What are some of the challenges you or your colleagues have faced in dealing with this specific population that differ from general psychiatry?
Unfortunately, seniors who are psychiatrically ill are often seen to be undesirable referrals from other physicians. Elderly patients with severe mental illness such as bipolar disorder or schizophrenia often need intensive care plans that involve frequent communication with case workers and other specialists involved in diseases emerging with age.
There are also unique risks associated with mental illness in late life. For example, elderly males are at an increased risk of completed suicide compared to the rest of the population. Seniors experience more pronounced medication side effects and drug interactions, and their symptoms will often persist despite our best efforts to optimize their treatments. It’s a challenge.
What is it about the work that you do, and the work done at CAMH, that provides fulfillment for you?
The reward comes in the little victories, like supporting a patient’s disability application so he or she can secure better housing, helping a patient hone cognitive strategies to improve their ability to remember their grocery list, or streamlining medications to avoid bothersome side effects. These seemingly small interventions often have an enormous impact on our patients’ lives.
People are paying more attention to mental health in general, thanks to greater public awareness and understanding in recent years. Has there been a shift in perception around geriatric mental health?
I think there’s a shift in expectations regarding what it means to age. The aging Baby Boomer population doesn’t see themselves as “elderly” and want to continue to live dynamic lives well into their eighth and even ninth decades. Society as whole will no longer tolerate the notion that an ailing mind is an inevitable consequence of aging.
In the past, you spoke on a panel about innovations in mental health. What have been the biggest innovations in how we treat geriatric mental health in recent years?
I think we’ve finally rejected old attitudes around aging and mental health. Researchers are aggressively seeking new treatments for major mental illness in old age. There is much hope around targeting the brain’s ability to rewire and repair itself. It’s called “neuroplasticity”. New, non-invasive brain stimulation therapies are now available including Repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial Direct Current Stimulation (tDCS).
At CAMH, we are also using cognitive training programs to strengthen cognitive skills for seniors with schizophrenia such as Cognitive Based Social Skills Training (CBSST) and Cognitive Remediation Training (CRT) with promising results.
A very exciting recent development is the grant awarded to CAMH from Brain Canada and the Chagnon Family. It will fund a five-year study to focus on combining tDCS with CRT, aiming at preventing cognitive decline and Alzheimer’s dementia among older persons with depression or mild cognitive impairment.
You’re on your way to becoming a geriatric psychiatrist. What are your aspirations for your professional practice?
I’m fully engaged with my clinical, research and academic activities as a Resident. I hope to keep my practice both diverse and intellectually stimulating while continuing to provide high quality care to our seniors with mental illness.
Video
Dr. Golas previously spoke on a panel at MaRS about innovations in geriatric psychiatry:
[youtube https://www.youtube.com/watch?v=wbOspaymPJE]