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Geriatric Psychiatrists

The Job

Geriatric psychiatrists treat elderly patients who suffer from mental and emotional illnesses that make it hard for them to cope with everyday living or to behave in socially acceptable ways. The most common problems treated are dementia and depression, although the elderly can have the same range of disorders as the rest of the population. Often, though, these disorders are not properly diagnosed. According to an article in Psychiatric News, experts estimated that one in five seniors has clinically significant anxiety and one in 12 is dependent on alcohol. In addition, these estimates may actually be low since mental illnesses in the elderly are often misdiagnosed or missed altogether.

Geriatric psychiatrists evaluate their patients using a variety of methods, depending on the patient's ability to articulate his or her thoughts and feelings and on the psychiatrist's preferred techniques and practice methods. Geriatric psychiatrists sometimes face special challenges in determining what might be causing erratic or problematic behavior in patients who are unable to express themselves well; sometimes the source of an inappropriate behavior is something relatively simple, such as a urinary tract infection that causes a patient to wet himself or herself. By correctly diagnosing problems, the psychiatrist can not only save the patient distress and discomfort but also avert inappropriate treatments that may be costly and to the patient's detriment.

In other cases, geriatric psychiatrists have to distinguish between the naturally occurring emotional complexities of aging and true illness. Sadness and grief are unquestionably a part of old age. As people reach the last stages of life, they experience many losses, from deterioration of their health and body to deaths of spouses, family members, and friends. The line between this natural sadness and genuine clinical depression can be a thin one. A geriatric psychiatrist must recognize symptoms that point to a genuine depression and treat it accordingly. Just as important, however, the psychiatrist must avoid "medicating away" some of the natural, inescapable feelings that accompany age. Some feelings of sadness may be normal as people realize they have little time left. Part of the geriatric psychiatrist's complex work is to determine what's normal, what's not, and the best course of action in either case.

Because geriatric psychiatrists are medical doctors, they typically begin their patient evaluations with a range of medical tests, including physical and neurological evaluations, laboratory tests, and X-rays. These tests will often reveal physical causes for behavioral problems and can result in the psychiatrist referring the patient to a specialist for the needed physical care.

Some psychiatrists rely largely on certain therapeutic techniques in their practices, such as talk therapy or behavior therapy. Naturally, though, these methods are only effective in those willing to try them and grow from the experience. Some people with impairments, such as patients in the late stages of Alzheimer's disease, may not have the ability to process their emotions or communicate clearly. These people may benefit from different therapies. Pharmacotherapy, which is the use of psychotherapeutic medications, such as antidepressants, mood-stabilizing drugs, and tranquilizers, is often used to help elderly patients. Because of this, geriatric psychiatrists must be knowledgeable about potential drug interaction problems, as elderly patients often take a variety of medications for physical problems, such as high cholesterol, arthritis, or diabetes.

No matter what therapy techniques psychiatrists prefer, however, they must individualize treatment programs to meet each patient's needs. Many older people are lonely and simply having someone to talk to on a regular basis can make an extraordinary difference in their attitude and outlook. For other patients, however, talk therapy alone isn't enough to help them feel better, and they benefit from taking medication. The psychiatrist may also use other techniques, such as art therapy (which involves participating in music, dance, or media art), occupational therapy (in which patients learn or relearn skills for caring for themselves), or group therapy (during which a number of patients discuss their personal problems), to help the patient.

An unavoidable component of geriatric psychiatrists' job is paperwork. They must do a large amount of documentation, both in keeping patient records up-to-date and in dealing with Medicare, Medicaid, HMOs, and other insurance companies. More and more psychiatrists, like other health care professionals, are reporting that getting through the increasing amount of red tape and meeting requirements for documentation are encroaching on the time they otherwise would have used to see patients.

Although many geriatric psychiatrists are in private practice, it is likely to become more common for nursing homes and other facilities to employ geriatric psychiatrists full time to better meet the needs of their residents. In this environment, the psychiatrist works as a member of a multidisciplinary team, including other nursing home staff. The team shares information, develops appropriate therapeutic approaches, and monitors the treatment for each patient. Because the number of elderly people in our country is large and growing rapidly, geriatric psychiatrists should have many opportunities. Nursing homes and other care facilities that have geriatric psychiatrists on staff will be seen by seniors and their families as institutions that offer quality care.

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