Geriatric Psychiatry

This is where geriatric psychiatrists come in. Whether you are a senior seeking mental health care that will be right for you, a psychiatry student looking to specialize, or a loved one hoping to find help for your aging family, you can benefit from learning about the basics of geriatric psychiatry and how it relates to mental and emotional disorders.

What is psychiatry?

Psychiatry is the medical study of mental illnesses and disorders, both acute and chronic, which psychiatrists then attempt to diagnose and treat. It is an area of medicine, much like oncology or cardiology. Because of this, it looks at mental health from a medical standpoint, unlike psychology which focuses on psychological aspects of mental health. 

Derived from Greek, the words psykhe and iatreia mean "mind" and "healing" respectively. Psychiatry focuses particularly on identifying and addressing the mental health needs of an individual, with the goal of “healing” a patient's “mind.”

Psychiatrists use varied evaluation and treatment methods, from talk therapy to electroconvulsive therapy. However, because they are medical doctors, psychiatrists are mostly known for their ability to prescribe medications to treat mental health conditions like depression, bipolar disorder, anxiety, and obsessive-compulsive disorder, to name a few. Unlike psychotherapists, as medical students, psychiatrists must complete medical school training programs as part of their education and are trained in residency programs just like general practitioners or physicians. 

To diagnose and treat mental illness, a psychiatrist will typically meet with a potential patient to discuss their presenting problem(s) at length. Psychiatrists then may order or conduct a physical examination as well to help rule out medical conditions such as hyperthyroidism, metabolic syndrome, and syphilis that can trigger symptoms that may be otherwise confused with mental illnesses. After ruling out a medical condition, the psychiatrist then may give the patient a diagnosis and a respective treatment plan.

What is geriatric psychiatry?

While all psychiatrists may treat elderly patients, there is a specific certification through the American Board of Psychiatry and Neurology that focuses on geriatric psychiatry. Specific populations, like the young or the elderly, often need more specialized care for psychiatric disorders. Just as a child and adolescent psychiatrist addresses the specific needs of young people, these psychiatrists specialize in providing psychiatric care to elderly patients.

According to the American Psychiatric Association, geriatric psychiatry professionals are experts in the biological and psychological aspects of aging. These psychiatrists understand that certain neurological disorders and mental illnesses can appear due to aging—and that, in many cases, these conditions can be comorbid. For example, mild cognitive impairment and Alzheimer’s disease are closely associated with depression in late life; and Lewy body dementia commonly develops alongside anxiety disorders. Additionally, geriatric psychiatry specialists may have expertise on how to handle other types of mental illness that can evolve and become more pronounced depending on the patient's age and life circumstances, such as substance use disorder or bipolar disorder. 

Not only do these professionals specialize in treating the symptoms of the psychiatric disorders at hand, but they're also often required to address the underlying issues and provide prevention strategies, just as psychologists and counselors do.

For example, anxiety could arise because of memory loss or a new medical diagnosis such as Alzheimer’s Disease. Similarly, the loss of family and friends could make depressive symptoms more pronounced or trigger a descent into substance use. Older patients often have a set of worries that are unique to their age group, like the state of the world, a fear of mortality, or feelings of grief, that can contribute to their mental state. Because of the interconnectedness of these issues, it is important that geriatric psychiatry practitioners understand the problems that may be facing senior citizens.

Mental illness in elderly patients can also be intertwined with physical health as our later life health tends to diminish. Because these professionals are medical doctors, they can make assessments about their patients that consider the person's emotional and medical history while providing clinical care to improve a patient’s well-being. A patient's depression, for instance, could be the result of a cancer diagnosis, or an unnoticed interaction of medications. It is a geriatric psychiatrist's job to consider all these factors when making decisions regarding a patient’s mental health care.

Where do these professionals practice?

With the growing population of older adults in America, the profession of geriatric psychiatry has also continued to grow. This means they are needed in a large variety of locations.

To some extent, these psychiatrists might practice in the same places as any other psychiatrist. These locations include practices and hospitals where patients can make appointments to receive services or receive services as part of their stay in the hospital. However, these professionals also might provide mental health services in facilities that are unique to their specialized fields, such as assisted living facilities, nursing homes, and veterans' homes where patients may also be residents.

