# What Is Geriatric Psychiatry? A Family's Guide > Geriatric psychiatry treats depression, anxiety, and dementia in older adults. Here's when to consult one and what care looks like. ## Meta - URL: https://aegisv2.epekdigital.com/resources/blog/geriatric-psychiatry-part-of-a-comprehensive-care-plan - Focus keyword: geriatric psychiatry - Category: health-conditions - Tags: depression-anxiety, dementia, emotional-wellness, social-connection, legal-planning, for-spouses, for-seniors - Published: 2015-11-09 Geriatric psychiatry is a medical subspecialty focused on the prevention, diagnosis, and treatment of mental and emotional disorders in adults age 65 and older - including depression, anxiety, dementia-related behaviors, sleep disturbances, and substance use. A geriatric psychiatrist is a licensed MD or DO with additional fellowship training who coordinates care with your parent's primary care physician, neurologist, and family to improve quality of life. Depression and anxiety are treatable at any age - they are not a normal part of growing older. ## Why does later-life mental health deserve its own specialty? Older adults face a different mix of stressors than younger patients: chronic pain, polypharmacy, bereavement, cognitive change, and shrinking social networks. Roughly 14% of adults aged 60 and older live with a mental disorder, with depression and anxiety leading the list ([World Health Organization](https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults), 2023). Yet late-life depression is frequently misread as "just aging" - and that delay matters. The risk is real. Adults aged 75 and older have one of the highest suicide rates of any age group in the United States ([Centers for Disease Control and Prevention](https://www.cdc.gov/suicide/facts/data.html), 2023). A geriatric psychiatrist is trained to spot the subtle presentations - withdrawal, appetite loss, somatic complaints - that primary care visits can miss. ## How is a geriatric psychiatrist different from a general psychiatrist? Both are physicians who can prescribe medication and provide therapy. The difference is depth of training in how aging bodies metabolize drugs, how dementia changes behavior, and how grief, hearing loss, and isolation compound mental health symptoms. **Geriatric psychiatrist** An MD or DO who completed psychiatry residency plus a one-year fellowship in geriatric psychiatry, board-certified by the American Board of Psychiatry and Neurology. **Geriatrician** A primary care physician with fellowship training in the medical care of older adults - manages overall health but typically refers complex mental health cases out. **Geropsychologist** A PhD or PsyD psychologist specializing in aging; provides therapy and neuropsychological testing but does not prescribe medication. **Neurologist** An MD who diagnoses brain disorders including the medical workup for dementia, but generally does not treat mood or behavioral symptoms long-term. ## What conditions does a geriatric psychiatrist treat? The scope is broader than "depression in old age." A geriatric psychiatrist commonly treats: - **Late-life depression and anxiety** - often triggered by loss, chronic illness, or medication side effects - **Dementia-related behavioral symptoms** - agitation, aggression, sundowning, paranoia, and sleep reversal in Alzheimer's, Lewy body, vascular, or frontotemporal dementia - **Sleep disorders** - insomnia, REM sleep behavior disorder, and circadian disruption - **Substance use** - including alcohol misuse and benzodiazepine or opioid dependence that began with a legitimate prescription - **Grief and adjustment disorders** after the death of a spouse, retirement, or a move into senior living - **Delirium** - sudden confusion from infection, dehydration, or medication, which is medically distinct from dementia - **Late-onset psychosis and bipolar disorder** An estimated 6.9 million Americans aged 65 and older are living with Alzheimer's dementia, and behavioral or psychiatric symptoms occur in the majority of them over the course of the illness ([Alzheimer's Association](https://www.alz.org/alzheimers-dementia/facts-figures), 2024). That overlap is why dementia care and psychiatric care so often work hand in hand - and why our pillar guide on [palliative and hospice care](/what-are-palliative-and-hospice-care/) often dovetails with psychiatric consultation in the final stages of life. ## How do you know it's time to call one? Consider two scenarios. First, imagine your 82-year-old mother, six months after your father's death, has stopped attending her bridge club, skips meals, and says she is "just tired." Her internist increased her blood pressure