Why go to a geriatric psychiatrist rather than a regular psychiatrist?
We send children to a pediatrician or a child psychiatrist because children need a special type of care. The same thing is true for older adults. People develop more illnesses with age, and when they’re on multiple medications, those medications tend to interact with one another, increasing side effects or making some less effective. Older people also have difficulty seeing and hearing. Their lifestyle is definitely different. If people have either retired or they can’t move a lot, they tend to be more sedentary, and their social support goes down. If they’re not working, they don’t have as many people to talk to. They also have financial stresses. For all these reasons, older people need different considerations for care than younger adults do. Is geriatric psychiatry a new practice? Europe has a long tradition of what they call old-age psychiatry. In the United States, geriatric psychiatry wasn’t recognized as a subspecialty until the 1990s. I was one of the early initiators. It needs to receive more attention.
The senior population is growing. Are you seeing a shortage of psychiatrists?
There are something like 1,600 geriatric psychiatrists in the US, which means about 1 for 11,000 older people. That’s not much! But the worst is yet to come. As the number of older people is increasing, the number of geriatric psychiatrists is not, so by 2030, you’ll have one for every 20,000 Americans. It’s a societal embarrassment. We are not doing enough as a country to help people get into geriatric psychiatry.
Why don’t more people get into the field?
One of the main reasons is financial; the Medicare reimbursement is fairly low. People spend a lot of money and take out big loans to go to medical school and become a resident. If we then pay them less for taking care of older people, why would anybody go into this field? That doesn’t make sense, does it? I think this is a crisis. When we get older we’re going to need specialists to take care of us.
How common are anxiety, depression, and dementia in older adults?
The most common neuropsychiatric disorder in old age is dementia. About 5 percent of people over the age of 60 have it. The incidence of new cases doubles every five years after age 60.* The cost of older people getting dementia exceeds the cost for cancer and heart disease, because when you treat dementia you’re not just taking care of the patient, you’re also taking care of the family involved. The caregivers are often the children or spouse, and they have to stop working in order to do so. This is a major problem as society gets older and dementia becomes more common. We’re going to need a lot more care—and research. We have no treatment for dementia at this time.
What can people can do to ward off dementia?
There’s nothing that would prevent it, but there are things that lower the risk and delay the onset. There are different kinds of dementia—the most common is Alzheimer’s disease. The second most common is vascular dementia, which is more common in people with high blood pressure, diabetes, and so on. So make sure those conditions are treated properly. Secondly, keep physically active. If I go to the gym for 1 hour, and then do nothing for 23 hours, that would actually negate the effects of that 1 hour of exercise. So what’s important is not only getting some moderate to vigorous exercise, but keeping yourself active for most of the day. Healthy diet is important, getting a good night’s sleep, and reducing stress levels to the extent that you can.
What are the signs a person should look out for?
The most important sign is if you see that behavior is changing, something is getting worse. For example, with normal aging, we tend to forget names and faces. That’s very common; that’s not dementia by itself. However if you find that it’s getting worse, that somebody gets lost going for a walk on their usual road, suddenly becomes confused, and needs help to get back—that’s a sign. Any major change in any behavior—someone eats a lot more or less, becomes much less active, or becomes more withdrawn. That doesn’t mean you immediately go to a geriatric psychiatrist, but you should talk to your primary care doc and get a physical exam and some labs done. There may be something undiagnosed that could be treated.
If we follow a healthy lifestyle, get regular checkups and take care of our illnesses, I think most people will do fine. Better than they’re doing now. But stay active. Not only physical activity but mental, social activity.
What are some beneficial mental activities? Playing cards, crosswords, reading?
Those things are for fun and that’s fine, however you need to do something challenging. Watching TV is not challenging. If you’re good at languages, learn a new language. If you know how to play guitar, then in older age, learn to play violin. If you don’t have any musical talent, maybe don’t try learning piano at the age of 60. Pick up something that’s challenging but not too stressful.
Seniors are facing a lot in 2017—housing woes, isolation, fear of outliving their savings. What’s good about growing older?
At the UC San Diego Center for Healthy Aging, we focus on the things that improve aging. Older people are often wiser, they have more control over their emotions. They’re more helpful to others, have more empathy and compassion, more experience, and they make better decisions that require experience.
Some people think old age is a disaster. They call it the Silver Tsunami. I say that’s totally wrong. We call it the Golden Wave. We published a paper showing that, as people get older, while their physical health and cognitive function declines, their mental health actually improves. People become happier and more satisfied in spite of physical disability.
I saw that study. Your 70s are your happiest decade.
That’s exactly right. That is a real finding, from real San Diegans age 21 to 100. We ask, “What is it that makes people click? What is the influence, and how can we actually facilitate that influence?” We’re also working with senior housing communities in San Diego. We held a free symposium on senior living last month. Upcoming lectures include “NASA’s Twins Study: Studying Aging in Space” (July 12) and “Sleep and Sleep Disorders: Better Sleep at Every Age” (August 16) at UC San Diego’s Garren Auditorium.
There are a lot of good things about getting older.
And it’s actually good for society: If we keep older people active and healthy, the health care costs will go down. Even from a strictly financial perspective, it’s a very good investment.
The UCSD Center for Healthy Aging is the only center of its kind that brings together the schools of medicine, engineering, pharmacy, management, and more across campus. Collaboration is critical. They say it takes a village to raise a child—it takes a village to help a person grow older.
Getting older has its advantages. And it’s up to us to see how we can increase those advantages. The idea that aging is doom and gloom can be a self-fulfilling prophecy. Nature and biology will allow us to stay healthy, but our behavior will have an impact on it. We can blame it on our genes, our parents, but a lot is still under our control, even in old age.
*Between 60 and 65, 1% will develop dementia; 65–70, 2%; 70–75, 4%; and so on. It stabilizes around 40%.
Growing Old Doesn’t Have to Be a Downer
UC San Diego professor Dilip V. Jeste.
