Elder Interventions

Abby was a 72-year-old woman who had many medical complaints, which interfered with her job as a clerk in a candy store.  She was referred to me by her family physician, after he had performed numerous evaluations.   All of the tests were negative, and he had nothing more to offer her.  Her family was concerned because they would often find her in a tearful mood at family gatherings.  She was adamant about the fact that she was not depressed but just worried about her job.  Initially Abby was quite upset that her doctor referred her to a psychiatrist, since she felt that she was not crazy.  I reassured her that she was not crazy, but at the same time I tried to focus on the fact that she seemed to be suffering from pain in a variety of areas of her body.  Pain, as I explained to her, was a very real symptom that needed to be taken seriously.  She could easily talk about her pain and how it prevented her from doing her job.  Abby had been out on sick leave for the last three months, due to perceived physical problems.  After further discussion, she admitted that her place of employment been the main source of stress in her life.  She was actually glad that she did not have to go to work.  Ultimately, she was able to accept the fact that perhaps her work was making her feel depressed.  After a few therapy sessions, she was able to go back to work for a different employer as a volunteer on a limited basis.  Her pain did not fully resolve, but she was happy with the fact that she could now work through the pain and do something productive in her life.  Ironically, after a few months her family doctor informed me that she was working almost forty hours per week and loving it.  She never did require the use of medications.

Elderly depressed individuals commonly present with medical complaints, most often pain.  It may be that it is more socially acceptable for them to have medical problems, rather than admit they are depressed.  Sometimes, they even refuse to accept that they may be depressed, since they believe any person would be upset if they had all of these medical issues.

A major challenge in such individuals is convincing them to seek some form of psychiatric help.  They are much more eager to put themselves through numerous medical tests costing thousands of dollars than seek mental health care.  Some of these patients have a difficult time accepting psychiatric medications such as antidepressants or tranquilizers from the family physician because they assume that their physician is labeling them as crazy.

There is no single, foolproof way to convince these people to get help.  It is often useful to obtain some information regarding the patient’s medical and social background so that it can be determined if they have had a bad experience with psychiatry.  Some of these individuals may have had a negative past experience with mental-health professionals or with family members or friends who had some type of psychiatric problem.  Once you have this information you can then develop an educational plan or strategy to convince the patient to obtain an evaluation.  Often they need to be told that having an emotional problem does not define them as crazy.  More importantly, they should be informed that many of these psychiatric disorders could be easily treated. 

Another way to bring a patient in for proper care is to initially focus on the person’s physical complaint and gradually tie it in with a discussion of how their symptoms affect them emotionally.  This roundabout dialogue can make them accept mental health care more readily, because they will find it easier to seek treatment for their physical problem.  Once they establish a strong relationship with their physician they will be more likely to accept a fully explained mental health referral.

Certain movies, articles and talk shows have painted a negative image of psychiatric patients.  If this causes the older individual to have a bias against receiving mental health care, they need to be educated fully about the positive aspects of psychiatric treatment.  It is often helpful, if possible, to introduce your loved one to someone who has been helped by a mental health professional.  Then, a plan can be developed to make a psychiatric consultation more appealing based on a more thorough understanding of mental illness.