The Three Ds of Geriatric Mental Health

As the U.S. population ages, more people find themselves caring for a spouse, parent, or other loved one. The U.S. Census Bureau projects that older adults will outnumber children under age 18 by 2034. Adults over age 65 already outnumber children in 11 states and almost half of U.S. counties.

Given this reality, many will encounter this situation at some point. Advanced planning can help ease the anxiety of that transition. When should someone start thinking about intervening or providing extra help to a loved one? Age is not the only factor. A diagnosis of a serious illness requiring caregiving can happen at any age. And some people unquestionably live to old age without requiring much assistance at all. What are some of the signs that someone needs help or that it’s time to get serious about planning?

Determining gaps in caretaking is a first step. Observe the person at home: Are they steady on their feet? Are they taking medications as prescribed? Do they seem confused or mentally unstable? Is there enough food in the house? Are bills being paid?

The difficulties a loved one is experiencing may not be what you think. The three Ds of geriatric mental health are depression, delirium, and dementia (some commenters add decline, delusions, disability, or drug-related problems for a fourth “D”). Misidentifying or failing to differentiate among these conditions can have significant consequences, and the conditions are not mutually exclusive.

Depression is a mood disorder characterized by feelings of loss, sadness, guilt, and low self-esteem where a person exhibits cognitive, physical and mood changes. Depression is not uncommon among the elderly and is frequently undiagnosed because it often presents differently in the elderly than in younger people.

Delirium is often confused with dementia but is distinguishable due to its rapid onset, fluctuating course, and potential for recovery. It is usually caused by an acute medical condition such as a urinary tract infection or pneumonia.

Dementia, a general term describing a group of diseases affecting the brain, is characterized by a progressive, persistent loss of cognitive and intellectual functioning. The term includes several types and sub-types: Alzheimer’s disease is the most common dementia for those over age 65 and usually starts with short-term memory loss, language difficulties, and getting lost. Decline is gradual. Lewy Body dementia is the second most common type, with symptoms such as visual hallucinations, changes in alertness and attention, and symptoms of Parkinson’s disease such as rigid muscles, slow movement, trouble walking, and tremors. Vascular dementia is caused by one or more strokes and presents as declining executive functioning, confusion, trouble speaking, and memory problems. Frontotemporal dementia is an umbrella term for a group of diseases that affect the frontal and temporal lobes of the brain, which are associated with personality, behavior, and language.

Dementia is not a disease that eventually affects everyone who reaches old age. Loved ones should pay attention to changes, ask questions, and listen carefully. Signs of dementia include an inability to carry out normal daily activities, hygiene decline, weight loss, poor cognitive skills, and loss of interest in social activities. Signs of depression overlap with those of dementia and can include irritability and agitation. Many people associate dementia with memory loss because of the emotional aspect. But often, a decline in executive functioning is the more serious problem.

Caring for a loved one can be overwhelming, but recognizing the “three Ds” and knowing what to look for makes the path more manageable. By staying attentive to warning signs and engaging professionals early, caregivers can create a safer and more supportive environment for a loved one.

You may visit our website at www.wrightabshire.com. Nothing contained in this publication should be considered as the rendering of legal advice to any person’s specific case but should be considered general information.