Chapter 73: General Topics in Geriatric Psychiatry

This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #56, #57, #59

Learning Objectives

• Understand the prevalence of mental health and psychosocial problems associated with aging, and their adverse consequences on longevity and quality of life.

• Learn about the epidemiology, common clinical presentations, evaluation tools, and management of psychiatric conditions commonly seen in older adults.

• Acquire information necessary to recognize suicidal behavior in older adults, best ways to assess suicide risk, and effective strategies to manage suicidal patients.

• Understand the principles underlying use of antipsychotic medications in older adults, assessment of their risk-benefit ratio, clinical indications, side effect profile, and monitoring of clinical response.

• Learn about the prevalence, diagnosis, and treatment of substance use and personality disorders in older adults.

• Gain new knowledge about how “successful aging” can enhance emotional and psychological health in older adults, and promote longevity through salutary effects on cognition, physical function, and social interaction.

Key Clinical Points

1. The prevalence of psychiatric diseases increases with aging and exerts adverse effects on longevity, cognition, physical health, social interactions, and comorbid illnesses.

2. Mood disorders are common in older adults and associated with a high risk of suicide. It is important to recognize suicidal behavior and learn how to assess suicide risk and best ways to manage suicidal patients.

3. Use of antipsychotic medications in older adults is associated with serious adverse effects, including higher death rates in patients with dementia. None of these medications are Food and Drug Administration (FDA) approved for management of behavioral or psychological symptoms of dementia (BPSD), and there is no evidence from randomized trials that they are effective in managing psychotic symptoms.

4. Anxiety disorders are common in older adults and can present in many forms, including as generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), or panic disorder (PD). Additionally, anxiety symptoms are often associated with depression, dementia, medical comorbidities, and substance abuse. Psychotherapy and selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) are the cornerstone of therapy for most anxiety disorders.

5. Promoting the principles of “successful aging” and positive psychological traits, such as optimism, resilience, and social engagement, enhances neuroplasticity and improves cognition, physical function, and overall quality of life.