Assessment of memory change, late-life depression, sleep disturbance and behavioural symptoms in older adults — including the medication review that most people over seventy badly need and rarely get.
The most common mistake in older people's mental health is attributing everything to age. Withdrawal, irritability, poor sleep, loss of interest and slowed thinking are treated as what happens at seventy-five. Often they are depression, which responds to treatment at any age, or a drug side effect, or a thyroid problem.
The second mistake is assuming memory change means dementia. It sometimes does. It also commonly means depression, B12 deficiency, untreated hearing loss, or the sedative someone was started on three years ago and nobody stopped.
Usually it is the adult children who notice first, and usually they have been noticing for a while before they say anything.
He asks the same question three times in an hour, then finishes the crossword perfectly.
Son, father aged 78She has stopped going out. She used to go every single day.
Daughter, mother aged 74He has started saying we are taking his money. He has never been like this.
Daughter-in-law, father-in-law aged 81Later life brings a particular combination: the body changes, the medicine cabinet fills up, and the social world shrinks. Each of those produces symptoms that look like the others.
Kidneys and liver clear drugs more slowly after seventy, so a dose that was fine at fifty can accumulate. Several very ordinary medicines — for sleep, bladder, allergy, blood pressure — directly impair thinking in older people.
Retirement, bereavement, children moving away, and the loss of driving or independence arrive close together. Depression in later life is frequently a response to real circumstances — which does not make it any less treatable.
The cost of assuming it is just age is not that nothing is done. It is that the treatable things go untreated for years, while the family adapts around a decline that did not have to happen.
Older adults are frequently poor reporters of their own change — either because they have not noticed it, or because they have and are frightened. The family's account is a required part of the assessment, not an optional extra.
What changed, when, and how quickly. Sudden change over weeks points somewhere very different from gradual change over years.
Structured bedside testing of memory, orientation, language and executive function, scored and repeatable so the next review can be compared with this one.
Bring every box, including what the physician, cardiologist and orthopaedic surgeon have each prescribed. Anticholinergics, sedatives and several common drugs impair cognition directly.
A large share of geriatric psychiatry is subtraction rather than addition. Many people over seventy arrive on eight or ten medicines accumulated from different specialists over a decade, several of which interact and at least one of which is probably causing the symptom that prompted the referral.
Where medication is needed, older adults are started lower and increased slower, and the physical health conditions they already have shape which drug is safe. Late-life depression in particular responds well to treatment — better, in many cases, than people expect.
This is one of the most common bookings in geriatric psychiatry. Book a consultation in your own name to discuss the situation, what you are seeing and how to approach it. Many families are also abroad — a video consultation with the parent at home and the adult child joining from another country works well.
Includes cognitive testing and a full medication review. Family may attend or join from anywhere. Reviews are ₹800.
No, and assuming so is the reason treatable causes get missed. Depression, B12 deficiency, thyroid dysfunction, hearing loss, sleep apnoea and medication side effects all present as memory change. Several are fully reversible once identified.
Yes. Bringing an older person to a doctor under a pretext damages trust at exactly the moment you need it most, and they usually work it out. Framing it as a general health and memory check-up is honest and is what it is.
Yes, and this is common. The parent joins from home in India, often with a helper present, and family joins the same video call from wherever they are. The written summary goes to whoever the patient consents to include.
An adult who understands the decision has the right to refuse, and that right is protected under the Mental Healthcare Act, 2017. Where capacity itself is in question, that is a clinical assessment in its own right and is discussed with the family directly.
Review an existing medication list
Late-life depression
Alcohol in older adults
Call Tele-MANAS 14416 — free, 24 hours. If someone is in immediate danger, call 112.