Let?s consider the geriatric population now and psychiatry.
Medication is a very important topic to think about when we are talking about the elderly.
So you always want to try to subtract medications from your geriatric patient
rather than adding medication on. This is a really important point and so I?m leading with it.
Be very careful about polypharmacy in the elderly individual.
But what is polypharmacy? Well, it?s the use of 4 or more medications by a patient
and it?s most commonly occurring in the elderly. It affects about 40% of older adults
and can lead to serious problems. Concerns about polypharmacy
include increased adverse drug reactions. So the more medicines somebody's on,
the more drug-to-drug interactions there gonna be, that are incredibly dangerous
not to mention the side effects from the medication. Then there?s this thing
called the prescribing cascade, where in good faith, doctors will often tend
to just keep adding a pill to treat a symptom but then a patient may get a side effect
which requires another pill and so on and so forth and it?s a terrible cascade that happens.
There?s a lot of cause associated with prescribing multiple medications
and it actually can lead to decreased quality of life for an individual, decreased mobility,
decreased cognition and actually earlier mortality.
So the geriatric population is growing very fast in the United States
and this group is just as susceptible to developing psychiatric disorders as anyone else.
Cognitive disorders and major depression are actually extremely common in the geriatric segment.
So when it comes to assessing an elderly patient, you wanna take the same approach
as you do to other adults. Form a good therapeutic alliance, take a thorough history
including a mental status exam and a very thorough medication list. Get collateral information.
Talk with the patient?s children or their grandchildren. Call their previous providers
whether it?s a psychiatrist, therapist or primary care physician and do screening tests.
You wanna look into cognitive problems, depression, suicidal thoughts
and also side effects to medication use. You also wanna be careful to check for abuse
and neglect in this population.
Factors associated with normal aging include decreased muscle mass and increased fat,
decreased brain weights, impaired vision and hearing and minor forgetfulness.
One problem for the elderly is that they?re often confronted with mortality
as they witness their friends dying and so it?s pretty common for the elderly
to go through grieving processes. Sometimes, more often than not.
So the stages of dying are as follows: First, there?s denial, then anger, bargaining,
guilt and finally, acceptance. These are of course the stages of dying as defined by Kubler-Ross.
The stages of dying maybe experienced in any order and some of them
can actually occur simultaneously, something to be aware of.
Another important point in the elderly is to consider depression. So we know they?re prone
to having depression. So let?s define this again. Major depression is common in the elderly
and they?re actually twice as likely to commit suicide than the general population.
We see it in 15% of nursing home residents and symptoms include problems with memory
and cognitive functioning. They can often be mistaken for dementia but of course,
the correct term is actually pseudodementia which is major depression in an older person
which presents looking like dementia. So patients may appear demented but in fact,
you can treat the depression and thereby reverse their cognitive problems.
Depressed elderly patients will often present with physical symptoms such as stomach pain
and memory loss. An important point to keep in mind.