{"id":41118,"date":"2021-08-17T13:06:24","date_gmt":"2021-08-17T19:06:24","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=41118"},"modified":"2023-07-03T13:33:42","modified_gmt":"2023-07-03T19:33:42","slug":"geriatric-mental-health-resources-clinic-treats-neurologic-mental-health-disorders","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/geriatric-mental-health-resources-clinic-treats-neurologic-mental-health-disorders\/","title":{"rendered":"Geriatric Mental Health Clinic is a resource for those with neurologic, mental health disorders"},"content":{"rendered":"
<\/div>
\"Sue
Sue Stretar and Dennis Stretar celebrate Dennis\u2019s 70th birthday in December 2019. Sue was diagnosed with dementia that year but the couple has since sought the help of geriatric mental health resources. Photo courtesy of Dennis Stretar.<\/figcaption><\/figure>\n

Often, signs of aging are obvious as time takes its inevitable toll. Shoulders slump forward. Joints groan. Hands tremble. Hair accumulates in brushes and combs.<\/p>\n

But aging also plays out on a far less visible stage: the brain. The consequences may be creeping memory loss and slower cognition. Many people adapt to these neurologic changes on their own or with the help of loved ones. In others, however, changes in the brain progress to serious problems, including dementia<\/a>, Alzheimer\u2019s disease, and Parkinson\u2019s disease, all of which may wreak havoc on their lives and loved ones.<\/p>\n

These physical brain battles may, in turn, intertwine with psychiatric problems, like depression, anxiety and psychosis, and emotional demands posed by aging. It\u2019s unwise to treat them separately, said Dr. Samantha Holden<\/a>, assistant professor of Neurology at the University of Colorado School of Medicine. Holden practices at the UCHealth Neurology Clinic \u2013 Central Park<\/a>, specializing in movement and cognition disorders.<\/p>\n

\u201cIt really is a false dichotomy to say, \u2018This is neurologic and this is psychiatric and never the twain shall meet,\u2019\u201d Holden said. \u201cIt\u2019s all your brain.\u201d<\/p>\n

Holden noted, for example, that psychiatric issues like depression, apathy and anxiety frequently accompany Parkinson\u2019s disease, a progressive neurologic movement disorder. The clinical line between the two is blurry, at best, she said.<\/p>\n

\u201cWe have to make sure that we look at the whole person and see how your condition affects you and your well-being,\u201d Holden said.<\/p>\n

Geriatric mental health resources<\/strong><\/h2>\n

Holden is part of a team that is doing just that. She joined last July with Drs. Karina Drake and Evan Plys<\/a> to launch the Geriatric Mental Health Clinic, part of the UCHealth Outpatient Psychiatric Clinic \u2013 Anschutz Medical Campus<\/a>. Holden, along with four other Neurology Clinic colleagues, refer patients they think will benefit from geriatric mental health resources to the clinic.<\/p>\n

\"Dr.
Dr. Samantha Holden, a UCHealth neurologist, refers patients needing psychological and psychiatric care to the Geriatric Mental Health Clinic. Photo by UCHealth.<\/figcaption><\/figure>\n

Drake, an MD who completed a fellowship in geriatric psychiatry, helps patients safely balance their often complicated medication regimens, while also providing psychotherapy and other support. Plys, a PhD geropsychologist<\/a>, focuses on individual therapy with patients who have mild or no impairment from their neurologic conditions. He also offered group therapy for caregivers last winter and spring and hopes to do so again in the fall.<\/p>\n

The Geriatric Mental Health Clinic aims to help patients and their loved ones regain at least a measure of control over the disruption caused by their neurologic disorders. The challenges may be psycho-social: grief, anger, depression, and apathy over the idea of losing the life they anticipated to an incurable disease. Left untreated, these symptoms \u2013 the most common being depression and anxiety \u2013 can further deteriorate patients\u2019 health, Plys said.<\/p>\n

Individual therapy to restore meaning and purpose<\/strong><\/h2>\n

\u201cPatients with these psychological concerns can have low motivation to engage in routine healthy behaviors, like exercise, diet and social engagement,\u201d he said. \u201cParticularly as we get older, it\u2019s essential to engage in these behaviors. When we see mood becoming a barrier that is often a good time for people to come in for therapy.\u201d<\/p>\n

