Due to changes in the brain, there is a partial loss of mental functions such as memory, attention, movement and perception. Determining how much of this loss in geriatric psychiatry is a natural and expected process and how much of it indicates a brain disease requires a meticulous examination. With the prolongation of human life expectancy, physical and mental health problems in old age gain special importance.
Geriatric psychiatry is psychiatric treatment specific to advanced age. The aim of geriatric psychiatry is to improve the patient's current psychology as well as the treatment of the patient. While the use of medication in geriatric psychiatry is recommended according to the type of the disease, it is necessary to cooperate with specialists related to different diseases of the person, and a multidisciplinary approach is required for this.
Geriatric Psychiatry Diseases
Geriatric psychiatric disorders are usually seen in older ages. In some geriatric psychiatric disorders, genetic inheritance has a significant rate. Geriatric psychiatric diseases are as follows;
Alzheimer's disease
Alzheimer's disease is a condition in which nerve cells in the brain die, making it difficult for the brain to transmit signals properly. In the early stages of the disease, Alzheimer's symptoms can be difficult to detect. People with Alzheimer's disease have problems with memory, judgment and thinking, which makes it difficult for them to work and participate in everyday life. The death of nerve cells occurs slowly over many years.
Alzheimer's disease is a form of dementia. Dementia is a consequence of the deterioration of the mental and behavioral functions of the brain in general. Alzheimer's does not equal dementia . Because there are many diseases and causes that result in dementia or that lead to dementia during its course. Alzheimer's disease is only one of them. In other words, every Alzheimer's patient has dementia, but not every dementia patient has Alzheimer's disease. Dementia varies depending on what disease or condition affects the brain and how it affects the brain. Basic knowledge of the relationship between brain regions and functions is important to understand these variations.
Depression in the Elderly
While the prevalence ofdepression is 5-8% in the general population, it is -15% in the population over the age of 65. This rate increases to 40% in elderly people living in nursing homes. Diagnostic criteria for depression do not differ between age groups. However, different features may be observed in the clinic. For example, some patients may have typical symptoms such as changes in sleep and appetite, decreased energy, depressed mood and apathy, while others, especially those over the age of 80, may have different symptoms. The patient may not describe depression and sadness. Irritability, restlessness and withdrawal may be observed. In some cases, masked depression and depression equivalents can be mentioned. For example, a patient who does not describe depression and does not appear depressed may complain of chronic pain and fatigue or be constantly worried about their health.
In elderly patients, somatic (physical) and cognitive (cognitive) symptoms are more prominent than emotional symptoms of depression. Older people who do not describe depression may say that they feel nothing or that they have lost interest and the ability to enjoy themselves. The fact that the elderly do not describe emotional symptoms has led to the use of terms such as "depression without sadness".
Suicide is 2 times more common in the elderly than in the general population. Suicide attempts decrease with aging, but the rate of finalization increases. Severity of depression has been found to be a strong reason for suicidal ideation. Therefore, in addition to questioning suicidal ideation, evaluating and considering the severity of depression in general plays an important role in determining the possible suicide risk.
Mania in the Elderly
Mania is rarely seen as a first episode in old age. Manic patients over 65 years of age cannot simply be described as the old age of those who were diagnosed with bipolar disorder in their youth. In many of these patients, the illness may have started in middle age or older. Familial burden is a risk factor for early onset bipolar disorder as well as for late mania. Therefore, familial factors are important for geriatric bipolar disorder. In addition, medical risk factors have been found to be important in late-onset mania.
The clinic of mania differs in the elderly. Enthusiasm and outbursts are less. Confusion, paranoia, restlessness and loss of attention are more common symptoms.
Psychosis in the Elderly
Paranoid psychosis is the cause of most psychiatric admissions in old age. Sometimes the only symptom is delusions of evil. In some patients, a schizophrenia-like clinical picture may be observed; delusions and hallucinations, thought disorder are present. Genetic predisposition, familial burden, sensory deprivation (especially deafness) and prolonged isolation play a role. Treatment is difficult because of the lack of insight. Response to antipsychotics is generally good. The choice of antipsychotic should be based on the risk of side effects in the elderly. In some patients, doubts may persist even if functionality improves.
Anxiety Disorders in the Elderly
Panic disorder is a chronic syndrome with improvements and relapses. A person with an early onset of panic attacks is likely to have symptoms of the disorder in the future. Many of these people have never received treatment or have received inadequate treatment. New-onset panic disorder in old age is rare. When those who were diagnosed with panic disorder before the age of fifty-five were compared with those with late onset, it was found that the symptoms during panic attacks were milder in late onset and that these patients showed less avoidance behavior related to the attacks.
