Steven Segraves MD
What is Geriatric Psychiatry anyway?
Many psychiatrists treat seniors, as many internal medicine or family physicians also see elderly patients. In medicine, gerontology is a specialty in which the physician receives additional training in the diagnosis and treatment of elderly patients. In the field of psychiatry, one may pursue specialty board certification in geriatric psychiatry. Once a general psychiatrist completes four years of residency post medical school, he/she may enter a one year fellowship where the new physician is further educated in the unique challenges in treating an older, mentally ill patient. Geriatric psychiatrists are in short supply around the country- The American Board of Psychiatry and Neurology reports that since the specialty was recognized in 1991, a total of 3500 certifications have been granted. Many of those physicians have either retired or failed to maintain certification. At last check, in the four state area of Nebraska, Kansas, Missouri, and Iowa, there are less than 60 board certified geriatric psychiatrists. Of that number, most of those psychiatrists are working in university hospital settings. Few are in private practice.
What makes the geriatric patient different than an adult when it comes to diagnosis and treatment?
First, while depression, bipolar disorder, and schizophrenia certainly are prevalent in the senior population, dementia and a variety of psychotic disorders can present late in life. Further, the way a senior metabolizes medications can change for a variety of reasons, including liver and kidney function and hydration levels in seniors vs adult aged patients. Seniors are more likely to be on more medication, which can cause interaction problems with meds that would not be present in a younger person. Seniors are much more likely to experience falls and have cognitive changes associated with medications.
The geriatric psychiatrist is uniquely trained and focuses his/her practice on the unique needs of this group of individuals.