Psychiatry 222C: Geriatric Psychiatry

This year, the first of the baby boomers—those born in the U.S. between 1946 and 1964—turn sixty-five. As this population ages, the prevalence of end-of-life illnesses will increase. Some of these illnesses, such as dementia, are psychiatric disorders, and they’re the focus of “Geriatric Psychiatry,” a medical-school elective taught by Mugdha Thakur HS ’03.

Older patients like the aging baby boomers experience some of the same emotional problems that younger psychiatric patients do, including depression, stress, and personality and mood disorders, according to Thakur. In contrast to younger mental-health patients, older patients are not as frequently plagued by substance abuse, and they are not upset by minor anxieties such as taxes, break-ups, or a lost pet because they have already conquered many of life’s challenges, she says. However, older adults are more vulnerable to medical problems, more frequently lose loved ones, and undergo difficult life transitions like moving to a nursing home.

This combination of biological, psychological, and social factors creates a complex clinical picture for geriatric psychiatrists to treat.

Take as an example, she says, an older patient who goes to the hospital after having a stroke and shows signs of depression and memory problems. Her husband recently died. The geriatric psychiatrist must consider the patient’s vascular disease, grief, and the possible onset of dementia to discern the problems requiring treatment.

Another challenge for the psychiatrist is handling any stigma the patient feels from some diagnoses. For example, some older patients believe depression is simply a lack of resolve.

“A geriatric psychiatrist,” Thakur says, “is like a detective who puts together all these pieces to come up with a treatment plan that addresses all the factors in a manner consistent with the patient’s values and preferences.”

Geriatric psychiatrists are not alone in their investigations. One of the most important lessons students learn in this course is the value of interdisciplinary collaboration in treating mental health. Part of the geriatric psychiatrist’s role is to build a cooperative spirit within the patient’s network of health-care providers, including the goal of devising a sustainable treatment plan.

Alexandra Bey M.D. ’12, a medical student who took the course, says, “You must involve the patient and his or her family, first and foremost. You need to have contact with the patient’s primary-care provider to ensure all aspects of their health care are integrated, plus people like social workers or community-health organizations to find ways to provide the level of care each older adult needs.”

In this course, in addition to information about the value of integrative health care, medical-school students are exposed to the complicated comorbidities—the simultaneous occurrence of two or more diseases—common in geriatric psychiatry and gain experience decoding them. Students see patients in the hospital, outpatient clinics, and nursing homes, where—with guidance from a psychiatry resident—they decide whether a patient gets admitted and when the patient may leave, interview patients and their family members, administer some neuropsychological tests, order labs, and create a treatment regimen and carry it out with psychotherapy and medication management.

As the baby boomers entering older adulthood grow less concerned with life’s minor bumps, Thakur advises geriatric psychiatrists and all members of their patients’ treatment teams to do the opposite with their older patients’ clinical pictures: Address every concern—big and small—like seasoned detectives.

Professor
Mugdha Thakur did her psychiatry residency and geriatric psychiatry fellowship training at Duke, where she is program director for the Geriatric Psychiatry Training Program. Her clinical practice consists of geriatric practice in nursing homes and adult and geriatric practice in the sleep clinic. She conducts research on late-life depression.

Prerequisites
None; however, this course is open only to second-year medical-school students

Readings
Readings on geriatric psychiatry

Assignments
Attendance at weekly seminars and biweekly discussions about students’ clinical experiences

—Martin DeWitt