Mental Functions in Geriatric Patients (Elderly)
Attention is a complex cognitive function. In geriatric patients, attention is frequently impaired due to dementia, depression and physical illnesses affecting brain function. Simple attentional functions do not normally deteriorate significantly with aging. However, the ability to divide attention to attend to more than one aspect of a task is a complex function that deteriorates considerably with advancing age.
The assessment of memory in geriatric patients is an important part of the examination and a guide to diagnosis. The patient's performance is important in differentiating normal old age from dementia and psychiatric disorders from dementia. In the evaluation of remote memory, the recall of old events is examined. While elderly individuals have difficulty in remembering new experiences, they often have no difficulty with old ones. Studies have shown that near memory deteriorates with age. A decline in performance can be expected with each decade. Near and distant memory can be evaluated in detail both by examination and by tests.
As with memory, executive functions also deteriorate with age. Executive functions are mental skills that require cognitive flexibility such as planning, organization, solving new problems and error detection. It is suggested that cognitive changes that occur due to normal aging are mostly in executive functions. Deficits in executive functions disrupt the person's daily life and impair social adaptation by causing reasoning deficits.
Perceptual skills can often be as good in the elderly as in the young, especially for simple objects. However, the ability to perceive objects in three dimensions and with correct placement in space deteriorates with aging. Similarly, the ability to draw simple two-dimensional shapes may be as good in the elderly as in the young. However, drawing complex three-dimensional shapes may deteriorate with aging.
Speech and Language Skills
Language-related functions are generally preserved with age. The number of words may even increase. There may be slight impairments in the recall of words from the vocabulary. However, this can change with the level of education.
In the elderly, language skills decrease with the addition of conditions such as depression and dementia. In particular, impaired naming has been shown to be related to dementia, and to a lesser extent to depression. Other language-related features such as comprehension, verbal fluency, writing and reading should also be reviewed during the examination.
Movement Skills
Slowing of movements may be due to normal aging or may indicate an underlying neuropathological process. Decreased muscle strength or speed may indicate a brain lesion (vascular, tumor or metastasis) or be a symptom of dementia. Impaired ability to perform complex motor actions (e.g. dressing, eating) may be due to dysfunction of specific brain systems. Impairment in motor skills is as sensitive as other cognitive assessments in distinguishing normal aging from dementia.
Psychiatric Examination in Geriatric Patients
The mental status examination begins with taking the patient's history and reviewing the complaints. The patient is asked questions to understand complaints about memory and other cognitive functions. He/she is asked about issues such as concentration of attention, remembering recent events, remembering where things are, difficulty in finding words, understanding what others say, whether he/she gets lost in familiar places. The characteristics, time of onset and course of the difficulties experienced are asked in detail. The objectives of mental status examination in the elderly are as follows;
- To distinguish mental changes due to normal aging from losses due to dementia
- Differentiating mental changes associated with dementia from those associated with depression
- To be able to diagnose depression, mania, schizophrenia-like psychotic states and anxiety disorders that can be seen in old age
- Ensure early recognition and treatment of dementia (because often even moderate signs of cognitive impairment go unnoticed by family members)
- To detect and identify brain dysfunction that is not neurologically evident
- Monitoring response to treatment for dementia and other cognitive disorders
History of head trauma, meningitis, encephalitis, seizures, alcohol and substance abuse/dependence is investigated. Since the patient may have memory impairment, it may not be reliable enough if the entire history is taken only from the patient. A history is also taken from family members or someone who knows the patient well.
NPISTANBUL Geriatric Psychiatry Treatment Options
Geriatric psychiatry is age-specific psychiatric treatment. The aim is not only to treat the patient, but also to improve their current psychological state. In addition, maximum treatment possibilities are used for the best interest of our patients.
In the geriatric psychiatry service, our clients receive inpatient treatment. Each ward in our hospital has been established within the framework of certain rules according to the privacy of inpatients and the risks of the disease.
NPISTANBUL Hospital, where the comfort of patients and their relatives is prioritized, has two types of room options designed for different needs. There are standard and type A suites. Type A suites and corner suites aim for high comfort without compromising on safety. In order to ensure the comfort and safety of our clients in each room, all furniture has been selected and specially designed accordingly.
In all our rooms, VIP services are provided for all the needs of patients and their relatives, from televisions with local and foreign channels to a safe, resting chairs and newspaper service.
In our hospital, there are interview rooms that aim to protect the privacy of patients and their relatives during physician interviews, waiting areas in each clinic, and day lounges and winter gardens on the patient floors to make patients feel comfortable and at home.
