Geriatric psychiatry: Proper diagnosis helps treatment

Age related issues

Man’s physical abilities and the capacity to apply intellectual reasoning is considerably impaired as he grows old. Geriatric psychiatry, also known as psychiatry of old age, entails treating and dealing with this essentially age-related problem.

Increasing elderly population

In India’s context Geriatric psychiatry has assumed paramount importance. As per the latest provisional data of Census of India, the elderly in the age group of over 60 comprise 8.3% of India’s population, second largest in the world. This 60+ group is also the second fastest growing segment of Indian population. The population growth is likely to register 3.5 times increase by 2050, in percentage terms.

Need for action-plan

This calls for a comprehensive action-plan to deal with Geriatric psychiatry, involving diagnosis, treatment and management of dementia and depression among aged persons. It is important to know that psychiatric illness of the elderly is different from the illnesses of adult patients. Doctors and psychiatrists need to be well prepared to deal with this problem to avoid any future complications.

History important!

To properly diagnose a geriatric psychiatric illness it is imperative to take a detailed note of the elderly’s history. The history needs to focus on:

• Changes in functional performance of daily life
• Need to document the drugs consumed
• Need to know if non-prescription drugs, responsible for psychiatric symptoms are being used
• Need for a proper physical examination of higher functioning
• Need to check all sensory systems such as hearing and vision
• Need to assess mental status through Mini Mental State Examination (MMSE)
• Need to conduct simple lab tests for electrolyte imbalance, anemia, malnutrition, metabolic abnormalities, urinary retention

Management of Geriatric psychiatry

Psychosocial intervention can make considerable difference to the elderly person’s condition.

• New drugs working through one neurotransmitter, of late, has been found to be safer
• Start the treatment without further delay. Risk of suicide increases with delay in treatment
• There is a need for adequate treatment of co-morbidity
• Mental functioning of patients and dementia may aggravate if treatment of any illness or severe infection is delayed
• It is better to avoid benzodiazepine group of drugs that cause more harm than benefit
• Medication needs to go slow and start slow
• Any sudden or early withdrawal of medicines should be avoided at all costs