Dr. Angelo Oliva
Dr. Stefano Oliva
Dr. Lucia Pozzi
The Psychogeriatric Service at Le Betulle Centre has been successfully treating neuropsychiatric disorders in the elderly for several decades; the department has expanded its range of diagnostic instruments and enlarged its team with a variety of professionals, specialized in different fields (radiologist, cardiologist, internist, urologist, physiatrist, etc.).
These improvements have allowed us to develop complex therapeutic plans, aimed at protecting patients from negative interactions between drugs, also through the use of specific rehabilitative treatments.
During hospitalization, which can be short term, mid-term or long term on a case by case basis, the patient is assisted by a team of specialists, coordinated by the Head of the Service, in order to:
- gain in-depth knowledge of the patient’s mental condition and its causes;
- carry out a complete physical check-up;
- start the appropriate integrated pharmacological, psychiatric and internist therapy, accurately monitoring possible side effects;
- give adequate assistance when necessary, measured to the patient’s needs, in daily activities and personal care (non self-sufficient or bed ridden patients; patients with severe depression).
After hospitalization, cures can continue as outpatients, with scheduled psychiatric and internist consultations or, when necessary, families may be helped to find appropriate solutions for long-term care.
The main conditions treated are: Elderly Anxious-Depressive Syndrome, Psychotic Disorders, Behavioural Disorders related to onset of Cognitive Decay, Dementia.
For infomation, appointments or hospitalization, please contact Dr Angelo Oliva and Dr Stefano Oliva (348 844 60 06) and Drs Lucia Pozzi, calling Le Betulle reception at 031 97 33 11.
PSYCHOPATHOLOGY OF AGEING
Although it can be more or less difficult for each of us to accept our body, where different levels of functioning characterize different stages of life (youth – adulthood – old age) and anyway for a limited time, it is clear how, especially in the last stage (old age) everyone finds residues of their previous personal psycho-emotional and somatic experiences trapped in their existential web, mediated by personal lifestyle and genetic makeup.
This makes ageing, contrary to what is usually thought, a stage of life which shows marked differences in same-age individuals, even if they are from similar cultural backgrounds.
Thus, it is useful to approach the subject of old age free from preconceived general ideas, and using accurate observation.
First of all, it is self evident that age is not an indicator per se, since there are perfectly healthy 80 year olds travelling the world, while in sheltered care there often are sixty-year-old people.
This basic principle certifies how, in no other phase of life, there are such marked differences.
Therefore, if on one hand a longer life has exposed people to a greater likelihood of traumatic events, it has also allowed more time for maturing strategic abilities to face them.
All this obviously mediated and influenced by those psychophisical resources present during the declining age curve, based on genetically and educationally acquired personality traits.
Some people have long since foreseen the “rules of the game” of existence and expect their encounter with old age, trying to equip themselves in an adaptive way.
Others, instead, faced with the onset of memory issues or premature fatigue, suffer from panic anxiety and depression, often setting off new behaviours of escape from their social roles, in the attempt to protect themselves from the intolerable frustration which would derive from being seen in public.
The resulting depressive disorientation which follows will inevitably worsen any performance deficit, creating a vicious circle.
Moreover, the subject’s auto-observational ability together with cultural competencies and knowledge acquired while assisting a parent, a relative or a friend, at times allows him to formulate a self-diagnosis, often incorrect because of hypochondriac anxiety or cultural prejudices.
An emotional flux will follow, strongly influenced by individual personality: a specialist consultation may be sought to reach an exact diagnosis, but the symptoms could also be hidden with the inevitable consequence of changes in behaviour: introversion, bad temper, dependency, depression.
These considerations strengthen the need to be cautious in building an effective doctor-patient relationship, directed to an in depth exam of the suspected diagnosis without arising needless alarm, as well as allowing to form a more productive alliance during the therapeutic plan and rehabilitative recovery.
One should always bear in mind that the main character in this journey (after a stroke, a heart attack, radical surgery, a serious infectious or dysmetabolic disease) is only capable of stressed out psycho-emotional resources which vary greatly in quantity and efficiency: these resources need to be underlined, supported with respect, encouraged and motivated; especially when the elderly patient is faced with the novelty of a disturbing new experience, at times dramatised by the observation of one’s irreversible mutilation, they risk an emotional state of anxiety block, desperation or depression.
Besides experiencing one’s own decadence and encountering several physical ailments, in old age it can also happen to progressively lose loved ones, because children grow up and leave or friends and relatives die.
The progressive isolation deriving from this, the absence of those who are no longer with us, can cause different psycho-emotional responses, sometimes difficult to diagnose: a state of depression often masked by persistent complaints of pains, unexplainable organ malfunctions, unjustified anxiety, different kinds of alarm, isolation, weight loss (sometimes alarming for the fear of a possible underlying tumour); often, instead, quite evidently simply parallel to loss of social ‘weight’.
The onset of a state of depression, at times evident, other times masked by somatic symptoms described above, suggests the need for a multidisciplinary clinical approach from those who are caring for an elderly patient, often presenting many problems.
These medical professionals will have to be able to produce, after diagnosis, a therapeutic plan with no internal conflicts, trying to avoid focussing on the false priorities of this or that ‘organ’ rather than respecting a global view of the possible quality of life, which is the true objective to be attained.
In these instances too, good multidisciplinary clinical harmonised team work can, without too much waste of time and energy, find a solution to the underlying problem.
More complex, instead, is the question of the progressive appearance of ideation disorders, with confusion between reality and dreams, inability to recognize people or places of everyday life, imperative or imploring requests to “return home”, evocative of a world where personal normality is lost.
Bizarre behaviours are also frequent, inversion of the circadian day-night rhythm, persecutory apprehension, obsessive need to control every gesture, inexhaustible demands.
Personality change, at times very surprising, is often the tangible sign of a dramatic personal failure to adapt to the ageing process.
Rectifying the derailments triggered along the path of life, following stressful encounters with different occurrences, is often a difficult task where everyone can help: patient, doctors and family members alike
It is obviously not possible to “revert the process” but, faced with human suffering, it is every human being’s responsibility, emotional and ‘technical’, not to accept a passive fatalistic view often just made up of ignorant platitudes, which at times only originate clumsy attempts to simply mask symptoms (with psychotropic drugs).
Instead, it is almost always possible to create an emotional, assisted and sometimes clinical system of care, which allows to enhance those resources still available in the patient, freeing them from inhibiting and impairing diseases, so as to allow the troubled elderly patient to live his everyday life in the best possible way, in his individuality, value, and even inevitable decadence which should always be respected to the full.