Plys said he uses cognitive behavioral therapy<\/a> to help patients identify the thoughts that create barriers to pursuing healthy habits and work on ways to overcome them. He described the sessions as collaborative, with patients developing \u201caction plans\u201d aimed at finding activities that produce a sense of meaning and purpose. Those are unique to each person: spending time with grandchildren, working in the garden, developing new hobbies, and connecting with old friends, for example. The idea is to build \u201cmastery,\u201d as Plys put it, over the mental disorders spurred by disease.<\/p>\n

The process is not open-ended, Plys said. He typically starts patients with six, 50-minute sessions, then \u201crenegotiates,\u201d based on their progress toward meeting their goals.<\/p>\n

\"Clinical
Clinical psychologist Dr. Evan Plys provides individual therapy for patients in the Geriatric Mental Health Clinic. Photo by UCHealth.<\/figcaption><\/figure>\n

\u201cThe whole idea of therapy is to promote a patient\u2019s function without a therapist,\u201d he said. \u201cI want to help you build skills and apply them to your own life. If I\u2019ve done my job successfully, I\u2019ve essentially made myself obsolete in the life of the patient.\u201d<\/p>\n

Medication management for neurologic disorders is crucial<\/strong><\/h2>\n

Some patients Holden refers to the clinic suffer from acute changes in the brain that produce not only depression and anxiety but also psychosis, delusions, and hallucinations. In these cases, Drake works to evaluate and manage patients\u2019 medications to safely treat both neurologic and psychiatric symptoms. She said she also considers the \u201ccomplex medical histories and cognitive disorders\u201d that increasingly emerge as people age.<\/p>\n

Drake said she conducts a full psychiatric evaluation of symptoms, medical issues, the neurological workup, and the progression of the patient\u2019s neurological disorder. She then develops a treatment plan to address each patient\u2019s psychiatric issues, depending on the underlying cause. That may include referring a patient to Plys for individual therapy.<\/p>\n

A big part of Drake\u2019s work is evaluating all the medications a patient is taking, because those prescribed for different problems may have dangerous interactions.<\/p>\n

\u201cPolypharmacy can be a huge issue in older patients,\u201d Drake said. \u201cIt\u2019s important to know a patient\u2019s updated medical issues, not only for prescribing medications, but sometimes deprescribing.\u201d<\/p>\n

The goal: eliminate medications that are redundant and those that produce unwanted side effects. She noted, for example, providers frequently prescribe benzodiazepines<\/a>, such as Xanax and Valium, to treat anxiety. They produce short-term benefits, but also long-term side effects like changes in cognition and confusion.<\/p>\n

\u201cThe long-term risks of these medications increase as people age,\u201d Drake said. \u201cThe question is how do we manage anxiety while working to get patients off these medications? It must be done slowly and cautiously.\u201d<\/p>\n

Drake emphasized that her work forms an interdependent triangle of care with neurology and psychology.<\/p>\n

\u201cWe are working together to address the far-reaching effects of cognitive disorders,\u201d she said. \u201cWe must approach the problem from multiple angles, given the complexities. Addressing one without the others is a losing battle.\u201d<\/p>\n

A ‘gut punch’ diagnosis<\/strong><\/h2>\n

The experience of Dennis and Sue Stretar of Aurora illustrates both the life-changing challenges presented by neurologic disease and mental health issues and the benefits of the collaborative care and resources provided by the Geriatric Mental Health Clinic.<\/p>\n

The Stretars, now married for 26 years, met in 1994 through a \u201cSunday Night Club\u201d for older singles through Colorado Free University. After marriage in 1995, they co-hosted \u201cColorado Today,\u201d a public affairs program on KEZW-AM radio covering lifestyle and health-related aging issues that ran from 1999 to 2006. In 2002, they expanded the program to public television and print through a Health and Human Services grant. During this period, Sue survived a bout with breast cancer \u2013 chronicled in a documentary Dennis produced for National Breast Cancer Awareness Month \u2013 and made a complete recovery.<\/p>\n

\"A
A smiling Sue and Dennis posed for a promo photo for their public affairs program \u201cColorado Today,\u201d which ran on KEZW-AM radio from 1999 to 2006. Photo courtesy of Dennis Stretar.<\/figcaption><\/figure>\n

Dennis, now producer and host for the Aurora-based Our Community Broadcasting Network, noted that he and Sue worked extensively with the Alzheimer\u2019s Association during their days with \u201cColorado Today.\u201d That helped prepare them in 2010, when Sue\u2019s mother, now 94, was diagnosed with Alzheimer\u2019s disease.<\/p>\n

