A Frame of Mind

With these hands I pray by Kenneth J. Martin

Remember when an old Elvis song contained the lyrics “I’m all shook up” and we thought it only pertained to the song and not about us? One would think that as we get into our senior years our worries and stress become less. After all, we’ve gotten through the terrible teens, the mid-life crisis, raising families and dealing with loss of friends and loved ones. So what does it mean when our stable, elderly loved ones become suddenly, or slowly, anxious or depressed?

We’re beginning to recognize anxiety and depression are as common for the elderly as for adolescents, children and young adults. When elderly anxiety exists with depression, it becomes exceedingly difficult to separate from the signs of dementia. Certainly serious health problems can bring out anxiety in all of us. In the elderly, when real health problems and cognitive impairment collide, the resultant mix complicates diagnosis and treatment. These patients describe feeling shaky, frequent sweating, muscle aches, dizziness, fatigue or stomach upset. Physicians can come up with a myriad of physical conditions responsible for these real symptoms. Family and friends also hope to find or label the medical problem in their loved one. Their hope is for a pill or procedure that will return their loved one to their ‘normal’ state. But when all the tests and come back normal we’re perplexed. Having exhausted our search for diseases or conditions responsible for these symptoms, we tend to discount anxiety or depression as being ultimately responsible.

But when it becomes obvious that anxiety, depression or both are ultimately responsible, then the treatment shifts. Geriatricians, or geriatric psychiatrists, are very valuable in providing us guidance as to the best form of therapy. Frequently, they’ll have access to extensive resources in the community willing to help give care or services. They also help us understand behavior and offer suggestions that help us cope. We just have to stay willing to consider a coexisting psychiatric disorder. Otherwise we miss an opportunity to provide care with emphasis on the mind. Which really does matter.

About Steve P. Sanders

A general internist writing and sharing ideas and art.

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