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A New Push to Teach Future Doctors About Late-Life Depression

Online modules developed at Johns Hopkins highlight how to recognize and treat the psychiatric disorder in elderly patients.

By Judy F. Minkove

Date: 11/09/2017

A New Push to Teach Future Doctors About Late-Life Depression

Looking defeated, the 80-year-old woman arrived at The Johns Hopkins Hospital from the Midwest. For two years, she’d seen doctors about her chronic shortness of breath and fatigue. But her heart turned out to be fine. Not sure what to do next, her husband found Johns Hopkins geriatric psychiatrist Susan Lehmann in an online search and scheduled an appointment.

Within minutes of meeting her new patient, Lehmann saw classic signs of depression: low self-esteem, poor sleep quality—and anxiety attacks, “the likely cause of her shortness of breath.”

“It’s not so mystical, but because she wasn’t tearful, her doctors never considered depression,” the psychiatrist says. This patient, like many Lehmann treats, benefited from antidepressants and psychotherapy

Lehmann directs the Johns Hopkins Geriatric Psychiatry Day Hospital Program and the school of medicine’s general psychiatry clerkship. “Most doctors don’t recognize the threat geriatric mental health problems bring because they’re not trained to do so,” she says. Now, with the release of self-paced, online learning modules she’s crafted for medical students, Lehmann aims to heighten future physicians’ awareness about late-life depression—and its nuances.

Depression affects as many as 15 percent of people age 65 and older. Other mood disorders, such as manic episodes, can also emerge later in life, says Lehmann, who recently published a book on bipolar disorder in older adults. And, she notes, suicide rates among the elderly are rising, especially among men.

Meanwhile, many Americans are living longer. About 15 percent of the U.S. population is 65 or older. By 2030, an estimated 20 percent of the population will be over 65. “We don’t have enough geriatric experts for the tens of millions affected by aging,” Lehmann says. “And a negative outlook on life can worsen comorbidities, like Parkinson’s disease, strokes and cardiac disease.”

Expertise in this field remains woefully inadequate. In a recently published paper in MedEdPORTAL Publications, Lehmann and colleagues found that some 21 percent of responding medical schools lacked specific instruction or clinical experience focused on geriatric psychiatry. Of those schools, 14 percent reported having no geriatric psychiatrist on the faculty.  At some point, says Lehmann, “Every doctor in almost every specialty will interact with geriatric patients. Students need to know what’s considered normal aging, from heart problems to memory to mental health.”

She says the new modules can bridge this gap with “easily digestible” clinical vignettes and videos showing how to engage with older patients and recognize and manage depression. She hopes more medical schools will adopt the modules, which are free of charge.

Lehmann draws from nearly 30 years of experience practicing and teaching geriatric psychiatry. In 2011, she was awarded the Berkheimer Faculty Education Scholar Grant, offering resources and time outside her regular duties to create the modules. After reviewing them, says Lehmann, students should be familiar with the signs and symptoms of geriatric depression and screening tools to help establish the diagnosis.

“I feel a sense of mission to our older patients,” she adds, noting that geriatric depression is highly treatable. “It’s so rewarding to help people find a better quality of life.”