Are we giving up on the elderly too easily?
Drickus Maartens • October 30, 2019
Positive prognosis for many seniors’ mental health, says geriatric psychiatrist
“People often consider cognitive decline to be a ‘normal’ part of the ageing process. In many cases, however, much can be done to support and improve the mental health and wellness of seniors.”
“While families tend to notice when children and younger adults experience mental health problems — in the elderly these are often mistakenly attributed to a decline associated with ageing and there is an unfounded belief that nothing can be done to improve their situation. As a result mental health problems in older individuals often go undiagnosed and untreated,” says Dr Ryan Fuller, who specialises in psychiatry for senior citizens.
“This is most unfortunate, as mental health problems in elderly people can in many instances be successfully managed. While dementia and Alzheimer’s disease are much more commonly associated with older age, it can be a mistake to assume that a loved one is experiencing memory loss and psychological distress as a normal part of their ageing process,” adds Dr Fuller, who has established multi-disciplinary psycho-geriatric MemoryCare units at both Akeso
Parktown and Akeso Alberton in Johannesburg in association with fellow psychiatrist, Dr Lolita Mostert.
According to the World Health Organization (WHO), approximately 15% of adults aged 60 and over globally suffer from a mental disorder of some kind. Given the steadily increasing elderly population both internationally and in South Africa, Dr Fuller believes that there is a need for much greater awareness of this field of mental healthcare.
“Approximately half of the patients that we see at our psycho-geriatric MemoryCare units do not actually have dementia but rather are affected by other mental health challenges such as bereavement, depression anxiety and/or severe stress. These can all impact memory and even appear to present in a similar way to dementia. In many individuals these conditions can be managed and successfully treated to enable elderly individuals to enjoy an enhanced quality of life.
“For these reasons we strongly advise families to have their loved one properly assessed and diagnosed by a team of healthcare practitioners who are experienced and specialised in supporting mental health in the elderly,” notes Dr Fuller.
Mental health problems in the elderly
Asked what kinds of mental health problems affect the elderly, Dr Fuller said that they tend to be similar to those experienced by any other part of the population, and can include anxiety disorders, post-traumatic stress disorder (PTSD), depression, bipolar depression, personality disorders, sleep disorders, and others.
Dementia, however, which is characterised by memory loss, and a deteriorating ability to perform daily activities due to conditions such as Alzheimer’s disease, occur much more commonly in the elderly, and is considered a particularly important mental health challenge within this particular population.
“Among the many challenges that form part of old age psychiatry in particular, is that existing psychiatric disorders can be exacerbated by advancing dementia, making it difficult for doctors who are not experienced in geriatric care to reach an accurate diagnosis, and therefore to treat the conditions involved appropriately.”
Dr Mostert says that in addition, elderly people often have to deal with so many changes in the later stages of their lives that a considerable number consequently suffer from severe anxiety or even PTSD.
“Anxiety disorders and PTSD — which may be caused by severe shock, for example, the loss of a loved one — are likely among the foremost undiagnosed mental health conditions in the elderly in South Africa.
“An additional challenge with PTSD is that symptoms can look a lot like other conditions such as personality disorders, making diagnosis exceptionally challenging for those not familiar with it. Anxiety disorders, on the other hand, can express themselves in obsessive-compulsive and hoarding behaviours, as well as phobias,” notes Dr Mostert.
A decline in kidney functioning in elderly people may also affect their reaction to medicine. In addition, those with memory problems may not be taking their medication as prescribed, which can result in them suffering drug interactions, overdoses and even delirium, which may seem like dementia.
When to seek help
When should caregivers become concerned about the mental health of an elderly individual? Dr Fuller says that the following warning signs could indicate a mental health concern:
- Confusion and disorientation.
- Memory loss, and difficulty in decision-making and in performing daily tasks.
- Depressed mood that lasts more than two weeks, loss of interest in activities that were previously enjoyed.
- Lack of self-care and changes in appearance and in appetite.
- Expressions of feelings of guilt, helplessness, and worthlessness.
- Increasing withdrawal from family and friends.
- Overwhelming feelings of anxiety and fear.
- Problems in coping with a deeply shocking event such as the loss of a loved one.
