Year : 2018 | Volume
: 60 | Issue : 7 | Page : 297--298
Clinical practice guidelines for elderly
TS Sathyanarayana Rao
Professor, Department of Psychiatry, JSS Medical College and Hospital, JSS University, MG Road, Mysore - 570 004, Mysore, India
Prof. T S Sathyanarayana Rao
Professor, Department of Psychiatry, JSS Medical College and Hospital, JSS University, MG Road, Mysore - 570 004
|How to cite this article:|
Sathyanarayana Rao T S. Clinical practice guidelines for elderly.Indian J Psychiatry 2018;60:297-298
|How to cite this URL:|
Sathyanarayana Rao T S. Clinical practice guidelines for elderly. Indian J Psychiatry [serial online] 2018 [cited 2021 Jun 20 ];60:297-298
Available from: https://www.indianjpsychiatry.org/text.asp?2018/60/7/297/224468
Population ageing is an inevitable reality. Worldwide the geriatric population comprises of about 11% of the total world population, and is projected to increase to about 22 percent by 2050. With declining fertility rates, reduction in mortality rates and increased life expectancy the elderly population constitutes as one of the fastest growing age segments. India too is witnessing a similar trend. It is estimated that the elderly population will increase from 8 percent (2015) to 19 % by 2050.
Ageing has led to an increase in prevalence of chronic non-communicable diseases/disorders and hence increased demands on health care services. Geriatric patients have different and diverse needs from the younger population.
Although, a larger number of physicians and clinicians are practicing in India but only a few clinicians are specially trained to deal with the ageing population. Geriatric population have diverse and different health care needs from the younger population. One such common example is the presence of sleep changes in elderly which may be in part due to the lack of structure in daily activities after retirement leading to laxity in sleeping habits with erratic wake up time, being awake in the middle of the night, early morning awakening (more commonly seen than younger population). The goal of treatment of sleep disturbances in Late Life Depression also changes a little, for example one of the behavioural targets include earlier bedtime and an earlier rising time as the clock time for sleeping period becomes earlier and earlier.
This Clinical Practice Guidelines (CPGs) developed by the task force on CPGs and its editors address the needs of ageing population covering the most commonly encountered psychiatric issues like Dementia, Psychosis, Sleep Disorders, Depression, Anxiety disorders, Delirium, Sexual Behaviour and Rehabilitation needs and their management in a complete yet concise manner which is easy to understand and apply in a busy clinical setting. The handbook starts with one of most important clinical tool –The Geropsychiatric Clinical Interview which encompasses interviewing skills, detailed history taking including the presenting complaints, past psychiatric and medical history, the tools and algorithms important for assessment and forming a diagnosis of Psychiatric Disorders in the Elderly. The chapter on elderly sexuality emphasises on sexual life which is of paramount importance in expression of love, passion, intimacy and emotional bonding during later years, it also elaborates on approaching the elderly patient (or couple in some cases), building enough rapport to elicit sexual history, taking precise and detailed sexual history, and appropriate Psychological and Pharmacological management of sexual disorders including the recent advances. The chapter on Depression differentiates myriad of presentations such as recurrent depression coming from early onset depression, late life depression which has chronic course, worse prognosis with higher relapse rates and lastly mood disorders secondary to general medical condition or substance use and their management. The chapter on Dementia and Anxiety disorders lays importance on picking up and diagnosing these disorders as they are commonly ignored, underdiagnosed and left untreated in elderly. It also gives detailed algorithms for treatment choices including psychotherapy and pharmacotherapy including dosage, titration and tapering of drugs. As the person ages the metabolism of the body changes and so does the renal and the liver functions, any slight change e.g. a stressor or electrolyte imbalances may cause psychoses and delirium respectively in elderly. These should be managed with utmost care as the pharmacodynamics and pharmacokinetics changes as the people age, hence a small dosage of drug may be needed and titrated, this preferred treatment concept of “starting low and going slow” has been extensively discussed in chapters on Delirium and Psychoses. Finally rehabilitation needs of elderly including psychosocial interventions, cognitive remediation and other models which have been potentially effective in improving the functioning and quality of life in elderly is discussed in this treatise. We hope that these guidelines would help in facilitating proper management of elderly patients presenting with various types of disorders and that the information provided will be of interest and may serve as a powerful tool to healthcare professionals.
The editorial team of IJP is grateful to the CPG task force on Geriatric Psychiatry and its editors for the opportunity to publish the same in IJP.