What is Psychogeriatrics?
Psychogeriatrics is the study of the behavioural and mental problems of the elderly. In older persons, physical, emotional and social changes that occur with the aging process can result in psychological problems.
Common pyschological disorders inthe elderly?
Depression
Depression is an emotional state characterised by exaggerated feelings of sadness, dejection and helplessness.
The elderly have a much higher risk of depression and suicide than the young because major losses tend to take place in the later stages of life eg. medical illnesses, changes in physical status, loss of income on retirement, death of parents and friends, loss of a life partner and changes in accommodation arrangements.Many depressions are missed or thought of as normal by the family and hence undetected. Early detection and proper treatment is crucial to prevent unnecessary suffering.
The common symptoms of depression include a recent change in mood, especially pessimism, gloom and loss of cheerfulness. There may be poor concentration, lethargy, loss of interest in activities, a sense of guilt, changes in appetite and sleep. There are also abnormal symptoms of severe anxiety or bodily complaints. Eg. the affected person may develop unnecessary worry over apparently trivial issues, or may be constantly seeking attention for bodily aches and discomfort. Sometimes, depression can also cause memory changes.
Delirium
Delirium is characterised by a sudden behavioural change, with agitation, inattention, disorientation and memory changes which fluctuate as the day progresses. To the family, the person affected may appear episodically confused.
Eg. a person who is independent and well can suddenly appear perplexed and restless, sometimes acting normal, only to become restless and agitated again hours later. Sometimes, there is drowsiness. The sleep-wake cycle is usually disrupted, and the fluctuations are usually more prominent in the evenings and at night.Delirium requires urgent medical attention as it is associated with higher health risks. It may be caused by infections, a minor stroke, undiagnosed or poorly controlled diabetes, hypertension (high blood pressure) etc. Side effects of certain medications can sometimes cause delirium. The person presenting with delirium for the first time often requires hospitalisation in order to identify and treat the underlying cause. Most patients improve with treatment. If left untreated, delirium may progress to dementia or death.
Dementia
Dementia is a loss of cognitive (mental) abilities severe enough to affect social or occupational functioning. In contrast with delirium, the symptoms of dementia occur gradually. The loss of cognitive abilities affects the memory, abstract thinking, problem solving, judgement, reading, writing, drawing and speaking. The elderly may experience poor short-term memory, encounter difficulties navigating in the neighbourhood and finding the right words when talking.
As dementia progresses, the elderly will require supervision and assistance in their activities of daily living eg. feeding, cleaning, dressing and toilet functions. Many sufferers do not have behavioural complications. However, when they do occur, behavioural complications may include repeated wandering, inappropriate social behaviour, mood swings.
Dementia may also cause behavioural and personality changes eg. a paranoid suspicion that others are stealing their belongings. Sometimes, some of the behavioural symptoms may be due to a mood disorder or a delirium. These can often be treated successfully if identified early. As the memory loss in dementia is usually gradual, families may not be aware of changes till more than six months have passed.
The two most common types of dementia are Alzheimer's Disease and Vascular Dementia. Over 50% of dementia are due to Alzheimer's disease. In this condition, the brain cells die off at a more rapid rate than normal, resulting in a progressive loss of cognitive function.
Vascular dementia is the second most common type of dementia. The underlying cause is due to ischaemia (reduced blood flow) or accumulated strokes in various parts of the brain. Often, there may be a background of hypertension or diabetes mellitus, which are strong risk factors to developing vascular dementia.
There are other less common causes of dementia. To identify the cause of dementia accurately, a full medical check is required, sometimes including a CT brain scan.
Psychosis in the elderly
Psychotic disorders are characterised by a disorganisation of thinking that affects logic and the perception of reality. The main symptoms are hallucinations, delusions and a loss of insight.
Hallucinations occur when the person perceives an object that is not there. Eg. a person may hear voices when there is no source around or may feel imaginary insects crawling on the skin.
Delusions are fixed, false beliefs inconsistent with a person's educational and religious background. The person may feel persecuted and fearful for his or her life, or may be deluded that the spouse is unfaithful or that they are suffering from an imaginary disease.
Psychosis in old age is associated with hearing and visual impairment and social isolation. Agitation can be a problematic symptom, and concurrent depression can complicate matters. Antipsychotic medication is usually prescribed at low doses.
Can mental illness be cured?
At Changi General Hospital, we have a comprehensive, multi-disciplinary assessment and treatment programme for people above 65 years old who are experiencing psychiatric difficulties. Each person is thoroughly assessed on their full range of physical, psychological, social and environmental factors that may be contributing to their problems. Our team comprises of consultant psychogeriatricians and geriatricians, psychologists, psychiatric nurses, occupational therapists, physiotherapists and social workers.
Once the assessment is complete, a treatment programme is individually tailored for the patient's needs. Wherever possible, we actively involve patients and their families in this process. Our emphasis is on providing a caring and supportive environment, focusing on nurturing their existing strengths and skills to reach their full potential. Treatment options include:
- Individual psychotherapy
- Family counselling
- Medication
- Skill development
- Sensory stimulation
- Relaxation and exercise therapy
Many mental disorders in the elderly can be treated successfully. Appropriate intervention can make a difference in reducing distress and improving quality of life. CGH offers both inpatient and outpatient psychogeriatric services. A Geriatric Centre is also available for suitable patients. Following discharge, our multi-disciplinary team will liaise with families, referring doctors, other professionals and community agencies to ensure continuity of care.