Dr. Robert Kohn – Dr. Robert Kohn

Treating Older Adults With Long-Term Mental Illness as Needs Change

An older adult may live with a mental illness for many years before a new concern changes what care must address. A hospital stay, new medical diagnosis, reduced mobility, loss, limited transportation, or reduced support can disrupt routines that once felt stable. The main question, especially when care depends on several people and services, is whether current care still matches daily life, safety, and available help.

Long-term mental illness means a psychiatric condition that has required treatment, monitoring, or support over many years. Some clinicians define serious mental illness as when symptoms cause significant functional impairment and limit major life activities. Aging can add new support needs even when the original diagnosis remains the same.

Physical health can change psychiatric care in specific ways. Physical pain, poor sleep, chronic illness, reduced mobility, or substance use can affect mood, attention, and follow-through. A psychiatrist may need to know about new medical diagnoses because physical symptoms can affect sleep, alertness, anxiety, depression, and treatment response. That context helps connect mental health treatment with overall health.

Daily function shows how changes appear outside an appointment. Function means how the person manages routines, responsibilities, personal care, transportation, and instructions, not only how symptoms sound during a visit. Missed appointments, difficulty using transportation, trouble following discharge directions, or declining personal care can reveal a need for more support. Function matters most when symptoms begin affecting safety or basic needs.

Medication safety deserves a focused review when an older adult is on several medications. A psychiatrist, primary care doctor, or pharmacist may need to review prescription and nonprescription medicines for dose, caution, side effects, interactions, or kidney-related concerns. The same review can compare recent medication changes with new confusion, sleepiness, or other symptoms. The goal is safer decision-making, not stopping medicine without clinical guidance.

Family members and caregivers can improve clinical decision-making by bringing concrete observations. They may notice withdrawal, appetite or sleep changes, missed routines, unsafe choices, or problems functioning before the older adult describes a change in an appointment. Their role is to report examples, not replace the person’s own account. The clinician should also confirm whether the older adult wants relatives included in care planning.

Transitions between care settings can create confusion when communication breaks down. A hospital discharge, new medication prescriber, or change in outpatient follow-up can leave different people relying on different information. The risk grows when no one clearly tracks follow-up, warning signs, transportation, appointments, or community services. Clear handoffs help each clinician understand what has changed and who is responsible for the next step in treatment.

A clinician may need to review memory, judgment, and planning during reassessment. The goal is not to assume Alzheimer’s disease or treat every thinking change as dementia. The visit may include questions about whether the person remembers recent directions, pays attention, makes decisions, and recognizes unsafe situations. Those answers can show whether the change may be temporary, medical, neurological, medication-related, or part of a longer care need.

Families and care partners do not need to decide whether aging, illness, medication, or the psychiatric condition caused every new problem. They can ask for reassessment when one change begins affecting meals, transportation, personal care, appointments, medicine routines, or safe decisions. That review helps the clinician separate a temporary disruption from a care need that requires a specific next step. A careful reassessment helps everyone work from the same plan when new concerns affect daily care.

How Mental Health Care Reaches People When Specialists Are Scarce

A person may need help for depression, anxiety, or substance use, but have no nearby mental health care specialists. Limited mental health professionals, under-resourced services, financial barriers, and access gaps can delay or prevent care. When people cannot reach specialists easily, care depends on a defined pathway. That pathway sets the first review, follow-up plan, supervision point, and steps toward higher-level help.

A care pathway is the planned route from first contact to assessment, support, follow-up, and referral when symptoms or risks require more care. A specialist is a psychiatrist, psychologist, psychiatric nurse, or another clinician with focused mental health training. A trained healthcare worker is not a specialist, but they can identify concerns and support the next step within a defined role.

Specialist scarcity changes where care begins. A person may first speak with a general practitioner, nurse, community health worker, or trained clinic staff member rather than a psychiatrist or other mental health professional. That first contact matters because the worker must recognize what local services can handle and what conditions require consultation, referral, or urgent care.

Global mental health sources use task-sharing to explain one response to this gap. Task-sharing means trained non-specialist health workers handle selected parts of care within a defined system, while specialists continue to support complex cases. The model does not lower the value of specialists because supervision, consultation, and referral remain part of the system.

In non-specialized health settings, structured guidance helps workers avoid guessing. That guidance can help a trained worker review the presenting concern, level of functioning, substance use, self-harm risk, and signs linked to priority conditions. The purpose is not to label every problem at once, but to organize the first review so the next step fits the concern.

Training gives that pathway consistency. A trained worker can learn how to assess, manage, follow up, document concerns, and seek help when a case exceeds the local role. Supervision adds accountability because difficult cases will not depend on a single local worker’s judgment.

