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Practice Practice Pointer

Ask the consultant: old age psychiatry

BMJ 2024; 385 doi: https://doi.org/10.1136/bmj.q445 (Published 03 May 2024) Cite this as: BMJ 2024;385:q445
  1. Krish Vedavanam, consultant in old age psychiatry1,
  2. James Warner, honorary consultant in old age psychiatry2,
  3. Sebastian Zaidman, core psychiatry trainee3
  1. 1South West London and St George’s Mental Health NHS Trust, London, UK
  2. 2Central and North West London NHS Foundation Trust, London
  3. 3Dorset HealthCare University NHS Foundation Trust, South West England
  1. Correspondence to K Vedavanam Krishnaveni.Vedavanam{at}swlstg.nhs.uk

Old age psychiatry doctors Krish Vedavanam, James Warner, and Sebastian Zaidman provide expert answers to questions from UK hospital based doctors on treating depression in older patients, assessing delirium and agitation, and managing dementia

What you need to know

  • First line antidepressant treatment in older people should be dictated by matching the side effect profile of a particular antidepressant with the patient

  • Drugs with significant anticholinergic properties (eg, quetiapine) should be avoided in older people because they may increase confusion

  • Around one third of patients with a diagnosis of mild cognitive impairment will “convert” to dementia over three years

BMJ Learning

To obtain accredited continuous professional development points, complete the full BMJ Learning module at https://new-learning.bmj.com/course/10060156. The module contains four additional questions submitted by users of BMJ Learning, related to agitation secondary to delirium, tools for diagnosing depression, low mood versus depression, and suicidal ideation

Test yourself

A 72 year old woman with a history of angina is admitted to hospital following a fall at home where she tripped over a step with her walking frame. She has bruising over her left side, but no evidence of fractures. Her family informs you that three months ago she was able to walk to the local shop and back, but has been more isolated following a fall around that time when she fractured her left hip.

The patient reports that she has been very low in mood since then and increasingly tired. She is sleeping more than usual. She also doesn’t want to leave the house as she is anxious that she may fall again and break the other hip. She does not report any suicidal ideation.

You discuss her case with the psychiatric liaison team and establish that she meets the criteria for a diagnosis of depression and should be offered treatment in the form of cognitive behavioural therapy …

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