Welcome to my new blog, PositivelyAging! I plan to blog about issues that impact the ability to age well both from my perspective as a geriatric psychiatrist as well as the daughter of two awesome 79 year old parents.
For my first post, however, I thought I would talk a little bit about what I do. I am a geriatric psychiatrist. Um, what is that? An older psychiatrist who is ready to be put out to pasture? Nope. A psychiatrist that has an extra comfy couch so that older patients can lie down and tell me about their mother (like the guy in the cartoon)? Also, nope (although I do enjoy comfortable furniture).
A geriatric psychiatrist is a psychiatrist that gets extra (1-2 years of subspecialty) training after residency in evaluating, diagnosing and treating the mental and cognitive health issues of later life like depression, anxiety and dementia. We manage patients with careful evaluation and assessment, medications, and psychotherapy (mostly focused on the here and now, and no lying on couches!). We maintain close linkage with other healthcare professionals, family and community resources. Our goal is to maximize quality of life and functionality for the older patient.
I chose this subspecialty for four main reasons. First, like many other geriatric psychiatrists, I had a very positive experience with an older adult growing up, my grandmother (YiaYia in Greek). At less than 5 feet tall, my YiaYia was the matriarch of the family and a repository of wisdom. Late in her life, after she had had a stroke, she also experienced depression and with treatment, was able to recover; this experience made a big impact on me. Second, I chose geriatric psychiatry because I loved the challenge of integrating the knowledge of psychiatry, neurology and medicine that is critical to understanding the mental and cognitive health problems of the older patient. For example, depressive symptoms can be triggered by life events, stroke, medical issues like anemia and thyroid problems, and medication side effects. Each patient’s issues are different and present a puzzle for me to solve. Third, whether or not they have previously experienced mental or cognitive health issues, the common feature of older patients is a lifetime of accumulated experience. So with help, they can adapt to change and improve their function. And that leads me to the fourth reason, my patients are my best teachers. Because of that lifetime of experience, our treatment relationship is a two-way street. One of my strongest career memories to date was on September 11th, 2001. I was in clinic that day and fear was in the air. My thoughts went to my children (aged four and one at the time), and I literally felt sick, thinking about what kind of world I had brought them into. As I brought my next patient back to my office, he must have picked up on this. Although he was there to get help from me, it was he who helped me that day. A veteran of WWII, he looked at me with a crinkly-eyed smile and said “Dr. Kales, our country has been through a lot, and we will get through this. I KNOW it.” And helping me with that comforting statement gave him a feeling of usefulness and purpose that made an impact on me as well. We all want to feel useful.
Here at University of Michigan, we have the unbelievable good fortune of having 10 geriatric psychiatrists on our faculty. There are only 1600 of us in the entire nation, and with an aging “tsunami” upon us, our mission is clear. We need to produce more geriatric psychiatrists and to train other providers to better manage the mental and cognitive health needs of older patients. That is a primary mission of the UM Program for Positive Aging.