Introduction: The Challenges of Treating Older Adults

This Geriatric Special Report highlights the diversity of problems presented by older patients as well as the complexity of treating them. With more and more baby boomers turning 65 every day, there will be an enormous increase in elderly patients needing psychiatric care over the next 20 years.

Sandra Ann Jacobson, MD, explores the benefits and problems of consultation psychiatry in hospital settings. She uses case vignettes to illustrate a range of psychiatric problems in patients whose treatment is often complicated by comorbid medical illness that brought them to the hospital. She warns that it is essential to tease out whether the psychiatric symptoms are a direct result of the underlying medical illness or the medications used to treat them.

Managing behavioral and psychological symptoms of dementia has always been challenging, but the FDA’s black box warning for neuroleptics in older adults has made their use problematic. Rajesh R. Tampi, MD, MS, and Deena J. Tampi, MSN, MBA-HCA, RN, discuss best practices in using neuroleptics in this population. Recently Kales and colleagues¹ published a paper in which they emphasized nonpharmacological treatments but noted “their uptake as preferred treatments remains inadequate in real-world clinical settings.”

Late-life depression is a common disorder in older adults, with a complex interplay with comorbid medical illness. Randall Espinoza, MD, MPH, and Aaron H. Kaufman, MD, contribute a comprehensive review of diagnosis and treatment of unipolar depression in older adults. They describe the different neurobiological underpinnings, presentations, and illness courses that distinguish early-onset depression from late-onset depression.

Hoarding may be a long-term problem, but as Mary E. Dozier and Catherine R. Ayers, PhD, point out in their article, it does not get clinical attention until the older person is no longer able to live in his or her home. They report that many older adults self-report symptoms of hoarding, perhaps because of the increased risks associated with living in a home in which “stuff” has been accumulating for many years.

Taken together, these articles illustrate the challenges and gratifications of working with elderly patients.

Disclosures:

Dr Liptzin in Chair of the department of psychiatry at Baystate Medical Center and Professor and Deputy Chair of the department of psychiatry at Tufts University School of Medicine in Springfield, Mass. He reports no conflicts of interest concerning the subject matter of this Special Report.

References:

1. Kales HC, Gitlin LN, Lyketsos CG, et al; Detroit Expert Panel on Assessment and Management of Neuropsychiatric Symptoms of Dementia. Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel. J Am Geriatr Soc. 2014;62:762-769.