\u201cBetween the two of us, we knew a lot about Alzheimer\u2019s and dementia in general,\u201d Dennis said.<\/p>\n

Then came another blow. In 2019, Sue, then only 63, began exhibiting signs of mental decline, including frequent rounds of confusion and forgetfulness.<\/p>\n

\u201cShe\u2019d suddenly be in the fog and very quizzical about what was going on and what she was supposed to be doing,\u201d Dennis said.<\/p>\n

He recalled a key incident that occurred on a morning he needed to pick up their car from a local repair shop. He woke Sue up to remind her to drive him over, then went back to his office to wait for her to get ready. He heard her go down the stairs, then listened to the sound of the garage door going up and the car pulling away. Startled, he waited about 10 minutes for her to return, with the explanation that she thought Dennis was going to make a long, cold-morning walk to the repair shop to meet her.<\/p>\n

After more instances of forgetfulness that she frequently blamed on Dennis, Sue finally conceded that there was a problem they needed to address. The two met with a neurologist, who verified that she had a memory issue. After a lengthy battery of tests, she received a diagnosis of dementia, which Dennis described as \u201ca gut punch.\u201d<\/p>\n

Dementia and depression form an explosive combination<\/strong><\/h2>\n

The problem was to worsen, as neurology and psychiatry crossed paths. Sue had also managed clinical depression for 30 years. But in March 2020, she began experiencing violent hallucinations, delusions and bouts of paranoia, Dennis recounted. In one particularly frightening encounter, her neurologist witnessed Sue \u201ccoming apart before her very eyes,\u201d he said. Sue received prescriptions for anti-psychotic medications, but by May 2020, Dennis said, she was close to needing hospitalization.<\/p>\n

Fortunately, Sue received a referral to Holden for further treatment of her dementia. He and Sue met in December 2020 with her for a complete evaluation, but it was a rocky encounter. Dennis described Sue\u2019s behavior as \u201cvery hostile,\u201d and Holden\u2019s recommendation as blunt.<\/p>\n

\u201cDr. Holden told me after that session that unless we can Sue\u2019s mood enhanced, we won\u2019t be effective in treating her [dementia],\u201d Dennis said.<\/p>\n

With that, Holden referred Sue to Drake, who met with the Stretars via Zoom in January 2021. Dennis said the collaboration between the two specialists was crucial.<\/p>\n

\u201cDr. Drake came in knowing what Sue was dealing with,\u201d he said. After evaluating Sue, Drake prescribed a combination of medications for anxiety and clinical depression. With that issue handled, Holden prescribed Aricept<\/a>, a medication to bolster cognition in early-onset Alzheimer\u2019s patients. Dennis said Aricept, while not a cure, has helped Sue improve her short-term memory retention and moderate her confusion.<\/p>\n

\u201cThe meds are working fine. I would call her very stable,\u201d Dennis said.<\/p>\n

Neurologic disorders: Adapting to a new way of life<\/strong><\/h2>\n

He is clear-eyed about the challenges that lie ahead, however. He recognizes that Sue will withdraw at times and enter periods of confusion that he describes as \u201cthe fog rolling in.\u201d He accepts that she will no longer connect with friends of longstanding and that he \u201ccan\u2019t push her to do that.\u201d<\/p>\n

Dennis strives to find ways to help both adapt to their new reality. They go out to eat, walk the dogs, and stroll through open malls to watch kids play in fountains. Sue loves to garden, so Dennis expanded the flowerbeds around the house to encourage that. He even went a bit against the conventional advice to keep people with dementia away from crowds and high-intensity situations by taking Sue to a Colorado Rockies game. He did so cautiously, purchasing club-level seats that would give them easy escape if she panicked. That went so well that in late July they attended another game, where she mingled with crowds in the rooftop section of Coors Field.<\/p>\n

As important as it is to support loved ones with neurologic and cognitive issues, Dennis added, caregivers must take care of themselves.<\/p>\n

\u201cYou have to avoid at all costs giving up your own personality, your likes and your loves,\u201d he said. \u201cFind something that is yours that is away from the caregiving issue.\u201d<\/p>\n

In his case, he finds time to visit old friends himself, usually in the mornings while Sue sleeps. \u201cI need socialization,\u201d Dennis said simply.<\/p>\n

