Los Angeles Jewish Home

It’s 2:15 a.m. Out of a deep sleep, you awaken to clanging noises in your kitchen. Not long ago, you would have thought someone was attempting to get into the house. But with everything that’s gone on lately, you realize it is actually someone trying to get out. It’s your mom. She’s ‘wandering’ again.

Recently, you’ve noticed she is having memory problems. It’s been harder for her to recall what was just said. Now she’s forgetting the day, the date and other little features of daily life. Learning new things seems especially challenging for her, and she is starting to make up details to fill in the parts of stories she’s forgotten.

At first, it was possible to chalk it all up to getting older. After all, there are many challenges to deal with as the years advance. But things have really begun to change for the worse.

Mom can’t sleep through the night. She wakes up disoriented and confused. During the day, she believes she has appointments that have never been made. She talks about going to see friends or family who have long ago passed away or moved. She gets mad and lashes out when she is prevented from doing things you know she can no longer do.

Sometimes Mom seems depressed. It is harder and harder to take care of her personal needs, and she doesn’t seem to understand why you want her to take a shower. Sometimes she even forgets who you are.

It seems that her symptoms are coming on faster and faster, and, since she took that fall last week, things have gotten so much worse. Her doctor prescribed some medication, but it really isn’t helping.

You get out of bed and go downstairs to try to help Mom back to bed. She isn’t settled until 4 a.m. You don’t know what you’re going to do. One of these days you might not be able to get to her in time.

Mom has dementia, and now you’re worried about her safety. You need someone to help you figure out what to do next.

The preceding scenario is a composite of several we’ve heard from families caring for loved ones with various forms of age-related dementia.

At the Jewish Home’s acclaimed Auerbach Geriatric Psychiatry Unit (AGPU), we counsel families on mental health services for their senior loved ones, and provide short-term (acute) intensive treatment for seniors experiencing stressful mental or emotional challenges.

More than 50% of patients treated are suffering from acute dementia. The goal of our small, specialized hospital unit is to help restore seniors to an optimal level of functioning so they may safely return to their home or residential setting.

While most people do not need to be admitted, the staff at the Auerbach Geriatric Psychiatry Unit can help you sort through your options, gain new insights on dealing with dementia, and where to go for additional help.

If you have a loved one who is experiencing acute mental health challenges, please call the Jewish Home’s Auerbach Geriatric Psychiatry Unit at (818) 758-5042. A helpful staff member will either talk with you immediately or get back to you promptly.

Labels: Aging, Alzheimer's, Auerbach Geriatric Psychiatry Unit, Dementia, Feature Articles, For the Mind, Luke Jackson, Memory, Parents, Wandering

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