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  • Lori Cochrane, Principal Fiduciary

Mental Health in the Context of Aging: A Chat with Geriatric Psychiatrist, Beverly Chang, M.D.

Dr. Beverly Chang developed a fondness for working with older adults early in her training. She was selected chief resident during her fourth year of residency and was also named a Geriatric Mental Health Foundation Scholar by the American Association of Geriatric Psychiatry.

She went on to pursue advanced training at UC San Diego where she completed a fellowship in Geriatric Psychiatry, which is the field of medicine dedicated to the diagnosis and management of mental health care in older adults. She now practices right here in our backyard, in Rocklin. I asked Dr. Chang for an interview so that I may help educate others. She graciously agreed, allowing me to share this with you.

How is a Psychiatrist different from a Psychotherapist?

A psychiatrist has medical training (MD or DO) and prescribes medications, while a psychotherapist may have a variety of degrees or certifications (Ph.D., LCSW, LMFT, MFT) and focuses on counseling. Therapists and psychiatrists work together to help their mutual patients/clients. Medications alone cannot solve the complex issues that many people face.

Is what you provide different from psychotherapy (talk therapy)?

In my office, appointments are longer to allow time for basic supportive counseling in addition to discussion of medications. However, in many settings, managed care has changed the way mental health is delivered and often the psychiatrist handles strictly medications while a therapist handles psychotherapy. Though I do a combination of both services, there are certain specialized forms of therapy such as EMDR for trauma that require a dedicated therapist with the appropriate certification. In this case, I refer my patients to an appropriate specially trained therapist.

How do you work in conjunction with psychotherapy?

If a patient is already working with a therapist, I update the therapist with any changes in medications or other observations I may make. Likewise, I rely on the therapist to continue reinforcing my recommendations (behavioral/lifestyle changes) since they are typically in weekly or every other week communication with patients. Therapists are also able to communicate to me from an objective standpoint the side effects or benefits of medications.

What common ailments do you treat?

Patients are often seeking ongoing treatment for chronic mental health issues including anxiety, depression, bipolar disorder, and post-traumatic stress. They need medications to be adjusted given the changes in their bodies related to aging. Other patients seek out help for mood symptoms due to neurologic disorders such as dementia or Parkinson's Disease.

What are some reasons why a person would seek out your services?

Patients are often referred for cognitive evaluations since depression can often resemble early dementia. Likewise, dementia onset can be associated with depression, irritability, paranoia, or other personality changes. Geriatric psychiatrists are part of the team of internists and neurologists that make diagnoses.

Behavioral symptoms of dementia can also be difficult to manage and geriatric psychiatrists are specifically trained to weigh the risks and benefits of medications used to manage these behavioral issues.

Lastly, many patients seek out a geriatric psychiatrist due to their difficulties coping with medical complications associated with aging.

Are there some specific signs I should be aware of that might indicate the need for your services?

Day-to-day mood fluctuations are normal. However, mood changes lasting for weeks with the inability to find pleasure in things that previously brought joy, are a reason to seek help for depression. Depression is often associated with sleep or appetite changes, or a withdrawal from support systems. Excessive anxiety causing physical symptoms for which there is no underlying medical cause is also a reason to seek help. Families also seek help on behalf of loved ones who may be experiencing cognitive decline.

Does a patient need to have an existing mental health diagnosis to visit you?

Patients do not need an existing diagnosis. Many patients never struggled with mood issues in their adult lives, but face new-onset anxiety or depression in the context of aging. Others may have never been formally diagnosed since mental health was largely stigmatized in the past.

How are people in the elderly population different from younger folks, when it comes to mental health?

I love working with the older adult population, as they have a wide range of experiences and resilience. They are susceptible to social isolation and loneliness, so the simple act of meeting in a "medical setting" that is not a hospital or outpatient clinic is therapeutic. They often do not want to take additional medications, which I appreciate due to the tendency for older adults to be at risk for polypharmacy.

Do you provide prescriptions for medications you recommend?

If I will be scheduling ongoing meetings with a patient, I will prescribe medications as needed/indicated by mood symptoms. If I meet and assess that a one-time consultation is appropriate, I make recommendations on medications (and behavioral measures) to the primary team.

Do you work with medical doctors if necessary?

It is absolutely essential to work with the medical team. Older adults have medical issues that can often contribute to depression or anxiety such as underlying cardiac or respiratory illnesses. A new patient visit is never complete until I have made contact with the other team members.

What other treatments do you typically offer as an adjunct to, or instead of medications?

I offer supportive therapy for mental and physical adjustments to aging, grief, and bereavement, and psychoeducation on the benefits of mindfulness techniques. If it is agreed that a patient requires more intense counseling, I work with them to find an appropriate referral. I often work with families on coping with their loved ones' cognitive and physical changes by directing them to partners in care (Caregiver resource centers, Parkinson's Association of Northern CA, Alzheimer's Association... to name a few).

Are your services covered by Medicare and my insurance plan?

Medicare and medicare advantage plans and private insurances cover these visits. Medicare is now permitting telemedicine and phone appointments as well due to COVID19 and other mobility and transportation issues.

How are you handling COVID?

I am currently doing a mix of in-person and telemedicine visits. Video or phone visits are not as ideal as an in-person face-to-face visit, but they are still a point of contact and a chance to assess an older adult's mood and cognition.

Thank you, Dr. Chang! You can find Dr. Beverly Chang at Geriatric Psychiatry Direct, a unique psychiatry practice in Rocklin, where care is individualized and your questions are fully addressed.

Schedule a consultation by contacting Geriatric Psychiatry Direct at: 5701 Lonetree Blvd, Suite 323 Rocklin, CA 95765

Call them at 916-303-4353

Or send an email to info@geropsychdirect.com