medication, but nothing changed. That pattern - anhedonia, withdrawal, and somatic complaints - is classic late-life depression and warrants a psychiatric evaluation, not a wait-and-see. Second, picture an 86-year-old father with mid-stage Alzheimer's who has begun lashing out at his wife during evening care routines, accusing her of stealing, and refusing to bathe. A geriatric psychiatrist can distinguish whether the behavior is driven by pain, a urinary tract infection, an unmet need, or progression of the disease - and intervene without defaulting to heavy sedation. Call for a referral when you see: - Persistent sadness, hopelessness, or loss of interest lasting more than two weeks - New paranoia, hallucinations, or accusations - Sudden personality change or rapid cognitive decline - Talk of being "a burden," wanting to die, or giving away possessions - Sleep that has flipped day-for-night - Escalating alcohol use or stockpiling of pills ## What does a first appointment actually look like? A geriatric psychiatry intake typically runs 60 to 90 minutes - significantly longer than a standard psychiatric visit. Expect the physician to: - Review the full medical history, every current medication (including over-the-counter), and recent lab work - Conduct a cognitive screen such as the MoCA or MMSE - Interview the patient alone, then meet with family or a care partner for collateral history - Screen for depression (PHQ-9), anxiety (GAD-7), and suicide risk - Order labs to rule out thyroid disease, B12 deficiency, or infection - Draft a treatment plan combining therapy, medication adjustments, sleep hygiene, and family education - Coordinate directly with the primary care doctor and, when relevant, the senior living community's nursing team As Louise Aronson, MD, geriatrician and author of *Elderhood*, has emphasized: aging is not a disease, and treating older adults well means looking at the whole person - biology, biography, and the environment around them - rather than chasing one symptom at a time. ## How are treatments different for older adults? Three principles guide geriatric prescribing: start low, go slow, and watch for interactions. Older kidneys and livers process drugs differently, and a medication that is unremarkable at 45 can cause falls, delirium, or arrhythmia at 80. The American Geriatrics Society Beers Criteria - the standard reference for potentially inappropriate medications in older adults - flags long-acting benzodiazepines, first-generation antihistamines, and certain antipsychotics as drugs to use with caution or avoid in this population ([American Geriatrics Society](https://www.americangeriatrics.org/), 2023). A geriatric psychiatrist knows this list by heart and chooses agents accordingly. Non-drug interventions are equally central: - **Cognitive behavioral therapy (CBT)** adapted for older adults - **Problem-solving therapy** for mild-to-moderate depression - **Reminiscence and life-review therapy** - **Light therapy** for seasonal symptoms and sleep disruption - **Behavioral interventions** for dementia agitation - addressing pain, hunger, boredom, and environment before reaching for a pill - **Electroconvulsive therapy (ECT)** for severe, treatment-resistant depression with strong evidence in older adults ## What does geriatric psychiatry cost, and does insurance cover it? Original Medicare (Part B) covers 80% of approved outpatient mental health services after the deductible, including visits with a geriatric psychiatrist, individual therapy, and an annual depression screening ([Medicare.gov](https://www.medicare.gov/coverage/mental-health-care-outpatient), 2024). A Medigap or Medicare Advantage plan typically picks up the remaining 20% or applies a copay. ServiceTypical 2024 cost before insuranceMedicare coverage Initial psychiatric evaluation (60 - 90 min)$300 - $50080% after Part B deductible Follow-up med-management visit$150 - $25080% after deductible Therapy session (45 min)$120 - $20080% after deductible Neuropsychological testing battery$1,500 - $3,500Covered when medically necessary Annual depression screening$0 to patient100% covered Telepsychiatry visits are widely available and covered by Medicare - a meaningful option for residents in rural areas or those who find office visits exhausting. ## How does mental health intersect with physical health in later life? Treating the mind is rarely separate from treating the body. Untreated depression worsens outcomes for heart disease, diabetes, and recovery after surgery. Hearing loss, in particular, is a quietly powerful contributor to social isolation and mood symptoms - read more about the [causes and symptoms of hearing