Why older adults need a different assessment
In later life, psychiatric symptoms mix with medical illness, pain, losses and medication effects. Sadness may appear as fatigue or memory complaints; sudden confusion may signal an infection; insomnia may be a drug side effect. The assessment must take all of this into account.
Dr. Petrus Raulino has long experience with older patients in general hospitals and has lectured on the subject at the Brazilian Congress of Psychiatry, including geriatric consultation-liaison psychiatry and palliative care.
Signs and symptoms
- Low mood, withdrawal, loss of interest
- Unexplained physical complaints, loss of appetite and weight
- Anxiety, fear of going out, excessive worry
- Insomnia or daytime sleepiness
- Irritability, agitation, suspiciousness
- Forgetfulness and difficulty with previously simple tasks
How it is diagnosed
The appointment includes the patient’s account and, when possible, input from family or caregivers, a review of all medications, an assessment of memory and daily functioning, and investigation of medical causes, with tests when needed. Contact with the geriatrician or other doctors helps integrate care.
Treatment
- Adjusting medications that may cause or worsen symptoms
- Psychiatric medication, when indicated, with attention to interactions and the greater sensitivity of older adults
- Psychotherapy, physical activity, cognitive stimulation and social contact
- Guidance for family and caregivers
When to see a psychiatrist
When changes in mood or behavior last weeks, or there is withdrawal, weight loss, persistent insomnia or forgetfulness that worries the family. Sudden confusion is a medical emergency and should be assessed in an emergency room.
Follow-up at the practice
At the practice in Campinas, appointments allow time to hear the patient and family. Dr. Petrus Raulino explains the diagnosis, agrees on treatment with caregivers and follows progress over time.
Staging: text awaiting medical review by Dr. Petrus before publishing.
This content is for information only and does not replace a medical consultation. Diagnosis and treatment depend on an individual assessment. In crisis or having thoughts of suicide? In Brazil call 188 (CVV, 24 hours, free) or go to the nearest emergency room. In an emergency, call 192 (SAMU).