Treatment Modification for the Elderly

(Spar, LaRue 1997) (Knight, 1996)

Be aware of these misconceptions about the elderly, the aging process and mental illness in general:

		Elderly are inflexible or rigid
		Old age is a miserable state
		Treatment for the elderly is not worthwhile or is dangerous

• Be aware of concomitant medical conditions that effect the elderly
• Need to be more active, proactive, informative, or directive
• Sessions may need to be shorter due to elderly person’s stamina
• Speak louder and slower
• Patients may require reminder calls for appointments, or between session phone contact
• Explanations may need to be simple and concrete and involve significant others
• Allow more time for responses, increased interview time
• Communication should be specific and concerns should be directly addressed
• In terms of medication, start at low doses and gradually increase the dose at a slow pace
• Cognitive impairment or psychotic symptoms are contraindications for psychotherapy, supportive therapies may be of choice with these patients
• Lack of mobility or transportation and lack of family involvement may restrict access to care
• Fixed incomes may limit certain therapies or medication treatments
• Family or significant other is usually more involved in treatment (teaching, transporting to appointments, caregiving) the clinician needs to ally with family or significant other
• Compliance with treatment may be a problem
• Combined psychotherapy and pharmacotherapy is more effective than either treatment used alone

Discuss the specific treatments with your primary health care provider, s/he will be able to explain the various treatments, benefits, risks and costs in detail.

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