loss](/resources/blog/causes-and-symptoms-hearing-loss/) if your parent has begun withdrawing from conversation. Chronic disease management is another pressure point. If your parent is navigating insulin, glucose monitoring, and dietary changes alongside a mood disorder, our guide with [tips for an elderly parent diagnosed with diabetes](/resources/blog/four-tips-for-an-elderly-parent-with-diabetes/) pairs well with a psychiatric treatment plan. And in winter, watch for [hypothermia, a winter hazard for seniors](/resources/blog/hypothermia-a-winter-hazard-for-seniors/) - confusion and apathy from cold exposure can mimic or mask psychiatric symptoms. As Teepa Snow, dementia care educator and founder of Positive Approach to Care, frequently reminds families: behavior is communication. A change in mood or conduct is rarely random - it is the person telling you something has shifted in their body, their environment, or their relationships. ## How do you find a geriatric psychiatrist near you? Start with these steps: - Ask your parent's primary care physician or geriatrician for a referral - they often know which local psychiatrists accept Medicare and have shorter waitlists. - Use the American Association for Geriatric Psychiatry's clinician directory at [aagponline.org](https://aagponline.org/). - Check Medicare's Care Compare tool at [medicare.gov/care-compare](https://www.medicare.gov/care-compare/) to verify a provider accepts assignment. - Contact your local Area Agency on Aging (find it through [eldercare.acl.gov](https://eldercare.acl.gov/home)) for community mental health resources and sliding-scale options. - Ask the senior living community - quality operators maintain relationships with visiting geriatric psychiatrists who come on-site. ## How does Aegis Living integrate psychiatric care? Aegis Living communities partner with licensed geriatric psychiatrists who consult on-site with residents whose physicians refer them. That coordination - between primary care, nursing staff, family, and a psychiatrist who knows the resident - is the difference between a one-off prescription and a treatment plan that actually changes the day-to-day experience of living with depression, anxiety, or dementia. If you suspect your parent is struggling with more than "just getting older," the next step is a conversation. [Find an Aegis Living community near you](/find-a-location/) or [contact our team](/contact/) to learn how our care partnerships can support your family. ## Frequently asked questions ### Is depression a normal part of aging? No. While loss and life transitions are common in later years, persistent depression is a medical condition, not an inevitability. The National Institute on Aging is explicit that depression in older adults is treatable and should not be dismissed as normal aging ([National Institute on Aging](https://www.nia.nih.gov/health/mental-and-emotional-health/depression-and-older-adults), 2024). ### Can a geriatric psychiatrist diagnose dementia? Yes, often in collaboration with a neurologist or primary care physician. They are particularly skilled at distinguishing dementia from depression, delirium, and medication side effects - conditions that can look identical at first glance but require very different treatment. ### Will my parent need to take medication? Not necessarily. A geriatric psychiatrist evaluates the full picture and may recommend therapy, behavioral changes, social engagement, or treatment of an underlying medical issue before prescribing. When medication is appropriate, doses are typically lower and choices are guided by the Beers Criteria to minimize side effects. ### How is telepsychiatry working for older adults? Telepsychiatry is covered by Medicare and works well for many older adults, especially follow-up visits. For initial evaluations involving cognitive testing, an in-person visit is often preferred, but virtual care has dramatically expanded access in rural areas and for residents with limited mobility. ### What if my parent refuses to see a psychiatrist? Reframe the conversation around their primary care physician. Ask the PCP to raise the topic, or describe the appointment as a "memory and mood check-up." A home visit, telehealth session, or referral from a trusted clergy member can also lower resistance. If safety is at risk, contact the local Area Agency on Aging or a geriatric care manager. ### How quickly do treatments work? Antidepressants typically take 4 to 8 weeks to show full effect in older adults - longer than in younger patients. Therapy benefits often appear within 6 to 12 sessions. Behavioral interventions for dementia agitation can produce changes within days when the trigger is correctly identified.