Some situations require urgent or specialist-level care. Self-harm risk, psychosis, extreme agitation or violence, severe substance use concerns, complex medication questions, or symptoms that local workers cannot safely assess should move beyond basic support. Immediate danger requires urgent local medical or crisis services.

Follow-up visits show whether the pathway still fits the person’s needs. Follow-ups can check whether symptoms, functioning, safety concerns, treatment effects, side effects, or adherence to treatment have changed. It also gives the worker a point to consult, adjust the plan, or refer the person to another professional if the concern is too complex.

Community-based care adds another layer beyond the first clinic visit. A coordinated network may include general health services with mental health care, task-sharing in primary care, community mental health services, crisis services, peer or social supports, and non-health settings. That network matters when limited facilities, insufficient workforce, access disparities, cost, language needs, or cultural fit make care harder to deliver.

Global mental health research studies how care can expand across countries and communities with different resources. It emphasizes local policies, community needs, workforce capacity, training, monitoring, and culturally appropriate adaptation. The goal is not one identical model everywhere. The goal is to match the care model to local capacity while checking whether workers receive training, complete follow-up, and move higher-risk cases beyond the local role.

An effective access model does not ask local workers to directly address every mental health concern. It gives them a defined next decision – continue basic monitoring, consult a specialist clinician, or move the person to urgent care. That decision point turns a limited first contact into a safer route toward appropriate treatment.

When Memory Problems and Mood Changes Appear Together

Memory problems can mean more than misplaced keys or forgotten names. The concern grows when an older adult repeatedly misses appointments, loses track of conversations, forgets familiar routines, or struggles with once-ordinary tasks. Mood changes may include sadness, anxiety, irritability, withdrawal, or loss of interest. When memory and mood changes appear together, families may need help because depression, dementia, medication effects, illness, grief, stress, and other health concerns can look similar at home.

Families often explain small changes at first. A stressful week, poor sleep, grief, or short-term worry may seem like a reasonable explanation. The pattern matters more when changes persist beyond a brief period, become more noticeable, or begin to interrupt daily life.

That pattern does not automatically mean Alzheimer’s disease. Memory problems can come from depression, anxiety, grief, poor sleep, illness, alcohol or drug use, or medication effects. A clinician’s review matters because different causes can produce similar changes in attention, behavior, and memory.

Depression in later life may not always look like obvious sadness. An older adult may lose interest in regular activities, sleep differently, seem unusually worried, have trouble concentrating, or become more irritable. Family members may notice a quieter routine or reduced motivation rather than a direct complaint about feeling depressed.

Dementia-related changes can affect how a person thinks through ordinary situations. An older adult may lose track of steps, repeat questions, misread a familiar problem, or struggle to adjust when a routine changes. Those signs raise concern about judgment, planning, and problem-solving, not only memory.

Daily function means managing routine responsibilities safely. Missed bills, medication mistakes, or confusion during familiar errands can show that memory changes are affecting independence. The key question is whether the older adult can still handle ordinary responsibilities with the same consistency and safety as before.

A primary care doctor may look for contributors that could be improved by treatment or medication changes. The doctor may review prescriptions, recent medication changes, sleep, alcohol use, pain, infections, falls, or other health problems. Medication review means checking whether a drug, dose, interaction, or side effect may be contributing to confusion, low mood, or changes in alertness.

Families can help by describing examples without blaming the older adult. Useful details include when the changes began, how often they occur, which tasks they disrupt, and whether symptoms come and go. A calm written log can keep the conversation specific, especially when relatives have noticed different concerns.

Those specific observations can help a doctor decide whether to continue primary care follow-up or refer the older adult to a specialist. A geriatric psychiatrist may help when questions about mood, behavior, or medication complicate care. A neurologist, neuropsychologist, or memory-care clinician may help when cognitive changes need more detailed testing.

The family’s next step depends on what the review finds. Depression, sleep trouble, pain, medication effects, grief, or another medical concern may call for one type of care. At the same time, dementia-related changes may require safety planning, caregiver guidance, or specialist follow-up. That difference is why the review should come before families choose support based only on what they see at home.

Families should seek guidance when memory and mood changes begin disrupting responsibilities, safety, relationships, or daily choices. At that point, a timely primary care review can turn scattered observations into a clearer next step. The right plan should reflect what the older adult is experiencing day to day, including symptoms, safety risks, and support needs.

2020 Study in BJPsych Contradicts the Stress Inoculation Hypothesis

Just as an inoculation against a viral infection prevents sickness by introducing a controlled amount of virus into the body, an inoculation against stress exposes an individual to a controlled and measured level of stress, which in turn helps them build up psychological resilience against future traumatic experiences. At least, this is the basic idea behind the stress inoculation hypothesis.

