Geriatric Mental Health Disaster and Emergency Preparedness

12 Geriatric Mental Health Disaster and Emergency Preparedness
also more sensitive to medication side effects, and they respond to psychotherapy
according to their level of cognitive impairment (Banerjee &
Dickinson). To make matters worse, there is a lack of empirical evidence
that can guide the clinician because a majority of clinical trials for psychotropic
medications are based on young individuals. This unfortunate combination
has made older persons with mental disorders at a higher risk
for poorer quality care (Bartels, et al., 2002). While in geriatric psychiatry
the empirical research base is limited, the principles of evidence-based
decision making can still be applied and hopefully will lead to a significant
improvement in quality of care.
OVERVIEW OF PSYCHOPHARMACOLOGICAL AND
NONPSYCHOPHARMACOLOGICAL TREATMENTS
This section provides a brief overview of the major psychopharmacological
medications and nonpsychopharmacological treatments, such as psychosocial
and behavioral strategies, commonly used with older persons
suffering from mental health problems. For a thorough, in-depth discussion
of these treatments, please see chapter 10 and chapter 14.
Medication management in the field of geriatric mental health is a real
and constant challenge. Older persons tend to take multiple medications,
have multiple comorbidities, have issues that can impair their adherence to
treatment, and be more sensitive to side effects. In fact, medications for
mental health problems, also known as psychotropics, are among the most
common medications associated with preventable adverse drug events in
older persons (Gurwitz, et al., 2003). To make matters worse, there is a lack
of empirical evidence to guide the health care provider because a majority
of clinical trials for psychotropic medications use young individuals. These
elements make the decision to start psychotropic treatment of an older patient
a challenge because the clinician has to assess the risk-benefit ratio.
PSYCHOPHARMACOLOGICAL TREATMENTS
Antidepressants
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are considered first-line agents for the treatment of depression based
on their safety and side effects profiles rather than their efficacy. In fact,