He credits Holden and Drake for helping to stabilize a situation that can be untenable for patients and caregivers who lack resources.<\/p>\n

\u201cThe concept of coordinated care is very important, and the time for it is now,\u201d Dennis said. \u201cDr. Holden and Dr. Drake are the best of the best when it comes to [that].\u201d<\/p>\n

Geriatric mental health resources: An increasingly important service in an aging world<\/strong><\/h2>\n

Holden said the Geriatric Mental Health Clinic fills a vital need for an aging population still wary of admitting the need for counseling and therapy. Fears of mental deterioration loom large in the imaginations of the elderly, she said.<\/p>\n

\u201cIf my brain is threatened, that\u2019s existential in a way that no other health condition is,\u201d Holden said.<\/p>\n

Too often in the past, she added, treatable mental health issues deteriorated to the point where admission to an inpatient psychiatric unit was the final option.<\/p>\n

\u201cWe see the clinic having overall benefits for quality of life,\u201d Holden said. \u201cWe\u2019re bringing psychiatry more into the fold of the normal standard of care.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Often, signs of aging are obvious as time takes its inevitable toll. Shoulders slump forward. Joints groan. Hands tremble. Hair accumulates in brushes and combs. But aging also plays out on a far less visible stage: the brain. The consequences may be creeping memory loss and slower cognition. Many people adapt to these neurologic changes […]<\/p>\n","protected":false},"author":2143,"featured_media":41119,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[113,112,184],"class_list":["post-41118","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-behavioral-health","tag-mental-health","tag-neurology"],"acf":[],"yoast_head":"\nGeriatric resources: Help with neurologic mental health disorders - UCHealth Today<\/title>\n<meta name=\"description\" content=\"The Geriatric Mental Health Clinic is a resource that aims to help patients and their loved ones with the challenges of neurologic disorders.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.uchealth.org\/today\/geriatric-mental-health-resources-clinic-treats-neurologic-mental-health-disorders\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Geriatric Mental Health Clinic is a resource for those with neurologic, mental health disorders\" \/>\n<meta property=\"og:description\" content=\"The Geriatric Mental Health Clinic is a resource that aims to help patients and their loved ones with the challenges of neurologic disorders.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.uchealth.org\/today\/geriatric-mental-health-resources-clinic-treats-neurologic-mental-health-disorders\/\" \/>\n<meta property=\"og:site_name\" content=\"UCHealth Today\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/uchealthorg\/\" \/>\n<meta property=\"article:published_time\" content=\"2021-08-17T19:06:24+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-07-03T19:33:42+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2021\/08\/17124922\/Stretartiny.jpg\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Tyler Smith\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@uchealth\" \/>\n<meta name=\"twitter:site\" content=\"@uchealth\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Tyler Smith\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"11 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/www.uchealth.org\/today\/geriatric-mental-health-resources-clinic-treats-neurologic-mental-health-disorders\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.uchealth.org\/today\/geriatric-mental-health-resources-clinic-treats-neurologic-mental-health-disorders\/\"},\"author\":{\"name\":\"Tyler Smith\",\"@id\":\"https:\/\/www.uchealth.org\/today\/#\/schema\/person\/98c85c0e40c4933eedcec2cd054f349d\"},\"headline\":\"Geriatric Mental Health Clinic is a resource for those with neurologic, mental health disorders\",\"datePublished\":\"2021-08-17T19:06:24+00:00\",\"dateModified\":\"2023-07-03T19:33:42+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/www.uchealth.org\/today\/geriatric-mental-health-resources-clinic-treats-neurologic-mental-health-disorders\/\"},\"wordCount\":2205,\"publisher\":{\"@id\":\"https:\/\/www.uchealth.org\/today\/#organization\"},\"image\":{\"@id\":\"https:\/\/www.uchealth.org\/today\/geriatric-mental-health-resources-clinic-treats-neurologic-mental-health-disorders\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2021\/08\/17124922\/Stretartiny.webp\",\"keywords\":[\"Behavioral health\",\"Mental health\",\"Neurology\"],\"articleSection\":[\"Innovative care\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.uchealth.org\/today\/geriatric-mental-health-resources-clinic-treats-neurologic-mental-health-disorders\/\",\"url\":\"https:\/\/www.uchealth.org\/today\/geriatric-mental-health-resources-clinic-treats-neurologic-mental-health-disorders\/\",\"name\":\"Geriatric resources: Help with neurologic mental health disorders - 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