Published in the peer-reviewed British Journal of Psychiatry in 2020, the study “Assessing the relationship between psychosocial stressors and psychiatric resilience among Chilean disaster survivors” produced findings that definitively contradict the stress inoculation hypothesis. The researchers analyzed post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) testing data from survivors of the historically powerful earthquake that struck Chile in 2010.

Comparing PTSD and MDD test results before and after this disaster, the study’s authors found that those who had experienced multiple stressors before the Chilean earthquake were more susceptible to stress related disorder from the quake compared to those with fewer stressors. These conclusions indicate that an “inoculation” of stress doesn’t decrease vulnerability to PTSD or MDD, but instead increases it.

The Importance of Geriatric Psychiatry

Geriatric psychiatry plays a pivotal role in addressing mental health concerns among the elderly population, recognizing the unique challenges and complexities associated with aging. This specialized field focuses on diagnosing, treating, and preventing mental health disorders in older adults, considering factors such as physical health, cognitive decline, social isolation, and medication management.

As individuals age, they encounter various life changes, including retirement, losing loved ones, declining physical health, and potential cognitive decline. These transitions can trigger or exacerbate mental health conditions such as depression, anxiety, dementia, and substance abuse. Geriatric psychiatrists undergo training to comprehensively assess these conditions, considering the symptoms and the broader context of an individual’s life circumstances.

One critical aspect of geriatric psychiatry is its emphasis on integrating physical and mental health care. Older adults often experience medical conditions alongside mental health issues. This integration ensures a holistic approach to healthcare, simultaneously addressing physical ailments and psychological well-being. Additionally, managing medications becomes increasingly complex in older adults due to potential interactions and sensitivity to drugs, making specialized psychiatric care essential.

Furthermore, social and environmental factors also affect elderly persons. Geriatric psychiatrists take into account the impact of loneliness, isolation, and changes in living situations on mental health. Addressing these factors may involve connecting patients with community resources, support networks, or therapy to alleviate feelings of isolation and improve overall mental well-being.

Research in geriatric psychiatry continually evolves, aiming to enhance diagnostic tools, treatment strategies, and interventions tailored to older adults. The field acknowledges the diversity within the aging population and strives for culturally sensitive and individualized care.

The significance of geriatric psychiatry lies in its specialized approach to understanding and addressing mental health concerns among older adults. By considering the multifaceted aspects of aging and mental health, geriatric psychiatrists play a pivotal role in improving the lives of seniors, advocating mental wellness, and delivering comprehensive care tailored to their specific needs.

Understanding Cultural Psychiatry

Cultural psychiatry, a multidisciplinary field, investigates the intricate interplay between culture and mental health. Rooted in the idea that culture significantly shapes individuals’ perceptions, emotions, and behaviors, this branch of psychiatry delves into the cultural dimensions of mental health and illness. Aiming to comprehend how cultural factors influence psychiatric disorders and treatment approaches, cultural psychiatry offers a nuanced lens through which mental health professionals can better understand and address the diverse needs of individuals.

The integration of cultural sensitivity in psychiatric practice becomes particularly crucial when considering the diverse cultural norms, values, and beliefs that influence individuals’ experiences of mental health. Cultural psychiatry strives to bridge the gap between different cultural perspectives and psychiatric care, fostering a more inclusive and practical approach to mental health care.

Research in cultural psychiatry underscores the impact of culture on the manifestation and interpretation of psychiatric symptoms. For instance, the cultural formulation interview (CFI) provides a structured framework for clinicians to explore cultural factors contributing to mental health issues. By recognizing cultural nuances, mental health professionals can tailor interventions that align with the patient’s cultural background, enhancing patient engagement and treatment outcomes.

Cultural psychiatry contributes to individualized care and facilitates the development of culturally sensitive healthcare policies and interventions. It emphasizes the need for a comprehensive understanding of cultural diversity within the broader mental health research and practice context.

Cultural psychiatry is a vital field that elucidates the intricate connections between culture and mental health. By acknowledging the influence of culture on individuals’ mental well-being, mental health professionals can adopt a more holistic and culturally competent approach to diagnosis, treatment, and overall care. Integrating cultural perspectives in psychiatry ultimately fosters a more inclusive and effective mental healthcare landscape.

Geriatric Psychiatry and Issues of Advanced Age

Geriatric psychiatry is a discipline focused on patients 65 and older. Among the medical conditions that come to the fore later in life are anxiety, dementia, depression, mood disorders, and sleep disturbances. In addition, aging is the leading known risk factor for the relatively common neurologic disorder Alzheimer’s disease.

