Dr Hari Subramaniam explores common mental health issues in the elderly, and when you should consider seeing an Old Age Psychiatrist.
Mental Health In Later Life
Dr Hari Subramaniam is a Consultant Old Age Psychiatrist who has over twenty years experience working with patients experiencing symptoms of mental illness, and those with existing conditions such as Dementia and Alzheimer’s.
Common conditions explained
WHAT IS DEMENTIA?
Dementia is a general description for a broad range of illnesses whose main feature is a disabling level of impairment of memory and other aspects of thinking, reasoning and information processing. ‘Disabling’ meaning that it is intrusive enough to interfere to some extent with the patient’s normal day to day activities.
Unfortunately most dementia-causing illnesses are progressive and irreversible, although there are always practical things that can be done to help and support the patient to maintain their independence for as long as possible.
For some types of dementia, medical treatments are available that may improve or stabilise some of the symptoms. Increasingly more and more advances and treatments are emerging for conditions like dementia due to Alzheimer’s disease.
WHAT IS MILD COGNITIVE IMPAIRMENT?
This is a clinically recognisable problem with memory, or sometimes other aspects of cognitive function (the way the brain works), which can be a nuisance and a source of concern. Because mild cognitive impairment is not really disabling, it therefore does not meet the criteria for dementia. MCI is not a single illness and it has a very variable prognosis. Some patients with MCI may progress to develop more troublesome cognitive problems over time.
WHAT IS ALZHEIMER’S DISEASE?
Alzheimer’s disease is a degenerative brain disorder which throughout most countries of the world is the most common cause of memory and other cognitive problems.
It is now thought that Alzheimer’s disease occurs as a result of the accumulation of abnormal proteins in the brain - a process which usually occurs over many years or even decades (even though symptoms may only arise in the later stages). Alzheimer’s is very treatable, even if the focus of treatments is to contain the progress rather than cure it. Several medicines are available to help treat the disease, and significant research into the condition is ongoing.
WHAT IS VASCULAR DEMENTIA?
This is a form of dementia in which the problems are caused by circulatory disease in the brain. Disease of the larger or small arteries results either in strokes or a more generalised pattern of reduced blood flow. Both of these processes can impair memory and other aspects of thinking and information processing.
Lifestyle changes and minimizing risks for stroke and heart disease is very important. Examples of this include reducing smoking and moderation of alcohol intake, alongside taking regular exercise and leading a healthy dietary lifestyle.
WHAT ARE ANXIETY RELATED ILLNESSES IN THE ELDERLY?
Anxiety and depressive illnesses are fairly common in the elderly and unfortunately can limit functioning and affect quality of life. Accurate assessments usually help distinguish conditions that may be treated with psychological and behavioural approaches, however some conditions may also warrant drug treatment. Therapies can be tailored to each individual patient’s requirements to optimise their effectiveness. Quite a lot of psychological problems can be contained by targeted and focused psychological interventions, that minimize negative thoughts and behaviours while reinforcing positive coping strategies.
The effect of mental health conditions on daily life
Capacity issues are particularly pertinent in the elderly. Sometimes failing memory and cognitive abilities might affect someone’s decision making skills with regards to making wills, managing property and affairs, and attending to one’s welfare. How much a person is affected will depend on their own individual symptoms, however the below provides general insight onto the most common scenarios.
POWER OF ATTORNEY
Elderly people who still possess abilities might be able to nominate a deputy who can manage their affairs on their behalf should the time come. A legal and valid way of doing this would be to appoint a ‘power of attorney’, which is a relatively straightforward process, with information available online and via most legal firms and solicitors. In the unfortunate position where this has not been done before people lose their abilities to make this nomination, a more arduous process called a ‘court of protection application’ is needed. Here the application is made to a court to arrive at the decision of how the affairs are to be dealt with. Unfortunately this is often more complex and expensive.
A diagnosis of dementia in itself does not mean that patients cannot drive; however there is a legal requirement to let the DVLA know if such a diagnosis has been made. This is needed not only for the safety of the patients themselves and other road users, but for insurance requirements and legal reasons which might otherwise lend the driving licence invalid thus raising the chances of being prosecuted.
Upon notification, the DVLA will usually start a process of gathering information and write to the necessary people (including the doctor). Until the DVLA reach their a decision on whether a person will retain their license, driving is usually allowed (although this will differ depending on individual circumstances). In very select, complex cases the DVLA might ask for an actual driving test to be taken.
Most people with dementia can drive until the advanced stages of the illness, and often get a yearly licence subject to review.
WHEN SHOULD YOU SEE A SPECIALIST
An Old Age Psychiatrist is able to conduct a number of assessments to help determine if someone in later life is suffering from mental illness. An ‘assessment for cognitive functioning’ should be considered if any of the following are becoming troublesome:
Poor concentration and intellectual decline.
Absent mindedness and disorganisation.
Personality and social changes.
Symptoms of forgetfulness and memory impairment are common. Sometimes they are transient and self-limiting but on other occasions they may be the beginnings of a progressive disorder. If they are diagnosed accurately and early, they can be controlled or treated to good effect. This assessment needs to be carefully conducted by a trained specialist to enable an early diagnosis. Depending on individual cases specialist investigation such as MRI and/or CT Scans of the brain may also be required. Drug treatments are available for suitable cases and often provide very good symptom control and stabilise functioning.
Other assessments that can be provided by a specialist Old Age Psychiatrist include:
Anxiety and depression.
Phobias, OCD and PTSD, resistant anxiety and depressed states.
Advice about mental capacity.
Issues with power of attorney.
Court of protection assessments.
In most instances, your General Practitioner will indicate when they think a referral to a specialist is necessary based on your medical history and symptoms.
Dr Subramaniam is a Consultant Psychiatrist for the Elderly at Leicestershire Partnership NHS Trust and an Honorary Senior Lecturer at the University of Leicester.
He sees private patients at the Nuffield Hospital Leicester and Holmfield Consulting Rooms Leicester, where treatment is available on an insured or self-paying basis.
For further information visit:
To arrange a private appointment telephone:
0116 274 3717 for Nuffield Hospital Leicester
0116 270 6841 for Holmfield Consulting Rooms appointments.