From uncertainty to understanding: Can psychodynamic theories improve our care of older adults?

Dr Juliette Brown is a locum consultant psychiatrist in CMHT for Older Adults in Newham and in liaison psychiatry at Newham University Hospital, and is a member of the Association for Psychoanalytic Psychotherapy in the NHS. 

Dr Cate Bailey is a Specialist Registrar in Psychiatry working in Liaison Psychiatry at Homerton University Hospital, and is a member of the Association for Psychoanalytic Psychotherapy in the NHS.

‘Psycho-analysis is not a child of speculation, but the outcome of experience; and for that reason, like every new product of science, is unfinished. It is open to anyone to convince himself by his own investigations of the correctness of the theses embodied in it, and to help in the further development of the study’ Sigmund Freud, On Psycho-analysis (1)

Can psychodynamic theory improve our care of older adults? A century of psychoanalytic thought and a half century of work by old age psychiatrists and psychotherapists suggest that it can (2-3). Psychodynamic approaches help in making sense of complex, bewildering and frustrating clinical encounters through the recognition and observation of unconscious communication (4). By becoming aware of the inner and outer worlds of ourselves and our patients we can provide more thoughtful and effective care.

Antidementia medication may improve survival in Alzheimer’s disease

Dr Christoph Mueller is an Academic Clinical Lecturer at the Department of Old Age Psychiatry at King’s College London. He and his co-authors published a paper on the influence of antidementia medication on survival in Alzheimer’s disease in Age and Ageing. He tweets at @DrChrisMueller

At present Acetylcholinesterase inhibitors, as Donepezil or Rivastigmine, are the only medications available for treatment of the early stages of Alzheimer’s disease. They can slow down the progression of the illness and alleviate distressing symptoms. However, their benefits are modest and they can have side effects, such as a slow heartbeat, indigestion, weight loss or an increased risk of falls. Moreover, dementia and Alzheimer’s disease is the leading cause of death for men and women 80 years or older in England and Wales. We investigated whether being prescribed antidementia medication was associated with survival in patients with Alzheimer’s disease.

Good mental health care is a part of good geriatrics

Tom Dening is Professor of Dementia Research at the Institute of Mental Health at the University of Nottingham. He tweets at @TomDening 

Sir Simon Wessely (yes, we are going through a phase where the RCPsych Presidents get gongs – I suppose it’s cheaper than investing in mental health services) has made some eloquent points about the current state of mental health provision.

He didn’t specifically mention older people, though of course they have common mental disorders like depression. Also he didn’t talk about the complex world where physical and mental ill health conspire against people and bring them into contact with geriatrics or old age psychiatry, or both.

Recognising delirium in frail hospital inpatients

Kathy Whittamore is a clinical researcher working as part of the Medical Crises in Older People programme at the University of Nottingham. She recently completed her MPhil looking at ways of recognising dementia in acute hospital inpatients. 

Before becoming a clinical researcher, I worked for some time as a health care assistant on a psychiatric assessment unit. Despite working at  the ‘coal face’ of a mental health ward, I was never told what delirium was, its risk factors, its causes and – perhaps most importantly – how to recognise it.

Since 2008, the Medical Crises in Older People (MCOP) research programme at the University of Nottingham has led a workstream devoted to better understanding the mental health problems of older patients on acute medical wards. When I began working as a researcher on the project I was educated in how to identify both delirium and dementia, but the more I learned the more I realised how many other healthcare professionals where not aware of what delirium was or how to recognise it. Delirium can be difficult to identify in older patients because it presents in a variety of different ways and can be difficult to distinguish from more long-term cognitive impairments such as dementia.