- Increased fatigue and loss of energy.
- Changes in sleep patterns and problems sleeping.
- Increasing obsessive-compulsive and hoarding behaviours.
- Physical problems such as aches and pains that cannot be medically accounted for.
Supporting mental health in seniors
Dr Fuller, who underwent specialised training in geriatric psychiatry in London, observes that geriatric mental healthcare can be highly complex. A trusted family doctor is nevertheless a good place to start should you have concerns about an elderly loved one, and they may refer the individual on to a geriatrician, or psychiatrist specialising in elder care.
“In our experience a multi-disciplinary ‘needs-led’ team approach to each case is ideal, as treatment and management mostly depends on the individual, but also the structure and function of the family system involved. The dedicated team can offer a range of interventions to support their particular condition and needs.”
These can include individual or group therapies, improving family support, and where necessary using appropriate psychiatric drugs, such as for example anti-depressants, to assist with depression and anxiety.
In addition to psychiatrists at the MemoryCare units at Akeso Parktown and Akeso Alberton, the teams also include psychologists, general practitioners, social workers and administrative staff, who assist in the development of a detailed care plan for each person.
“With such a comprehensive approach we can successfully manage the mental health of many elderly individuals and meaningfully improve their quality of life,” he concludes.
Migraines affect 15% of the global population, causing severe pain and disrupting daily life. Neurologist Dr. Michael Huth emphasises the importance of understanding different migraine types and their triggers.
Dr Michael de Villiers explains why people can become sick every flu season and why the influenza vaccine is generally recommended every year.
Colorectal cancer, one of the most prevalent yet preventable cancers, can develop in the colon or rectum, often starting as small polyps that can quietly become malignant if left unchecked. Dr Mpho Ramabulana, a colorectal surgeon and gastroenterologist at Netcare Akasia Hospital, underscores the life-saving power of vigilance and the importance of early detection.
Cardiologist Dr Robert Routier urges the public to check their personal risk factors regularly to help prevent or manage cardiovascular disease.
The physical strain pregnancy puts on an expectant mother’s body should not be underestimated. An obstetrician gynaecologist offers her insights for alleviating discomfort and promoting wellbeing with exercise and stretching throughout pregnancy.
Dr Patience Sigwadi, a leading paediatric nephrologist practising at Netcare Unitas Hospital in Centurion, has issued an urgent call for increased focus on skills development to address the escalating kidney disease crisis among children in South Africa.
Paediatric Nephrologist Professor Bhimma was recently awarded the Fellowship to acknowledge his extensive work in research, community-based outreach and teaching of paediatric nephrology, among others.
Netcare congratulates Professor Bhekifa Dube on his invitation to join the European Society for Vascular Surgery's clinical practice guidelines committee. His selection as the only specialist from the continent highlights the significance of this achievement on the global stage.
The lives of millions of South Africans with a litany of rare diseases can be vastly improved, and even saved, by addressing challenges in identifying, studying and treating their conditions. With Rare Disease Day on the 28th of February 2025, the Rare Diseases Access Initiative (RDAI) is driving an evolution of the country’s healthcare, through innovative strategies to better care for over 4.2million people living with an estimated 7000 rare diseases. “As our healthcare system faces significant changes in the years ahead, it is vital that we also advocate for people living with rare diseases in South Africa, especially those with limited healthcare access,” said Kelly du Plessis, CEO of Rare Diseases South Africa (RDSA), a member of RDAI. “As part of our ongoing research and awareness efforts, RDAI has conducted an initial analysis of the incidence and prevalence of rare diseases within the country.” This research will assist in improving access to healthcare, policy development, and patient advocacy, while giving critical insight into the challenges faced by patients. “According to research, some rare diseases affect fewer than 1 in a million people, while others, such as Down syndrome, cystic fibrosis, and haemophilia, have a more recognisable prevalence,” says Dr. Helen Malherbe, RDAI lead researcher on rare disease prevalence data. “Many conditions are undetected, underdiagnosed or misdiagnosed, with too many having no information available about them at all.” The RDAI was formed in 2019 to promote a more favourable environment for those impacted by rare diseases in South Africa. Participants include Ampath, the Board of Healthcare Funders (BHF), Discovery Health, Genetic Counsellors South Africa (SASHG), the Government Employees