Your Health Choices East Midlands Full magazine | Page 20
Mental Health
The effect of mental health conditions on daily life
Capacity issues are particularly pertinent in the elderly.
Sometimes failing memory and cognitive abilities might affect
someone’s decision making skills with regards to making
wills, managing property and affairs, and attending to one’s
welfare. How much a person is affected will depend on their
own individual symptoms, however the below provides general
insight onto the most common scenarios.
in later life
POWER OF ATTORNEY
Elderly people who still possess abilities might be able to
nominate a deputy who can manage their affairs on their behalf
should the time come. A legal and valid way of doing this
would be to appoint a ‘power of attorney’, which is a relatively
straightforward process, with information available online and
via most legal firms and solicitors. In the unfortunate position
where this has not been done before people lose their abilities to
make this nomination, a more arduous process called a ‘court of
protection application’ is needed. Here the application is made to
a court to arrive at the decision of how the affairs are to be dealt
with. Unfortunately this is often more complex and expensive.
Dr Hari Subramaniam explores common mental health
issues in the elderly, and when you should consider seeing
an Old Age Psychiatrist.
Your
health expert
Dr Hari Subramaniam is a Consultant Old Age Psychiatrist who has over twenty
years experience working with patients experiencing symptoms of mental illness,
and those with existing conditions such as Dementia and Alzheimer’s.
© Feng Yu - stock.adobe.com
An Old Age Psychiatrist is able to conduct a number of
assessments to help determine if someone in later life is suffering
from mental illness. An ‘assessment for cognitive functioning’
should be considered if any of the following are becoming
troublesome:
© Minerva Studio - stock.adobe.com
WHAT IS ALZHEIMER’S DISEASE?
Alzheimer’s disease is a degenerative brain disorder which
throughout most countries of the world is the most common
cause of memory and other cognitive problems.
It is now thought that Alzheimer’s disease occurs as a
result of the accumulation of abnormal proteins in the brain - a
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process which usually occurs over many years or even decades
(even though symptoms may only arise in the later stages).
Alzheimer’s is very treatable, even if the focus of treatments is
to contain the progress rather than cure it. Several medicines
are available to help treat the disease, and significant research
into the condition is ongoing.
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WHAT ARE ANXIETY RELATED ILLNESSES IN THE
ELDERLY?
Anxiety and depressive illnesses are fairly common in the
elderly and unfortunately can limit functioning and affect
quality of life. Accurate assessments usually help distinguish
conditions that may be treated with psychological and
behavioural approaches, however some conditions may
also warrant drug treatment. Therapies can be tailored to
each individual patient’s requirements to optimise their
e ffectiveness. Quite a lot of psychological problems can be
contained by targeted and focused psychological interventions,
that minimize negative thoughts and behaviours while
reinforcing positive coping strategies.
Poor concentration and intellectual decline.
Absent mindedness and disorganisation.
Judgement changes.
Personality and social changes.
Forgetfulness.
Symptoms of forgetfulness and memory impairment are
common. Sometimes they are transient and self-limiting but
on other occasions they may be the beginnings of a progressive
disorder. If they are diagnosed accurately and early, they can be
controlled or treated to good effect. This assessment needs to
be carefully conducted by a trained specialist to enable an early
WHAT IS VASCULAR DEMENTIA?
This is a form of dementia in which the problems are caused
by circulatory disease in the brain. Disease of the larger or
small arteries results either in strokes or a more generalised
pattern of reduced blood flow. Both of these processes can
impair memory and other aspects of thinking and information
processing.
Lifestyle changes and minimizing risks for stroke
and heart disease is very important. Examples of this include
reducing smoking and moderation of alcohol intake, alongside
taking regular exercise and leading a healthy dietary lifestyle.
Most people with dementia can drive until the advanced
stages of the illness, and often get a yearly licence subject
to review.
diagnosis. Depending on individual cases specialist investigation
such as MRI and/or CT Scans of the brain may also be required.
Drug treatments are available for suitable cases and often
provide very good symptom control and stabilise functioning.
Other assessments that can be provided by a specialist Old Age
Psychiatrist include:
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Anxiety and depression.
Phobias, OCD and PTSD, resistant anxiety and depressed
states.
Advice about mental capacity.
Issues with power of attorney.
Court of protection assessments.
In most instances, your General Practitioner will indicate
when they think a referral to a specialist is necessary based on
your medical history and symptoms.
Dr Subramaniam is a Consultant Psychiatrist for the
Elderly at Leicestershire Partnership NHS Trust and an
Honorary Senior Lecturer at the University of Leicester.
He sees private patients at the Nuffield Hospital
Leicester and Holmfield Consulting Rooms Leicester,
where treatment is available on an insured or self-
paying basis.
WHAT IS MILD COGNITIVE IMPAIRMENT?
This is a clinically recognisable problem with memory, or
sometimes other aspects of cognitive function (the way the
brain works), which can be a nuisance and a source of concern.
Because mild cognitive impairment is not really disabling,
it therefore does not meet the criteria for dementia. MCI is
not a single illness and it has a very variable prognosis. Some
patients with MCI may progress to develop more troublesome
cognitive problems over time.
Upon notification, the DVLA will usually start a process
of gathering information and write to the necessary people
(including the doctor). Until the DVLA reach their a decision
on whether a person will retain their license, driving is usually
allowed (although this will differ depending on individual
circumstances). In very select, complex cases the DVLA might
ask for an actual driving test to be taken.
When should you see a specialist?
Common conditions explained
WHAT IS DEMENTIA?
Dementia is a general description for a broad range of
illnesses whose main feature is a disabling level of impairment
of memory and other aspects of thinking, reasoning and
information processing. ‘Disabling’ meaning that it is intrusive
enough to interfere to some extent with the patient’s normal
day to day activities.
Unfortunately most dementia-causing illnesses are
progressive and irreversible, although there are always practical
things that can be done to help and support the patient to
maintain their independence for as long as possible.
For some types of dementia, medical treatments are
available that may improve or stabilise some of the symptoms.
Increasingly more and more advances and treatments are
emerging for conditions like dementia due to Alzheimer’s
disease.
DRIVING
A diagnosis of dementia in itself does not mean that patients
cannot drive; however there is a legal requirement to let the
DVLA know if such a diagnosis has been made. This is needed
not only for the safety of the patients themselves and other road
users, but for insurance requirements and legal reasons which
might otherwise lend the driving licence invalid thus raising the
chances of being prosecuted.
For further information visit:
www.leicesterprivatementalhealthconsulting.co.uk
To arrange a private appointment telephone:
0116 274 3717 for Nuffield Hospital Leicester
or
0116 270 6841 for Holmfield Consulting Rooms
appointments.
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