UH Geriatric Psychiatry Program Serves Needs of Complex Older Adults

UH Clinical Update | June 2024

Mental health concerns among older adults are a large and growing problem. A recent analysis of insurance data compiled from 2019 through 2023 revealed somewhat surprising findings. The largest increase in mental health diagnoses for any age group, it showed, was among those age 65 and older – at an eye-popping 57.4% increase in just four years. Complicating this fact is the reality that many of these same older adults have co-existing neurologic disorders with psychiatric sequelae -- neurocognitive and neurodegenerative disorders such as Alzheimer’s or Parkinson’s disease.

Philipp Dines, MD

At University Hospitals, the geriatric psychiatry program at UH Cleveland Medical Center is optimally designed to care for these medically challenging older adults.

“We have a very large umbrella, and we take care of a lot of different complex patients,” says Philipp Dines, MD, Medical Director and Chief of Geriatric Psychiatry at UH Cleveland Medical Center. “But generally what we do is take care of very complex patients who have both neurologic and psychiatric issues. We are a tertiary service. We receive referrals from neurology, general psychiatry or geriatric medicine when issues become more challenging.”

Dr. Dines says one of the most difficult problems he and his colleagues face when caring for these complex older patients is differentiating the neurologic from the psychiatric. He describes, for example, a recent case of a patient presenting with depression, but also memory loss. After ordering neuropsychological testing, the Montreal Cognitive Assessment (MoCA), and a brain scan, he was able to get a clearer picture of what was going on.

“It all fits together,” he says. “I explained that all to the person, along with their family member or supportive person. But right now, their most immediate problem is the depression.”

Part of it is distinguishing the primary from the secondary problem, Dr. Dines says.

“With dementia, a lot of times patients will develop psychiatric features, which are mood disorders,” he says. “They can be depression. They can develop bipolar symptoms. That may have been primary or may develop secondary because of the dementia. We may have patients who develop bipolar-type symptoms secondary to the dementia. They might have depression secondary to the dementia or they could have psychotic features.”

Because their patients are so complex, Dr. Dines says he and his colleagues do their best to ensure that every patient has a support person in attendance at every office visit.

“That's something I discuss right at the beginning with the family,” he says. “If the support person is reluctant, or thinks that the person should only be seen alone, I dispel them of that notion right away. They are an integral part of the evaluation. Without them, it really impairs our ability to provide the best care.”

The Alzheimer’s Association reports that by the year 2050, the aging of the Baby Boom generation will help increase the number of Americans with Alzheimer’s disease to 13 million – up from 7 million today. Parkinson’s disease, at the same time, has the distinction of being the fastest-growing neurological condition in the world. With facts like these, the need for the geriatric psychiatry specialists at UH Cleveland Medical Center will only increase.

Dr. Dines says he and his colleagues will continue to work and offer their specialized expertise to make a difference for these increasingly complex patients.

“We're really at the pinnacle of managing the most challenging neuropsychiatry cases,” he says.