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Longevity and Medical Needs

Photo by Matthew Bennett on Unsplash

Progress in Medicine has led to unprecedented longevity. Many of us are reaching ages that were rare in our parents' and grandparents' generations. Thus, in accord with that very real observation, the impact of many things on our physical and emotional well-being could not have been well studied. In fact, many clinical medical trials exclude patients over a given age, thus failing to validate some observations with regards to patients of advanced age. To rectify this problem, Medical Departments of Gerontology and some specialized medical study groups are now addressing the needs of this population. The present column, and hopefully others to come, will provide ESRA Magazine readers with suggestions for management from the current literature.

A recent article from the Journal of the American Medical Association, authored by Patrick Baumgart, MD, Department of Psychiatry, University of Southern California, discusses the commonly observed phenomena of depressive symptoms in patients with significant concurrent medical illnesses. It is obvious to all that the common symptoms of significant clinical depression, including loss of appetite, fatigue, insomnia, weight changes, impaired concentration and psychomotor slowdown, are all symptoms that can be associated with either chronic medical illnesses or, as side effects, of the many different medications being used today. The distinction between severe depression from the side effects of medications and warranting treatment, and benign mood disorders can be challenging to the most well-informed and sensitive physician.

Some of the alternative diagnostic considerations include demoralization, adjustment disorder, delirium, substance or medication effects, and grief/bereavement, as opposed to the classical severe depressive illnesses. The diagnostic distinctions among these conditions are made by assessing the time course and trajectory of symptoms, sense of awareness and the nature of medications or substances being taken. These distinctions are not always straightforward and frequently the total clinical picture may reflect the concurrence of several of the mentioned clinical syndromes.

Coping with such symptoms requires the care partner to take the following steps:

  1. Consult with your Family Doctor as to whether the symptoms, as you describe them, can be related to either medications being taken, or in the case where it's applicable, to intake of alcohol or other potentially harmful substances.
  2. Consult with your Family Doctor as to whether there should be consultation with a Neurologist, Psychiatrist, Psychologist, or Social Worker.
  3. Keep in mind always that distinctions between Severe Chronic Depression and any of the other diagnoses is very dependent on the time course and trajectories of the symptoms. The situation will wax and wane. Keep records as to symptoms, concurrent medications and psychomotor activity. Some diagnoses can only be established with certainty with the passage of time and with therapeutic trials of anti-depressants.
  4. Be aware that as the caregiver, you carry a special burden. Make sure that you have a support system in place. 
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Thursday, 30 June 2022

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