Mental Illness in the Elderly
Most of the mental illnesses that afflict older people are treatable. The trick is recognizing them among a myriad of other symptoms.
Geropsychiatrist Shreekumar Vinaker, M.D., doesn’t need notes to remind him of the challenges in dealing with the mental problems of a growing elderly population. He can cite the frightening statistics from memory.
The incidence of Alzheimer’s disease doubles for every five years of age after 60, so by the time someone reaches 85, his or her chance of developing this dreaded, irreversible condition is 50-50.
Eighty-five to 95 percent of people in nursing homes have a psychiatric illness, many of which would be treatable if properly diagnosed.
By some estimates, the elderly population in the United States will double to 70 million by 2030. By then, there will be only 2,000 additional trained geropsychiatrists to meet the need, yet many of the country’s current 2,500 geropsychiatrists will be “off the scene” by then.
“As we get older, and as advances in medicine keep the population alive and well, degenerative diseases of the brain will present a health care challenge that is phenomenal,” Vinaker said. He added that it will be increasingly important for primary care physicians to recognize treatable mental illnesses in their older patients that may be masquerading as other ailments.
Vinekar, a geropsychiatrist for the past 30 years and professor of psychiatry and behavioral sciences at OU since 1998, is a veteran at unmasking a patient’s surface complaint and revealing the underlying psychiatric illness.
“Anxiety disorder and depression are very common in the elderly and are easily missed because they are masked” by other symptoms, such as abdominal pain, Vinekar said. When these problems are identified and treated, the patient can regain his or her personality and ability to function.
However, when the problems aren’t recognized, and many aren’t, the patient may enter a nursing home where the likelihood of a diagnosis and treatment is virtually nonexistent, Vinekar said. The critical need for this care is demonstrated in studies showing that 15 and 30 percent of nursing home residents suffer from treatable major depression, he said.
Family, friends and even some physicians fail to realize that the maladies afflicting the elderly may be syndromes that can be treated, often because of the cultural bias called ageism, Vinaker said.
“There’s an attitude toward older people that if there is something wrong, it’s just part of their aging. If a person is forgetting things, well, everybody forgets things as they get older. Everybody is losing their friends and relatives as they get older, so isn’t it normal for him to be a little bit gloomy? It’s an attitude of accepting and tolerating symptoms as part of life for the aged.”
Late-onset schizophrenia, which manifests itself after 45, is one serious but treatable disease that can appear, like Alzheimer’s, as a patient ages. Older adults experience hallucinations and paranoia, but their symptoms are generally milder than those in younger people. Diagnosing late-onset schizophrenia can be a challenge, Vinekar said.
“If a patient says her son is trying to poison her, is she showing manifestation of dementia or depression, thinking she’s being punished? Or delusion, because she’s schizophrenic?” Vinekar said. “It’s very difficult for a primary care physician to know. You’d need a geropsychiatrist.”
Geropsychiatry is a relatively new sub-specialty, created first as certification-related in 1991. A training program in this field at OU is in the planning stages, Vinekar said. Meanwhile, fourth-year residents can elect a geriatric psychiatry rotation under his preceptorship or that of fellowship-trained geropsychiatrist Jo Ana Fields, M.D.
The OU Department of Psychiatry and Behavioral Sciences operates a 15-bed acute care service at St. Michael’s Hospital in Oklahoma City in joint venture with St. Anthony Hospital. For families, the acute care unit provides treatment “before the family or physicians give up their hope of being able to maintain the patient in the community. Our goal is to maintain the elderly in the community and provide adequate treatment for a good quality of life,” Vinekar said.
“A person may not get out of bed, may be depressed, behave as if he is forgetting, isn’t able to concentrate, has sad moods, his severe guilt feelings mount, and he becomes paranoid, thinking people are stealing from him. His condition resembles dementia, and the family thinks it’s time for him to go into a nursing home. But if they bring that individual to the hospital, and we treat the depression with antidepressant medications and the paranoia with antipsychotic medications, the condition may clear up.”
Unfortunately, for some patients, treatment doesn’t succeed well enough for them to return home. “At that time, we support the family in finding long-term care. This is a sad event in an elderly person’s life.”
Alzheimer’s is a genetic disease that is neither curable nor reversible, Vinekar said. Treatment to arrest the progression of the disease is available, but this only slows the unrelenting deterioration. Caregivers can help by orienting the patient several times a day as to where he is or what day it is, where the bedroom, bathroom and dining room are, and so on.
The prospect of life with a disease as remorseless as Alzheimer’s inevitably brings up the question of whether it’s possible to postpone, perhaps indefinitely, its development.
Vinekar said the answer isn’t known, although two recent discoveries offer tantalizing hope. One shows that antidepressants stimulate formation of new neurons. The other demonstrates that if your brain stays active as you grow older, dendrite connections will continue to develop.
source: oumedicine.com
