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When aging and psychiatry intersect — medication review, behavioral management, and caregiver support
Mental health disorders in older adults are under-recognized and under-treated, yet depression affects 10–15% of community-dwelling elders and up to 30% of those in residential care. Delirium affects 10–30% of hospitalized medical patients and is a psychiatric emergency. Dr. Ruja's clinic provides comprehensive geriatric psychiatric assessment: differential diagnosis of depression vs dementia vs delirium, medication review for anticholinergic burden and polypharmacy, behavioral management of dementia-related agitation, and caregiver psychoeducation and support.
Kathmandu Neurology Clinic & Cognitive Center
Authored and reviewed by Dr. Ruja Shrestha (MBBS, MD (Psychiatry), NMC 19766). Evidence-based, no fabricated outcomes.
Mental health disorders in older adults are under-recognized and under-treated, yet depression affects 10–15% of community-dwelling elders and up to 30% of those in residential care. Delirium affects 10–30% of hospitalized medical patients and is a psychiatric emergency. Dr. Ruja's clinic provides comprehensive geriatric psychiatric assessment: differential diagnosis of depression vs dementia vs delirium, medication review for anticholinergic burden and polypharmacy, behavioral management of dementia-related agitation, and caregiver psychoeducation and support.
Reviewed by Dr. Ruja Shrestha, MBBS, MD — Consultant Psychiatrist & CBT Therapist (NMC 19766), Kathmandu Neurology Clinic. For evaluation, book an appointment.
Geriatric psychiatric assessment requires attention to medical comorbidity, polypharmacy, sensory impairment, cognitive change, functional decline, social isolation, and caregiver burden. Depression may present atypically — somatic complaints, apathy, and cognitive impairment (pseudodementia) rather than sadness. Delirium must be excluded before attributing symptoms to dementia or depression: acute onset, fluctuating course, and inattention are cardinal. The clinic uses MMSE/MoCA, GDS (Geriatric Depression Scale), and NEECHAM Confusion Scale.
Medication starts low and goes slow — SSRIs first-line for depression (sertraline, escitalopram), with attention to drug interactions and QTc. Benzodiazepines avoided due to fall risk and cognitive effects. Behavioral management of dementia-related agitation prioritizes non-pharmacological approaches: structured routine, sensory stimulation, caregiver training, environmental modification. Antipsychotics used only for severe agitation with safety risk, with explicit informed consent and time-limited trials.
Guidelines referenced:
NICE CG159 — Depression in adults with a chronic physical health problemAGS Beers Criteria: American Geriatrics Society 2023 updated AGS Beers CriteriaInouye SK. Delirium in older persons. N Engl J MedContent on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified healthcare professional. Always seek the advice of your physician or other qualified provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. In case of a medical emergency, contact emergency services immediately. No doctor–patient relationship is established by use of this site or by contacting the clinic through the site.