Beyond cognitive decline, the root of such issues include social, emotional, and mental health challenges unique to each individual. As loved ones and life partners pass on, feelings of isolation, loneliness, and purposelessness can take hold. In addition, the stress and worry involved in managing physical health and mobility issues can take a toll over time.

Grief is another major burden, as the death of a friend, family member, or spouse can have a major impact. In addition, an intense fear of terminal illness and one’s own mortality may arise. With low self-esteem present, repetitive behaviors and bad habits may multiply, creating a sense of being trapped in a negative cycle.

Geriatric psychiatry brings together practitioners with a background in helping those of advanced age deal with these unique challenges. In addition to diagnosing conditions and prescribing medicine, they may provide psychotherapy and organize support groups to bring a shared, social element to working through life’s problems.

About Traumatic Stress

People respond in various ways following a traumatic experience, like sexual assault, combat, accidents, childhood abuse, mass violence, or losing a loved one. However, the common responses include intense and unpredictable feelings of nervousness, anxiousness, and irritability. Your thoughts and behavior patterns may also change, and you may think about the event out of the blue, which can cause panic attacks, a rapid heartbeat, and sweating.

Environmental factors may trigger panic attacks. Depending on the nature of the traumatic event, common triggers include loud noises, sirens, and sounds like a car engine misfiring. All of these can stimulate memories of the event and fear of recurrence.

Traumatic stress often affects interpersonal relationships. You may experience increased conflicts with friends, family, and colleagues, and in cases where the traumatic event involved sexual abuse, a strenuous relationship with your partner. Lastly, the trauma may manifest physically as frequent headaches, nausea, back pain, and chest pain. These can require medical attention to alleviate. Also, traumatic stress exacerbates pre-existing conditions like cardiovascular ailments, diabetes, and cancer.

Psychologists and psychiatrists recommend several measures to deal with traumatic stress. One involves leaning on loved ones for support. The support includes listening, discussing the event, and assisting with daily activities like house chores, babysitting, and driving. However, the road to healing starts with facing your feelings and fears.

While it’s normal to experience the aforementioned signs and symptoms, deliberately oversleeping, avoiding people, and substance abuse only prolong the stress. Other than taking steps to ease back into a routine, prioritize extra self-care habits like healthy nutrition, exercise, and sufficient sleep.

Creative Activities Can Boost Mood and Relieve Stress and Anxiety

A Rhode Island psychiatrist from Providence, Dr. Robert Kohn, MD, entered the field in 1989. Outside of helping patients at his private practice, Dr. Robert Kohn is a member of the American Psychiatric Association (APA), which studies mental health and mood.

Findings from a poll published in July 2023, the APA found that Americans who engaged in creative activities weekly described their moods as excellent or good. Morning Consult’s July Healthy Minds Poll, focused on creativity and mental health, sampled 2,202 adults.

In general, 77 percent of adults reported their mental health as excellent. Of that percentage, 71 percent engaged in creative activities more often than those who reported good (50 percent) or fair/poor (46 percent).

The study also reported that 46 percent of those who participated in creative activities did so to relieve stress, and 14 percent did so during crisis. Activities for stress relief included listening to music, creative writing, solving puzzles, crafting, singing/dancing, or drawing/painting/sculpting.

According to APA President Petros Levounis, MD, MA, these are stressful times when jobs or responsibilities can be energy drainers. Creative activities allow individuals to step back from the daily and relax.

Study Links Sleep Deprivation to Increased Alzheimer’s Risk

A physician with decades of experience as a geriatric psychiatrist, Dr. Robert Kohn is a temporary advisor for the Pan American Health Organization/World Health Organization. Dr. Robert Kohn also serves as a professor of psychiatry in a local medical school in Providence, Rhode Island. In his solo practice clinic in Providence, Robert Kohn, MD, treats older adults with intellectual and developmental disorders, such as Alzheimer’s disease and other forms of dementia.

A team of scientists has found that sleep deprivation may cause impairment in the brain, and lack of sleep over long periods may be linked to an increased risk of Alzheimer’s disease. The study was published in the American Chemical Society’s Journal of Proteome Research.

The researchers used mice to discover that sleep deprivation can cause neurologic damage to the hippocampus, the part of the brain primarily involved in learning and memory. During the study, the mice were evaluated based on how well they navigated through a maze and how they recognized new objects in the maze after being deprived of sleep for two days. Then, proteins were extracted from the mice’s hippocampi and noted how the abundance of such proteins had changed. They also compared the mice’s performance with other animals not involved in the study.

The researchers found that the pleiotrophin (PTN) of the mice that lacked sleep declined, which may eventually lead to the death of the hippocampus. PTN is a protein-coding gene associated with growth factors. Compared with human genetics studies, PTN is implicated in neurodegenerative diseases such as Alzheimer’s.