Applying Geriatric Psychiatry to Mental Health Treatment: An Interview with Dr. Jeffrey Gandin

Helping any client find relief from psychological distress begins with identifying the root causes of that distress. In geriatric populations, reaching diagnostic clarity can pose special challenges, as symptoms of mental illness and the natural aging process may overlap and mimic each other.

One of the primary clinical challenges is distinguishing what is abnormal aging from what is considered normal aging,” Dr. Gandin tells me. “For instance, we tend to lose memory as we age, and yet there are these illnesses like Alzheimer’s where there can be considerable memory difficulties beyond the norm.

Unfortunately, many clinicians aren’t trained to diagnose and treat the geriatric population and don’t have the resources to clearly distinguish between psychiatric and neurological concerns. Dr. Gandin’s specialized training in geriatric psychiatry uniquely positions him to achieve diagnostic clarity using targeted assessment tools that illuminate the underlying sources of distress and impairment.

I perform different batteries of cognitive tests like the Mini-Mental State Examination, Verbal Paired Associates, and various neurobehavioral tests. Our neuropsychologist, Dr. Judy Ho, can do more extensive diagnostic testing. If needed, we can have neuroimaging performed to help elucidate what the problem is, including CT scans, MRIs, and PET scans. Clients can also receive a medical workup and requisite blood testing.

In addition to psychological, neurological, and medical testing, diagnosis relies on a series of clinical interviews with the client as well as those close to them to get a complete history of symptoms. “I’ll want to reach out to people who have known the client, including the clinicians who have been treating the client and sometimes family members or friends.”

With a full picture of a client’s psychiatric needs in place, the treatment planning process can begin. At Bridges to Recovery, all clients receive a personalized treatment plan that uses therapies designed to address their individual areas of concern in a way that is relevant to them. One of the most important pieces of creating effective and meaningful treatment experiences is assembling a treatment team with the knowledge and experience to deliver care of the highest standard.

For geriatric clients, pharmacological therapies in particular must take into account the physiological changes that come with age as well as any physical medical conditions an individual may have. It is critical that the prescribing psychiatrist has the expertise to create safe and effective medication protocols for geriatric clients.

“There’s a greater sensitivity to medications that elderly patients have due to decreased renal function and other bodily changes,” Dr. Gandin explains. “Dosing is a big issue because drugs tend to be metabolized differently by elderly patients, so drugs should be given at lower dosages to start and increased gradually over time.” In addition to dosage considerations, the specific type of medication must be carefully chosen.

Geriatric patients tend to be susceptible to side effects from certain classes of medications. For instance, benzodiazepines and anticholinergic medications can have a more adverse effect in older patients than in the general population. There are also certain medications that may have cardiac side effects where we might be a bit more careful in using those.

The close oversight afforded by residential mental health treatment gives clinicians the ability to continuously monitor each client’s progress. Dr. Gandin follows his clients throughout their time in treatment and meets with them weekly to assess the efficacy and tolerability of medications, identify any areas of concern, and make treatment modifications as necessary.

Pharmacological therapy is not appropriate for all patients, and even for those whose treatment plans do include medication, it is only one piece of the puzzle. “In terms of psychosocial development, older people are often at a stage in which the existential questions emerge,” Dr. Gandin says.

People are asking, ‘Am I okay to have been who I’ve been?’ People are contemplating their accomplishments and they’re at a crossroads where they’re trying to develop integrity about how they live their lives versus dealing with dissatisfaction and despair about aspects of their lives.

Individual psychotherapy, therapy groups, and holistic therapies allow clients to explore not only their mental illnesses, but also undergo a process of profound self-discovery that may be particularly valuable for geriatric clients.

I believe experiential therapy and analytic therapy is invaluable and I think that those things not only help address specific mental health issues a person may have, but it can also be elucidating and help with growth more generally. There’s a great chance of success the more treatments a person can experience. Having a comprehensive array of therapies makes a positive outcome more likely.

If the assessments and clinical interviews reveal that a client has neurological or other medical issues in addition to psychological illness, Dr. Gandin can also refer them to an outside practitioner during their time in treatment. “We work regularly with an internist,” he tells me. “If a client needs to see a neurologist or some other specialist, we’ll arrange for a consult.” By concurrently treating the full spectrum of a client’s needs, they can begin healing from multiple conditions simultaneously, leading to better outcomes and faster relief from distress.

The unique challenges faced by seniors must also be thoughtfully considered during aftercare planning to ensure that the gains made during residential treatment are preserved. “A lot of the time treatment planning involves bringing in family members,” Dr. Gandin explains. “If there is significant cognitive impairment, for instance, many times it’s necessary to coordinate care with family.” Placement may also become an issue, as where they were living prior to treatment may not be a suitable environment. At Bridges, each client works with their dedicated treatment team as well as our discharge planner to create a roadmap for continued success that includes referrals to outpatient treatment providers and housing options as needed.

Changes in psychiatric treatment over the years have drastically altered the way care is delivered and where it is delivered. Unfortunately, for many these changes have reduced rather than expanded access to the kind of care needed for true healing. “When you look at longer-term care, there isn’t a whole lot available,” Dr. Gandin explains, “The psychiatric hospitals don’t serve the purpose that they once did for longer-term psychological care. If there’s a need for more extensive treatment, residential treatment can be invaluable.”

The immersive experience provided by residential care at facilities like Bridges can be life-changing for people of all ages suffering from mental health disorders. Limited access to care, however, disproportionately affects older people, who often face practical barriers to treatment. As such, residential treatment facilities can be especially helpful for geriatric clients. With access to a full range of therapies and experienced clinicians within a supportive and compassionate environment, clients can receive the care they need to achieve rapid relief from the pain of mental illness. “It’s a one-stop shop, so to speak.”

Many clients who come to Bridges are referred by their current physician or other clinician. Dr. Gandin recognizes and honors the relationships referring clinicians have established with their clients and invites their continued involvement in the treatment process. “During our initial contact, I ask for any background or treatment recommendations that may be relevant,” he says.

I also make myself available to answer any questions and maintain ongoing contact throughout the client’s stay. At the end of treatment, I reach out to the clinicians to discuss the course of treatment and the discharge plan.

By engaging referring clinicians throughout treatment, clients can benefit from continuity of care after their stay at Bridges has come to an end, and build on the transformations they have made while in residential care.