Symptoms and Signs
Psychiatric symptoms that develop in later life are often dismissed as normal manifeslations of aging. Even schizophrenia-like symptoms may be dismissed as eccentricity or misdiagnosed as senility. Treatment cannot be planned if a problem is not acknowledged and identified.
Memory and intellectual difficulties: Significant changes in intellectual functioning are no longer readily dismissed, given the heightened awareness of Alzheimer’s disease. But the degree to which depression, anxiely, and other psychiatric disorders can inlerfere with cognition is still underappreciated. Pseudodementia (eg. depression or psychosis mimicking dementia) is an extreme form of such interference.
Change in sleep pattern (see also Ch. II): Complaints of diminished sleep time are often met with assurances that it is a normal part of aging. However, such a change should be viewed clinically as a group characteristic that does not apply to all individuals. Not all studies have found that total sleep lime is reduced in later life. Furthermore, the reduction is typically gradual; a change in sleep pattern should not be taken for granted, especially if it is of recent onset. An older person who reports noticeable reduction in sleep time (not just sleeping less at night because of daytime naps) should be evaluated.
Besides signaling potential medical (eg. musculoskeletal, genitourinary, cardiac) problems, changes in sleep pattern can be a hallmark of psychiatric disorders. Early morning awakening may be an important clue to an underlying depression; difficulty in falling asleep or restless sleep with frequent awakenings may signal an anxiety disorder.
Change in sexual interest or capacity (see also Chs. 68 and 69): As a group, healthy older men and women with a history of normal sexual activity and current opportunity retain an interest and capacity for sexual experience, although individuals may be exceptions. Significant changes, particularly of recent onset, call for diagnostic assessment with a focus on medical and surgical factors, drug side effects, and psychiatric causes. Medical problems and drug side effects affect the sexual function of men more than women, since these factors can interfere with erectile and ejaculatory capacity.
Common medical causes of erectile dysfunction include atherosclerosis (especially in diabetic patients), hypothyroidism, malnutrition, and Parkin_son”s disease. Among possible drug causes, alcohol consumption should be considered; alcohol in high amounts not only serves as a depressant, thereby negatively influencing sexual interest, but also can interfere with erectile and ejaculalory capacity. Depression or anxiety in both men and women can lower motivation for romantic involvement and diminish sexual satisfaction. Regardless of the cause, many sexual problems can be ameliorated or eliminated with proper intervention.
Fear oldeath: Research shows thai while the elderly often think about death, they fear dealh less than do other age groups. Thinking or talking about death is not the same as fearing or dreading it. Thoughts or conversations about death are naturally more common in the elderly, since they more likely have peers and relatives who have died or are dying. Dread of death is uncommon in persons who are not dying or experiencing some major loss, although reports show a normal and common dread of death in middle-aged persons, who may suddenly perceive how little time is left. At this stage, people find themselves confronting an existential awareness of their own mortality; with further aging, they adapt to this realization.
A terminal illness, an underlying depression, or other emotional conflict—not the awareness Of aging itself—predisposes certain elderly persons lo death anxiety. In these cases, confronting mortality is different; a terminal illness brings an awareness of dying that can lead to despondency. Eventually, most people come to terms with their fate and can reasonably accept their condition. Depression at any age clouds a person’s thinking and often increases thoughts about death. A noticeable and persistent uneasiness about death may signal underlying depression that could benefit from trealment. Evaluation is all the more important given the high rate of suicide in the elderly and the role of depression as a major risk factor.