Medical Consultation

Mental health problems in old age are common. A few examples are depression, anxiety, sleep disorders, loneliness, late-onset schizophrenia, and post-menopausal problems in women ranging from hot flashes to clinical depression. There is a lack of awareness and stigma associated with talking about these problems, which is where a psychiatrist may become the first point of reference to start a dialogue.

The first duty of your psychiatrist is to provide a diagnostic formulation emphasising abilities and deficits. The psychiatrist will then help the patient and family understand the illness and provide pharmacological and therapeutic treatment, as required. Treatment respects the individual patient's wishes, and dignity and autonomy are maintained as long as possible. Psychiatrists work closely with many other specialists, such as psychologists, general physicians and neurologists, and are all involved in the care process. The central role of the psychiatrist is to diagnose the clinical condition, explain the future course of illness and prognosis, and prescribe and monitor medication and the physical health of the patient whilst undergoing treatment.

Psychiatrists can successfully treat many mental illnesses in old age. However, some (particularly the dementias) are chronic and/or progressive, but appropriate intervention can improve quality of life. Early diagnosis is crucial in these cases. For example, vascular dementia may be prevented or slowed by treatments that reduce the risk of stroke.

You should follow up with your psychiatrist regularly. Older people with mental illnesses (particularly depression) may take longer to respond to treatment. Psychiatric illnesses in late life also have a high relapse rate, but they can be prevented through close follow-up and continued treatment. Older people are particularly vulnerable to side effects of drugs, and therefore due consideration must be given to age-related changes in drug handling. Interactions between psychotropic medications and older patients' comorbid physical illnesses (and their treatment) are also common. Your psychiatrist’s role is to consider the patient as a whole and tailor management for each individual as per their priorities. Apart from helping the patient, the psychiatrist and their team’s role is to provide support and knowledge to the family. They also help caregivers with coping skills to reduce stress and caregiving burden and improve the quality of life for all.