The importance of the geriatrician figure is growing in step with the progressive ageing of the population. The longer the expectations of life, the greater the value of these specialists and the more delicate tasks they can perform, the more valuable they become. This is a specialty that has long been mistreated and accused of being “poor” medicine. Instead, the professional evaluates and manages health problems and the typical needs of the elderly, which would require the intervention of different specialists, avoiding, for example, inappropriate and excessive intake of drugs. Often the geriatrician is fundamental in diagnosing psychological disorders and emotional difficulties related to aging. In this regard, we interviewed Dr. Mariangela Bonzani, a specialist in Geriatrics and Gerontology at Humanitas Medical Care Arese, who has long experience in hospitals and health and social facilities.
Depression after a certain age
“In the elderly the problem of depression is significant – confirmed the specialist -. The forms of this disorder can be different: some are called “depressions below the threshold”, ie are forms of mild depression that, however, can sometimes accompany the cognitive decline and sometimes precede it. This state in the elderly is complicated by the coexistence of a cognitive component.
As with young people, in the elderly too, the depression is often and mainly characterized by the presence of mood anomalies, insomnia, irritability, difficulty in making even simple decisions, loss of interest and pleasure, weight loss, eating disorders. “The elderly person often tends not to report the sadness he feels – said the doctor -, but communicates his discomfort by projecting it on the body, ie verbalizing the disturbances of the somatic type.
How does the geriatrician intervene?
“The geriatrician is a doctor who can customize, in other words, he turns to the care of the person as a whole and not only to the treatment of the disease itself,” says the expert. This specialist deals not only with the study and treatment of diseases of the elderly, but also tries to understand especially those that are the psychological, social, welfare components that occur with aging. In geriatrics we often speak of “low technology and high touch”, in the sense that the geriatrician collects the information of the elderly patient, the family history, the clinical history and proceeds to the objective examination. But, in order to approach the problem in its entirety and be able to examine the different components, the specialist often uses the method of multidimensional evaluation. “At the level of screening, of course, the different scales allow us to assess the functional autonomy of the elderly person, that is, his ability to carry out the activities of daily life, or what are his motor problems, or even recognize an initial cognitive decline and identify emotional problems, including, above all, depression,” explains the doctor.
The link between depression and cognitive disorder? We speak of pseudo dementia of the elderly to understand the depression that manifests itself together with a cognitive deterioration, so much so that it can be mistaken, precisely, for a dementia. In other words. “Sometimes the expression of the depression symptom is so pushed towards the cognitive disturbance that it is interpreted as the emergence of a dementia”, explains the expert. She adds: “This is a very delicate aspect because, if the basic problem is depression, a therapeutic approach, pharmacological or not, can improve cognitive skills”. At other times it is exactly the opposite: a depressive condition is thought of when, instead, this disorder can be one of the prodromes, that is, one of the emotional aspects with which a cognitive decline can manifest itself.
Do any factors trigger the depressive state?
The factors that are most often associated with late depression are comorbidities (coexistence of different diseases), a problem of disability, poor social contacts, a bereavement, especially the loss of the spouse, a chronic pain that you can not control.