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The proportion of elderly at any age without any chronic conditions is small, and disease can trigger a cascade of events resulting in functional deficits and disability. An increase in the number of activities with which an elder has difficulty increases linearly with comorbidity, that is, coexistent medical conditions that further complicate not only the genesis of a functional deficit but also its treatment. For example, rehabilitation for a stroke for an individual who also has painful, degenerative changes in the foot and a low tolerance for stressful activity secondary to angina with exertion would present a particular rehabilitation challenge. Yet, this example encapsulates geriatric rehabilitation specialist’s emphasis on care and function, not cure and disease. (more…)

Because there are no placebo-controlled treatment studies of Obsessive Compulsive Disorders in elderly, Obsessive Compulsive Disorders treatment guidelines are generally extrapolated from studies of younger populations and case reports of treated elderly. Selective serotonin reuptake inhibitors (SSRIs) are the drugs of first choice for OCD. (more…)

Obsessive-compulsive disorder (OCD) is a common neuropsychiatric condition that is frequently unrecognized and untreated, resulting in significant personal suffering and functional impairment. This article reviews the current state of knowledge of OCD epidemiology, clinical features and natural history, differential Obsessive-compulsive disorder diagnosis, and Obsessive Compulsive Disorders treatment options, focusing on how Obsessive Compulsive affects elderly. (more…)

Only about 5–12% of people attending specialty Obsessive Compulsive Disorders OCD clinics are 60 years or older. However, OCD is rarely diagnosed in general outpatient settings in the elderly, as noted in a study of the Kaiser Health Maintenance Organization in which only 29 cases per 100 000 patients were reported. OCD seldom begins in late life, and most elderly people with this disorder who present for treatment have had symptoms for decades. A study of consecutively evaluated outpatients found only 1% of those in an OCD clinic had the onset of the disorder after age 50. (more…)

There are a number of issues that must be considered in geriatric pain assessment. The major issues that merit attention are presence of comorbidities, mental status, depression in late life, limitations in ADLs, medications, and the importance of family and other support systems (see Depression; Social Networks, Support, and Integration). (more…)

The principal reversible dementias are metabolic. Hypothyroidism and exposure to industrial or environmental toxins should be considered; iatrogenic cognitive impairment due to medications is a common example. Depending on the acuteness and intensity of the metabolic disturbance, the clinical presentation may be more similar to delirium than dementia. These dementias are reversible, but often not completely, depending on the length of exposure of the brain to the abnormal metabolic environment. (more…)

It is estimated that about 6 million Americans over 65 suffer from depression in late life. The sad reality is that 10% are looking for and get treatment of late life depression. It is common that many illness and disabilities are accompanying late-life depression. When people reach certain age in this age, your support system begins to collapse. Family and friends, Spouses, siblings and friends die. You are about to retire or move. People with depression are likely to see a decline in quality of life. This can deprive them personal joy and productivity and he hope for the future. (more…)

Depression in late life is closely linked with senescence at a very basic level. Before discussing medical illness and disease processes, however, it will be helpful to review some more basic processes that may trigger, or at the very least exacerbate, depression through biochemical or neuroanatomical mechanisms. (more…)

Depression is not a monolithic disorder. Rather, it presents in a variety of syndromes that may vary in severity, length, and association of depression with other symptoms. A number of ongoing controversies attend identification and differential diagnosis of depression in late life. This section considers three such issues: common clinical syndromes and diagnoses, major versus minor depressive syndromes, and the question of whether late-life depression is qualitatively different from depressive syndromes at younger ages. (more…)

The majority of older adults who suffer from depression experience lower-level symptoms that do not meet diagnostic criteria for major depressive disorder. The DSM recognizes several well-defined disorders that are considered minor depressive states. Dysthymia is defined as presence of one of the two defining symptoms plus at least two other symptoms of depression continuously for a period of at least 2 years. This chronic, low-level depression typically manifests relatively early in life and is in fact less prevalent in older than in younger persons. (more…)