Medical Scheme (GEMS), Health Funders Association (HFA), Medihelp, Medscheme, North-West University (NWU), Rare Diseases South Africa (RDSA), the South African Medical Association (SAMA) and The South African Medical Technology Industry Association (SAMED). The Council for Medical Schemes (CMS) participates as an observer. In the same year, Rare Disease International signed a memorandum of understanding with the World Health Organisation leading to an international rare disease policy framework. In 2021, the United Nations General Assembly moved to adopt a resolution recognising 300 million people living with rare diseases worldwide. “A general lack of awareness and delayed diagnosis remain major hurdles for those affected by rare diseases. Policymakers and healthcare stakeholders need to prioritise access to treatment, diagnosis, and support for rare disease patients,” says Bada Pharasi, CEO of IPASA, “Through this initiative, working collaboratively with stakeholders at every level of the healthcare supply chain, we can bring real and meaningful change to those affected, including family members and care givers, through smart and efficient strategies.” The globally agreed definition of a rare disease is any medical condition with a specific pattern of clinical signs, symptoms, and findings that affects fewer than or equal to 1 in 2000 persons in a population. “Most are genetic, and some are inherited and passed down in families,” Malherbe says. “Some affect only the patient’s genetic recipe, while others may be acquired during life due to infection, trauma, or environmental effects. For many, the cause is still unknown. “These conditions mainly affect children, as they are largely incurable and many are life-threatening. Some require specialised and co-ordinated care, some have limited and expensive treatment options, while others have no information or effective treatments at all,” she adds. The RDAI is calling for a patient-centred care model built on equitable access, transparency and efficiency. Naturally, this model calls for the open participation of patients, the healthcare industry, health professionals, and the Government. “The most critical elements are robust diagnosis standards, improved access to treatment, data collection and management, co-ordination of care, measurement of outcomes and ongoing collaborative research,” du Plessis says. “We need to establish rare disease advisory committees, map gaps and opportunities, establish system requirements, create a roadmap and plan a phased implementation with clear timelines.” The RDAI states that these policy development steps would be a start in quantifying the disease burden and defining standards of care. This would be followed by building and strengthening the capacity to facilitate appropriate diagnosis, treatment, continuity and data monitoring. Thoneshan Naidoo, Chief Executive Officer of the Health Funders Association noted that, “We appreciate the unique opportunity provided by RDAI which enables stakeholders across the industry to work together and identify strategies that improve equitable access to the appropriate diagnosis, treatment and healthcare services for rare disease patients, in an affordable and sustainable manner, taking account of the other pressing needs across the healthcare system.” “True innovation in healthcare is only possible through partnerships and joint advocacy efforts that raise awareness and improve access to treatment. Our long-term goal is the development of a rare diseases policy framework and guidelines for coordinated care,” says Pharasi. “Our members are united in the commitment to unlocking improved patient outcomes and improving access to services and robust health needs assessment facilities.” he concludes. About RDAI The Rare Diseases Access Initiative (RDAI) is dedicated to advocating for improved healthcare access, policy development, and patient support for those affected by rare diseases in South Africa. The initiative brings together key healthcare stakeholders, including pharmaceutical associations, funders, genetic specialists, and patient advocacy groups, to drive impactful change. About RDSA Founded in 2013, Rare Diseases South Africa (RDSA) is a non-profit organisation advocating to ensure that people living with rare diseases and congenital disorders experience greater recognition, support, improved health service and better overall quality of life. Started out of personal need following the diagnosis of organisation founder, Kelly du Plessis' son, it became evident that there was a lack of awareness and support for rare diseases in general in South Africa. About IPASA The Innovative Pharmaceutical Association South Africa (IPASA) is a voluntary trade association representing 24 leading pharmaceutical companies committed to research, development, and innovation. Our mission is to drive healthcare advancement by advocating for policies that improve patient access to safe, high-quality, and affordable medicines.
Gastroenterologist Dr. Barbara Makumbi discusses common risk factors and offers tips for managing reflux and the longer-term condition known as gastroesophageal reflux disease (GORD).
