Geriatric Psychiatrists: How Can We Help You?

55 Comments

I am a geriatric psychiatrist. Um, what is that? An older psychiatrist who is ready to be put out to pasture? Nope. A psychiatrist that has an extra comfy couch so that older patients can lie down and tell me about their mother? Also, nope (although I do enjoy comfortable furniture).

A geriatric psychiatrist is a medical doctor (four years of medical school after college) with four years of general psychiatry training (an internship/residency following med school) and an extra one to two years of sub-specialty training (a geriatric psychiatry fellowship).

Our goal is to maximize quality of life and functionality for the older patient. We evaluate, diagnose and treat mental and cognitive health issues in older adults such as depression, anxiety and dementia.

Caring for older adults requires a special understanding of their physical, emotional and social needs. We manage patients with careful evaluation and assessment, medications (knowing when they can help and when they can't is key) and psychotherapy (mostly focused on the here and now, and no lying on couches). We maintain close linkage with the older adult's other healthcare professionals and family caregivers, as well as community resources.

Why I Became a Geriatric Psychiatrist

I was drawn to this profession for several reasons. Like many other geriatric psychiatrists, I had a very positive experience with an older adult growing up, my grandmother. Late in her life, after she had a stroke, she also experienced depression. I saw the way it impacted our family when this strong, vibrant woman changed before our eyes. With treatment, she was able to recover; this experience made a big impact on me.

I love the challenge of integrating the knowledge of psychiatry, neurology and medicine that is critical to understanding the mental and cognitive health problems of the older patient. For example, symptoms of depression can be triggered by life events (like loss of a spouse or a move), stroke (which can interrupt the pathways that impact mood and behavior), medical issues like anemia and thyroid problems (both of which can cause extreme fatigue and affect motivation) and medication side effects. Each patient's issues are different and present a puzzle for me to solve.

Whether or not they have previously experienced mental or cognitive health issues, the common feature of older patients is a lifetime of accumulated experience. So with help, they can adapt to change and improve their level of functioning.

I enjoy the teamwork of working together with the patient's other doctors or health professionals and the family to help the patient get better. Caregivers are my best partners. Ideally, we tailor care to the older adult and their particular circumstances. The caregiver is a key player who can provide an understanding of what is "old" and what is "new." For example, has the older adult always had an explosive temper or is this a completely new symptom? Caregivers offer a window to the older patient's past personality, their likes and dislikes, and home functional abilities that would be difficult for me to get in an office visit alone. We can then work together to come up with tailored strategies to help improve the older adult's function, which can benefit the entire family.

A Unique Program

At the University of Michigan, we have the unbelievable good fortune of having 10 geriatric psychiatrists on our faculty in our Program for Positive Aging. However, since there are only 1,600 of us geriatric psychiatrists in the entire nation, and with an aging "tsunami" upon us, we know that we need to find ways to reach older adults and their caregivers beyond our walls.

Thus, we are very excited about partnering with AgingCare.com to provide expert information that will help caregivers link with the right information at the right time.

In the coming months, look for posts from our Program for Positive Aging multidisciplinary expert faculty including geriatric psychiatry, nursing, social work and psychology.

We also very much look forward to hearing from you about topics that you as caregivers would be most interested in seeing us address, so please don't hesitate to let us know in the comments section below!

Helen Kales, M.D., is professor of psychiatry and Director of the Section of Geriatric Psychiatry at the University of Michigan. She is the Director of the Program for Positive Aging (PPA), which focuses on emotional wellness, aging well and improving life for those with later-life depression or dementia and their caregivers.

