Los Angeles Jewish Home

Interview with Dr. Nitin Nanda: Treating Seniors' Mental Health

Dr. Nitin Nanda is Chief of Psychiatry and Behavioral Health at the Los Angeles Jewish Home. He also serves as medical director of the Lisa and Ernest Auerbach Geriatric Psychiatry Unit, a part of the Brandman Research Institute at the Home's Joyce Eisenberg-Keefer Medical Center.

Q. What are the most common mental health issues seniors face today?

A. A number of concerns arise as people age, including depression, memory loss, and other cognitive issues that can interfere with day-to-day functioning. Anxiety disorders are also common, as is substance abuse, primarily alcohol.

Q. Are medical conditions a risk to mental health?

A. Yes, many times medical conditions directly affect a patient's emotional well-being. It's very important to understand that mental health issues are not a part of normal aging. Unfortunately, because depression has been associated with aging, it is often under-recognized and under-treated. Unaddressed emotional needs can lead to a significant decline in both mental and physical health and functioning.

Q. What prompted the Jewish Home to open the Auerbach Geriatric Psychiatry Unit?

A. Mental health and emotional wellness are vital components of successful aging, and as a provider of a full continuum of care, the Jewish Home believes it is important that we be able to provide these specialized services here on campus.

Q. How do you address a patient's mental health needs at the Auerbach Unit?

A. First with an expert staff that provides patients with a comprehensive geriatric evaluation, both psychiatric and medical. Both teams, psychiatry and medicine, make sure that medical issues are being treated and drug interactions are monitored.

Second, we perform a memory evaluation and work-up, and determine if there are any psychosocial or 'life' stressors, such as conflicts with, or the loss of, loved ones, challenges to independence, financial situation and so on that affect a patient's sense of well-being. With our philosophy of treating the whole person, we are well-prepared to provide whatever therapies — including physical, speech, and occupational therapies — are needed.

Q. How important are preventive measures to senior mental health, and what can seniors and their families do to look after themselves in this way?

A. We have created a list of ten warning signs of mental health problems in seniors (see the sidebar). If there is any cause for concern, we encourage seniors or their families to contact their family physician sooner rather than later. Also, the Home now offers a monthly Emotional Wellness Clinic on each of our campuses. These are open to the public and are intended to improve the quality of life for our residents and all of our senior community.

Q. Who can participate?

A. Anyone over 55 may be seen in our clinics for an evaluation of their psychiatric and medical history and symptoms, and receive helpful information and referrals about treatment options.

Q. When do you recommend inpatient mental health services for seniors?

A. When symptoms can't be managed on an outpatient basis, hospitalization is recommended to closely monitor and treat our patients. A number of issues can become unbearable for seniors, particularly depression, which can be life-threatening. Severe depression can interfere with daily functioning and cause people to isolate themselves and feel hopeless and helpless. Symptoms can come on suddenly. We look for agitation, insomnia, personality changes, apathy, and changes in dietary habits.

Q. What kind of assessment or treatment can you provide that you couldn't provide on an outpatient basis?

A. Hospitalization may seem like a drastic step, especially to seniors who are ailing and frightened, but it provides an opportunity for a full neuropsychiatric and medical assessment to see if the condition is treatable, to make sure there are no underlying medical problems causing the condition, and to help improve the situation as quickly as possible. The inpatient team — a geriatric psychiatrist, geriatric internist, program director, charge nurse, social worker, activity therapist, dietician, and pharmacist — sees the patient daily, typically for 7 to 10 days, though sometimes less. Patients are transitioned back to their regular lives and physician's care when target goals for their well-being are met.

For additional mental health resources,click here

Robin Heffler is a Los Angeles-based journalist whose writing and editing span the fields of health, social services, education, law, the environment, religion, arts, and culture. Her work has appeared in the research publications of UCLA, USC, and Cedars-Sinai Medical Center, as well as in the Los Angeles Times and The Forward.

Labels: Aging, Auerbach Geriatric Psychiatry Unit, Feature Articles, Heffler, Mental Health, Nanda, Psychiatry, Warning Signs