Geriatrics is the branch of medicine that focuses on health promotion, prevention, and diagnosis and treatment of disease and disability in older adults.

Geriatric Psychiatry

Geriatric Psychiatry also known as Gero-psychiatry or psychiatry of old age, is a subspecialty of psychiatry involves the evaluation, diagnosis, prevention and treatment of those individuals who are over 60 years of age with various mood, anxiety, and psychotic disorders, as well as dementia.

Geriatric psychiatry emphasizes the biological and psychological aspects of normal aging, the psychiatric effect of acute and chronic physical illness in older age groups.

Geriatric Psychiatrist

Geriatric Psychiatrist is a medical doctor with special training in the diagnosis and treatment of emotional, psychological and mental disorders that may occur in older adults. These disorders include, but are not limited to, dementia, depression, anxiety, and late-life schizophrenia. Older adults have special physical, emotional, and social need.

Role of a Geriatric Psychiatrist in older Adults

 A geriatric psychiatrist offers comprehensive psychiatric care to senior and elderly patients in need, whether it be listening and responding to the concerns of the older adult, helping families and when necessary, working with older health care professionals to develop effective approaches to treatment.

Geriatric psychiatrists focus on prevention, evaluation, diagnosis and treatment of mental and emotional disorders in the elderly and improvement of psychiatric care for healthy and ill elderly patients.

Geriatric Psychiatrists are perhaps the only specialty in medicine that has something to offer dementia patients and their families/caregivers at every stage of the disease. Geriatric Psychiatrists are often asked to consult on issues of competency and informed consent and the appropriateness of surrogate management arrangements such as guardianship

At beyond psychiatry, we provide care to elders and realize the importance of family involvement, support, counseling, family education and guidance for appropriate Community resources and level of care.

Common Conditions in Geriatric population

Memory-Cognitive Impairment & Dementias

There are several types of dementias such as Lewy-Body dementia, frontal-temporal dementia, and Parkinson’s disease dementia as well as the more common disorders such as Alzheimer’s disease (AD).

Alzheimer’s disease is by far the most common cause of progressive dementia among older adults. The Alzheimer’s Association estimates that more than five million Americans are currently affected. Advanced age is the primary risk factor for AD. With our aging population, we will see a doubling of AD by 2030.

It is emphasized early detection, diagnosis and treatment lead to improved life and delays placement into long term facilities.

Mild cognitive impairment (MCI) may be a prodrome for AD or early manifestations of a progressive dementia

Depression & Anxiety Disorders

Depression is a major problem in older adults, particularly among those in the hospital or outpatient setting and especially in the nursing home, where 20–25% of residents may suffer from depression. Older adults have double the suicide rate of the general population and also have a higher rate of psychotic and catatonic depression. In the latter condition severely depressed older adult stop eating and drinking and become cachectic. This may be a true psychiatric-medical emergency, often requiring aggressive medication treatment requiring electro-convulsive therapy (ECT).

Delirium & Agitation

Delirium, or acute confusion is a very common finding in older adults. Studies estimate a prevalence of 10–60% among older adults in the acute care setting and about 0.5% among non-demented elders living independently in the community. Delirium is also common in long term care or the nursing home setting.

The key feature of delirium is the area of attentiveness specifically difficulty focusing and maintaining attention. Consequently, even a simple task such as reciting the days of the week backwards from the current day or subtracting by threes from one hundred may prove difficult.

The major risk factors for delirium are advanced age and pre-existing cognitive impairment, such as dementia. Heading the list of causes are drugs (anti-cholinergic, benzodiazepines and narcotic analgesics) and infections (urinary tract and upper respiratory).

Delirium is always assumed to be reversible until proven otherwise. The key to treatment is to identify the cause or trigger and remove or address it. Until a cause is found the behavioral/psychiatric concomitants of delirium may be difficult to manage. These often include agitation and psychosis.

Recent trends in the management of psychiatric symptoms of delirium are to minimize the use of psychotropic and to prioritize the use of environmental-behavioral interventions. These would include a quiet environment which is not over-stimulating, the use of soothing music, touch, aromas and presence of familiar, reassuring faces such as family members.

In the acute, out of control patient, use of medication is warranted. The immediate goal is to prevent the patients from inadvertently harming themselves or others.

Other Syndromes

There is significant occurrences of sleep disturbances, pain syndromes, personality disorders, and alcohol-substance abuse issues in older adults.