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• W4233992045 abstract "Susan K. Schultz, MD, DFAPA, EditorView Large Image Figure ViewerDownload Hi-res image Download (PPT)The evidence base for treating older adults with psychiatric disorders is ever increasing, yet few persons are trained to treat the elderly through geriatric psychiatry fellowship training programs. Therefore, the bulk of patient care devolves to general psychiatrists, primary care practitioners, and mental health professionals other than psychiatrists. Even so, specialty-trained geriatric psychiatrists must keep up with the latest in our understanding of psychiatric disorders and their comorbidities among older adults. To this end, we have selected an outstanding group of clinicians and clinical investigators to provide an update of a series of topics from which we believe every health care provider for older adults can benefit. Some of the topics are familiar (delirium, depression, and anxiety disorders). Others are less familiar yet most important (psychiatric problems that result from hearing loss, palliative care in dementia and chronic mental illness, and posttraumatic stress disorder [PTSD]). We begin this issue with an article from Sharon K. Inouye and her colleagues on delirium. They provide a comprehensive review of the epidemiology, etiology, and pathophysiology of delirium. Of most importance, however, they review a nonpharmacologic intervention program that has been demonstrated to be moderately successful in preventing delirium among hospitalized patients. Prevention of delirium may decrease the risk of permanent decline in cognitive function. The article by Dan Blazer reviews the neglected topic by psychiatrists working with the elderly, namely the problems that result from hearing loss and the current treatments for hearing loss about which many psychiatrists are not familiar. Hearing loss is a proven risk for cognitive decline. In the next article, Wei Jiang reviews one of the more frequent, serious, and complex comorbidities faced by clinicians working with older adults: depression and cardiac disorders. Serious cardiac problems increase the risk of depression, and depression increases the risk for adverse outcomes from cardiac problems. The clinician must develop a care plan that combines psychiatric and cardiologic intervention and that complements one another. Schizophrenia is the topic covered in the next article in this issue, where the reader will find an overview of the advances in the conceptualization and study of schizophrenia in later life by Carl I. Cohen and colleagues. In doing this, the authors integrate theoretical and clinical models in psychiatry and gerontology. They examine the concept of recovery from schizophrenia in the context of aging as well as how clinical dimensionality affects diagnoses in older adults. They further address how various features of schizophrenia are implicated in models of accelerated and paradoxical aging, and how outcome in later life is more dynamic and heterogeneous than had been assumed previously. As we experience the aging of our society, including all types of severe mental illness, this article offers new insights on the latest longitudinal findings. Melinda A. Stanley and her colleague, who have been working for many years in the study of interventions for anxiety disorders in the elderly, review this topic in their article. Anxiety disorders in later life often fly under the radar of health care professionals treating older adults. Though they rarely lead to hospitalization, they are a clear burden for those who suffer, especially when practitioners can do something about them. In the article by Marilyn Albert and her colleagues from Johns Hopkins, an extensive review of cognitive reserve in the elderly is provided. Evidence is mounting that cognitive reserve, as built up over the years via education, participation in cognitive-stimulating activities, and remaining socially engaged, may be one of the more important preventive factors in protecting against the problems that arise from the dementing disorders. The article by Charles H. Kellner and colleagues addresses an important treatment for geriatric patients, electroconvulsive therapy (ECT). ECT has been long known to provide needed remission of symptoms for older patients with severe depression, mania, psychosis, and catatonia as well as comorbid depression and agitation in dementia. ECT has been shown to be even more effective in the elderly than in mixed-age adult populations. The safety and findings relating to cognition in the context of ECT in older adults are addressed here. The topic of bipolar disorder occurring in older adults is reviewed comprehensively by Annemiek Dols and Aartjan Beekman. In this article, the condition is termed “older age bipolar disorder” or OABD; the authors describe how a better understanding of late-life symptoms may lead to more specific recommendations for its specific characteristics and needs due to age-related somatic and cognitive changes. The diagnosis of late-onset mania has a broad differential and requires full psychiatric and somatic workup, including brain imaging. First-line treatment is similar as for any adult with bipolar disorder with specific attention to vulnerability to side effects and somatic comorbidity. Future research is needed to clarify best interventions given the limitations in extrapolating data based on younger adults. In the article by Ryan D. Greene and colleagues in this issue, the authors explore the frequent cooccurrence of depression and neurologic disorders. They emphasize the important yet difficult task of differentiating the symptoms of depression from neurocognitive disorders. Even so, it is critical to make this differentiation so that appropriate therapies can be prescribed. Behavioral and psychological symptoms of dementia (BPSD) are addressed in the next article by Lauren B. Gerlach and Helen C. Kales. These symptoms are universally experienced in dementia and cause a significant negative impact on quality of life for both patients and caregivers. Nonpharmacologic treatments have been recommended as first-line treatment of BPSD and should target patients with dementia factors, caregiver factors, and environmental factors. The DICE (describe, investigate, create, evaluate) approach can provide a structured method to investigate and treat BPSD with flexibility to use in multiple treatment settings. The topic of palliative and hospice care is addressed in another article by Jaffrey Hashimie and colleagues in this issue. With the growing care needs of the older population at the end of life, there has been a substantial increase in attention to the management of the dementia patient in hospice and palliative care services. This article reviews issues in access to care and the optimal management of the dementia patient particularly in the context of neuropsychiatric complexities. Special issues, such as delirium, cachexia, behavioral symptoms, and pain management, are addressed. Future challenges in research, such as the development of better prognostic models, are noted as well as the importance of attention to access to care. Stephen J. Bartels and colleagues provide an assessment of opportunities for comprehensive medical and psychiatric care for older persons with chronic mental illness in their article in this issue. They note the important issue that persons with serious mental illness frequently receive inadequate medical care and are more likely to experience difficulty navigating the health care system compared with the general population. Models to address this issue may include programs in collaborative primary care that are designed to create a person-centered care environment for middle-aged and older adults with serious mental illness and medical comorbidity. Peer involvement to engage patient self-management is discussed as an innovative strategy to improve outcomes. In the article by Rebekah J. Jakel, the rarely discussed yet increasingly important problem of PTSD in later life is explored. We typically associate PTSD with younger persons, often those who have returned from conflicts in Iraq and Afghanistan. Yet PTSD can emerge in later life secondary to service in Vietnam as well as in persons who have experienced other types of traumatic events. PTSD impacts both older men and women. We planned the issue so that a range of psychiatric conditions encountered by all health care workers who seek to provide both efficient and effective services to our older citizens would be discussed. Increasing our knowledge is the first step to improving our skills in our mission to this ever-growing segment of our population." @default.
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• W4233992045 title "Geriatric Psychiatry" @default.
• W4233992045 doi "https://doi.org/10.1016/j.cger.2019.11.014" @default.
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