Caring for the Mental Health of Older Adults

A wise friend once advised me that you cannot change human nature, but with the right approach you can change human behaviour. In the business world, that translates into providing the right incentives to promote good behaviours and penalties to punish harmful actions. With recent corporate scandals such as Nortel and Enron, one hopes that psychiatric interventions to regulate behaviour in ill patients would be more successful. I personally feel that that is the case. Modern understanding of age-related mental disorders, along with newer and less toxic pharmacological agents, have resulted in improved patient care and better control of the behaviours that can so disturb the patient and his or her loved ones.

I have mentioned in this bully pulpit in the past how important I feel geriatric psychiatry has become. Not only has the discipline sparked a much-deserved interest in the problems of aging adults, it also exemplifies psychiatry’s place within the mainstream of medical practice. Having watched (and worked closely) with gifted geriatric psychiatrists for many years, I am continually impressed by the ubiquity of psychiatric issues in clinical practice.

This month’s issue focuses on mental health, with a subfocus on behavioural disorders. Dr. Lonn Myronuk has written an article about one of the most important issues in geriatrics, namely “Treating Depression in the Older Adult.” Dr. Kenneth Shulman, perhaps Canada’s most famous geriatric psychiatrist, provides an article on a fascinating topic, “Mania in Old Age: A Neuropsychiatric Syndrome.” Dr. Chanaka Wijeratne writes about a common problem for primary care providers, “Somatic Presentations of Distress in Primary Care.” Randy Harris, MSW, tackles an often-neglected issue, “Approaches to Treating the Older Substance Abuser.” Dr. Lynn McNicoll’s article, “Outcomes Following Delirium in Critically Ill Older Persons: Need for Future Research,” rounds out our focus articles.

The general articles in this issue are particularly strong and relevant this month. Dr. James Shepherd has tackled a topic that highlights the inappropriate therapeutic nihilism that some physicians display in treating older adults. The article is entitled “Do Our Seniors Deserve Cholesterol-Lowering Statin Therapy?” Dr. Janet McElhaney writes on a topic that should be on most physicians’ minds at this time of year, “Optimizing the Prevention and Management of Influenza in Older Adults.” Amit Morris and Drs. Henry Moller and Colin Shapiro contribute the second article in a series, “Insomnia in Older Adults, Part II: Treatment.” Drs. Namesh Nagarsheth and Jamal Rahaman review the management of cervical cancer in “Cervical Cancer in the Older Patient: Diagnosis and Management.” Dr. Conan Kornetsky, in our regular Biology of Aging column, provides “A Review of Pain and Analgesia in Older Adults.” Dr. A. Mark Clarfield concludes this issue with his engaging article, “Appearances are Deceptive in Grandfather’s Room.”

Enjoy this issue,

Barry Goldlist