Program for Positive Aging

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55 Comments

Hi all! I very much appreciate the warm welcome from all of you. I am happy to try to address your comments/questions here to the best of my ability. "Vegaslady" asked about the interaction of medical and psychiatric issues. Great question. This is a key feature of the work we do, sorting out interactions, including those from medications. And because of interactions, the medications that worked in the past, might not work now or in the future. Seeing another psychiatrist especially one with geriatric training would be best to help you figure our next steps. Check out the Geriatric Mental Health Foundation "Find a Geriatric Psychiatrist" locator to see if there is someone near you (http://www.gmhfonline.org/gmhf/find.asp). "Norestforweary" thanks for all the great suggestions. I will share them with our PPA faculty for future posts. Let me just say that the limitations of antipsychotics is a topic that is very important to discuss. I have done a lot of research on the mortality risks of these medications. RIsk/benefit is very important. At times, the benefit may outweigh the risks. But that said, they are used too much and too many times in people for whom the risk outweighs the benefit. The PPA is working with colleagues to get useful and practical behavioral management techniques for caregivers out into the "real-world". Stay tuned! "Momsonlyhope" a full evaluation is the best way to sort things out, starting with your PCP. And caregiver respite is equally important. Do not go "down with the ship"! "Jeannegibbs" thanks for the kind words! Dr. Helen is fine. "Newdolliegirl" we most certainly will be posting on information on aging from a variety of perspectives in the coming months (our group includes experts from geriatric psychiatry, nursing, social work and psychology). "Jessiebelle" thank you for your welcome. We are excited to be here.
Thanks "Captain" and "Gigi11" for your thoughts. "Phoenixfarms" your comment makes me think how to deal with wandering in dementia would be a great future post. In general, medications are NOT a good solution for wandering. They only work by the side effect of oversedating the person with dementia (e.g. they do not directly impact the behavior) and the sedation can lead to falls and injury which can be devastating. We will say more in the future post but know that wandering has many possible causes (for example, reaction to medications, desire to exercise, sensory overload or deprivation, boredom, etc). So, it is best to try to figure out the underlying cause and make some simple environmental and behavioral interventions. More in the future post! Thanks for the suggestion.
"Thanks "Captain" and "Gigi11" for your thoughts. "Phoenixfarms" your comment makes me think how to deal with wandering in dementia would be a great future post. In general, medications are NOT a good solution for wandering. They only work by the side effect of oversedating the person with dementia (e.g. they do not directly impact the behavior) and the sedation can lead to falls and injury which can be devastating. We will say more in the future post but know that wandering has many possible causes (for example, reaction to medications, desire to exercise, sensory overload or deprivation, boredom, etc). So, it is best to try to figure out the underlying cause and make some simple environmental and behavioral interventions. More in the future post! Thanks for the suggestion."

I'm glad you'll be talking about this on a future post. I'd also like you to consider that care givers do need to sleep. Medicating for wandering might indeed cause more falls, if that person isn't watched closely, but even if they are, the elderly are going to fall anyway. That's a given. And doc, half of us spend all of our days trying to figure out new and improved environmental and behavioral interventions to calm our elderly, wandering parents. The ones that wander all day and night. If they're up, we're up. And we're not made to handle endless years of it. At a certain point, I didn't care if they gave my mom enough meds to knock out a rhino. Sad, but true. I would have wanted anything at that point to sedate her, and risk of yet another fall be damned. Pro's and con's from a care taker's side of the fence. We have to consider not only the patient, but ourselves. My mom's doc's weren't too keen on medicating her. I was jumping through hoops to keep her distracted, calm and soothed. It wasn't working. Nothing you would have come up with would have worked either, even if you had turned this entire house upside down trying to make it a better environment, even at 5 star hotel quality. Sometimes the elderly need meds. H***, doc's are writing prescriptions left and right for the worlds happy pills. Why deprive the elderly...and their grateful care givers? It took a nurse over here about 5 minutes flat one day, listening to my mom for one hour, to make a call to her doc and have a prescription for her. They wouldn't even take my calls, or call me back to talk about the issue. I was feeling desperate at that point for some relief. Your ideas are all well and good, but until you doc's find the magical happy place that calms and soothes all elders equally and puts them instantly into a state of calm, peaceful tranquility and actually makes them SLEEP for a minimum of 5 blessed hours, give them some drugs if they need it.

If doctors really want to come up with solutions to the elderly, especially those with alz, dementia, etc, etc, etc, then you should be required, for one year, to house an elderly alz patient in your own home, up close and personal, so you gain the knowledge you really need to make ideas for them that work. Watching them part time, or studying from a distance part time, isn't going to help much. That's not even reality as I see it.