Geriatric psychiatry and brain health in old age

By 2030, one in six people across the world will be ⩾60 years old. ¹ In real numbers, this global older cohort will increase in size from 1 billion in 2020 to 1.4 billion by 2030 and then 2.1 billion by 2050. At the same time, the number of people ⩾80 years old will triple in size, up to 426 million. It is estimated that approximately 14% of adults ⩾60 have a neuropsychiatric disorder, and these disorders account for 10.6% of the total years lived with disability for this age group. ² Common neuropsychiatric disorders among older adults include anxiety disorders, mood disorders, substance use disorders, neurocognitive disorders, especially due to Alzheimer’s disease (AD), and delirium.^3,4

Despite being common and causing significant difficulties, psychiatric disorders are often undiagnosed and untreated in late life. ⁵ It has been noted that when compared to younger individuals, older individuals are less likely to receive a psychiatric diagnosis, have fewer visits with a psychiatrist, and receive less psychotherapy, but have greater rates of psychotropic medication visits (121.4 per 100 population vs 56.8 per 100 population). ⁶ Furthermore, it is more common for non-psychiatrists to prescribe most of the psychotropic medications for older people with one study finding that among older adults, only 5%, 4%, 17%, and 13% of the visits for antidepressants, anxiolytics, antipsychotics, and mood stabilizers, respectively, were with a psychiatrist. ⁷ Inadequate assessment and management of common psychiatric disorders can worsen outcomes among older patients including both decreased quality of life and increased morbidity and mortality.^5,8

To educate professionals on the best practices in caring for older adults with neuropsychiatric conditions, Therapeutic Advances in Psychopharmacology has assembled a special collection of articles titled “Geriatric Psychiatry and Brain Health in Old Age.” ⁹ This collection includes five articles on relevant topics in geriatric psychiatry including alcohol use disorder, treatments for anxiety, depression, delirium, and the management of multi-morbidity among older adults. These articles were prepared by experts in geriatric psychiatry and include the latest information available on these topics in their respective manuscripts.

In the first article, Schroder et al. investigated the frequency and characteristics of potentially serious alcohol–medication interactions, potentially inappropriate medications (PIMs), and potential drug–drug interactions (pDDIs) in a population of older patients with alcohol use disorder over a 10-year period using a retrospective monocentric cohort study design. ¹⁰ The investigators identified that these patients are frequently exposed to potentially serious alcohol–medication interactions, PIMs, and pDDIs, especially with regard to cardiovascular and psychotropic drugs. In the second article, Stahl et al. ¹¹ prepared a scoping review of the literature on the types and efficacy of psychosocial interventions for improving antidepressant pharmacotherapy adherence among depressed and anxious older adults using the PRISMA-ScR guidelines. The investigators identified that there are effective interventions for improving antidepressant medication adherence among depressed older adults but there is a lack of such interventions for anxious older people. In the third manuscript, Srifuengfung et al. provide a comprehensive guide to optimize medication management in older adults with depression in the outpatient setting. ¹² In addition, the authors also describe appropriate medications for managing anxiety, insomnia, allergy, overactive bladder, psychosis, and muscle spasms in depressed older patients.

In the fourth article in the special issue, Faeder et al. provide narrative literature on nonpharmacologic and pharmacologic approaches to prevent and treat delirium among older adults. ¹³ The authors also critically review whether antipsychotics should be used among older adults with delirium. In the fifth and final article in this collection, Carlson and Yarns discuss the important topic of medical and psychiatric multimorbidity among older adults. ¹⁴

We hope that the readers find the information provided in this special collection of articles useful in providing the latest evidence-based care for their patients. Early detection and appropriate treatment of neuropsychiatric disorders among older adults will help improve their quality of life, and minimize the morbidity and mortality due to these disorders.