empowering yourself through information can really help caregivers cope with the changes brought on with an ageing relative experiencing cognitive decline,” David says.
Epworth Clinic’s aged psychiatry service is dedicated to the care of people aged 65 and over with mental health issues. The mental health team is comprised of nurses, psychologists, social workers, occupational therapists and psychiatrists specialising in mental health conditions of old age. Patients require a GP referral for consultations. Alzheimer’s Australia: www.fightdementia.org.au for information on courses.
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