Because of the high concentration of older adults in these types of facilities, these psychiatrists are often included as a part of the healthcare teams in nursing homes and assisted living centers. In a community like these, psychiatrists also might be on-call throughout the day and night to serve these unique, residential populations.

However, patients do not have to live in one of these specific facilities to receive specialty services from those in the field of geriatric psychiatry. Patients can visit these psychiatrists in their offices and at hospitals, and some may even make house calls. 

In addition, according to the American Association for Geriatric Psychiatry, geriatric psychiatry is a field that offers a number of opportunities for cutting-edge research. Specialists in geriatric psychiatry can help facilitate scientific discovery in their field by conducting studies, analyzing details, or developing surveys. They may choose to practice in a research lab, where they can help develop new treatment options for aging patients. In the field of psychiatry, geriatric psychiatry is one of the newest specialties, so there are many opportunities for clinicians to practice almost anywhere they are interested in working.

Treating mental health disorders in older individuals

Those practicing geriatric psychiatry offer similar treatment options to those presented by a general psychiatrist. Medication, behavior plans, and talk therapy are all options that one of these professionals might explore with their clients.

Before treatment can occur, however, these psychiatrists must go through the process of diagnosing their patient. Due to increasing physical ailments in elderly patients, these professionals may have greater difficulty diagnosing and treating patients. Psychiatrists specializing in older medicine must be aware of the ways psychiatric symptoms may manifest differently in older patients. For example, individuals with late-life depression often report more cognitive impairments than younger patients with depression. 

Some physical issues present with psychotic or depressive symptoms as well as some mental disorders can result in physical symptoms like lethargy, for example. Those practicing geriatric psychiatry must, then, conduct extensive physical assessments and psychological questionnaires to distinguish the causes of certain symptoms.

Before deciding on a treatment plan, geriatric psychiatrists may consider:

• Will the patient remember to take their medication if memory-related issues are present?

• What type of support system does my patient have?

• How will treatment interact with any other medications or medical conditions that my patient has?

• Is the patient living alone, with family, or in an assisted living facility?

• How can the side effects of psychiatric medication be neutralized?

• Will my patient be open to psychiatric services?

Although attitudes are changing, some of these psychiatrists find that older generations may still carry the stigma of receiving psychiatric or psychological care. Some clients may be resistant to treatment or in denial that they require it in the first place. Being respectful while still working through these barriers is another element of the treatment plan that these professionals may need to consider.

Diagnosis and treatment in also must address the interpersonal context of the care of older individuals. Older adults may have a strong network of support around them, made up of family and other medical practitioners; because of this, these professionals typically work as part of a larger care team.

The client's family also tends to be more actively involved in treatment that would be typical of a psychiatric patient. Geriatric psychiatrists often collaborate with a patient's family to ensure that treatment can be delivered successfully and to help them grapple with their elderly family's issues. To gather information that a patient is unable to give them and to get a larger picture of the patient's psychological issues are also reasons that one of these psychiatrists might work with a patient's family.

Navigating mental disorders with online therapy

Seeking mental healthcare can be difficult, especially for seniors. Between mobility concerns and potential social stigma, many older adults may have trouble getting the care that they need. Similarly, caretakers of elderly patients can have trouble finding time to receive care themselves. If you’d like more information on mental health care for the elderly, visit the Substance Abuse and Mental Health Services Administration’s Resources for Older Adults page. 

No matter what your situation, receiving mental health care can be expensive, overwhelming, or inaccessible. If care from a medical doctor is out of reach, there is still a way to seek professional help for your problems.

BetterHelp can set you up with convenient counseling that can give you the care you need. With a variety of flexible, digital counseling options, BetterHelp can provide help that is discrete and available on your time. Users of BetterHelp can communicate with their counselors by exchanging messages, instant messaging, talking on the phone, or through video conferencing.

Research shows that online therapy can be particularly helpful to older adults, especially as they may have mobility issues or a worry of leaving the house to seek out therapy in-person. Online therapy has many other benefits, for example, a review of 17 studies showed that e-therapy tends to be more cost-effective than its in-person counterpart while potentially providing the same positive outcomes and mental health benefits.

Once you fill out a short questionnaire, BetterHelp can place you with a counselor who meets your needs. Geriatric counselors are available for you and your family.