Old Age Psychiatry

# Living with Dementia: When Older Adults Say Death Might Be Preferable

As people age and face declining health, particularly conditions like dementia that affect memory and independence, difficult conversations about quality of life become increasingly important. This Swiss study tackles a sobering question: are there certain health conditions that older adults would find worse than death itself? Understanding these preferences is crucial for geriatric psychiatry and mental health care, as it helps families and healthcare providers honor what matters most to patients when they can no longer speak for themselves.

The study surveyed 124 pairs of healthy older adults (average age 72) and the family members who might someday make medical decisions on their behalf—typically spouses or adult children. Participants evaluated 17 different health conditions, particularly focusing on impairments associated with dementia, such as not recognizing family members, losing the ability to care for oneself, or becoming entirely dependent on others. The findings were striking: more than half of the older adults rated eleven of these health states as equal to or worse than death. Their potential future decision-makers had remarkably similar views, with ten health states receiving the same harsh assessment from over half of this group. Importantly, when comparing responses within each family pair, there was strong agreement between what older adults wanted for themselves and what their relatives thought they would want.

These results reveal just how much value older adults place on cognitive function, independence, and maintaining their sense of self. The strong agreement between older adults and their family members is encouraging news—it suggests that when the time comes for surrogate decision-making, relatives may be well-positioned to honor their loved one’s wishes. However, it’s worth noting that all participants were currently healthy; research shows that people’s preferences sometimes shift when they actually experience health challenges, as they adapt and find meaning in ways they hadn’t anticipated.

For healthcare providers working with older adults, particularly in psychiatry and dementia care, this research underscores the importance of having frank, early conversations about goals of care before crisis strikes. Tools that ask patients to compare health states with death—so-called “States Worse Than Death” approaches—can open these difficult discussions and ensure that treatment plans truly reflect what patients value most. For families, the message is clear: talk openly about these preferences now, while your loved one can express their wishes, recognizing that maintaining dignity, mental clarity, and independence often matter more than simply prolonging life at any cost.

Source Information

Original Title: Is it worse than death? Appraisal of health states among older adults and their relatives in Switzerland.

Authors: Fischer G, Hock U, Schwegler V, Buchmann A, Gruber E

Journal: Health and quality of life outcomes (Oct 2025)

PubMed ID: 41121253

DOI: 10.1186/s12955-025-02439-y

This summary was generated using AI to make recent geriatrics and frailty research more accessible. Please refer to the original article for complete details.

# Understanding Brain Connection Problems in Schizophrenia: An Important Update

Schizophrenia affects people across their lifespan, and understanding how the condition impacts brain function becomes particularly important as patients age. Many older adults with schizophrenia experience what clinicians call “negative symptoms”—reduced emotional expression, decreased motivation, and social withdrawal—which can significantly affect quality of life and independence in later years. Research into how brain networks function differently in people with these symptoms helps inform better care approaches for aging populations living with this mental health condition.

This publication is a corrigendum, which means it provides corrections to a previously published research article about impaired brain connectivity in people with schizophrenia who experience negative symptoms. While the specific corrections aren’t detailed in the available information, the original study examined how different regions of the brain communicate with each other in people experiencing these challenging symptoms. Understanding these neural connection patterns is crucial because negative symptoms often respond poorly to standard treatments and can be particularly debilitating for older adults who may already face age-related cognitive changes.

For elderly patients with schizophrenia and their support networks, accurate research findings about brain function patterns are essential for developing targeted interventions. Families and caregivers should know that scientific understanding of schizophrenia continues to evolve, and researchers work diligently to ensure published findings are accurate and reliable—which is exactly what corrigenda accomplish. Healthcare providers working with older adults can use corrected research findings to better understand why certain symptoms persist and to explore treatment approaches that address specific brain connectivity issues rather than relying solely on general medication strategies.

The commitment to publishing corrections demonstrates the scientific community’s dedication to accuracy in mental health research. For geriatric psychiatry, where treatment decisions must balance multiple age-related factors, having precise information about how schizophrenia affects brain function helps clinicians provide more personalized and effective care for their older patients.

Source Information

Original Title: Corrigendum to “Impaired functional neuronal connectivity in schizophrenia negative symptoms” [Behav. Brain Res. 496 (2026) 115865].

Authors: Rogalski J, Wysokiński A

Journal: Behavioural brain research (Oct 2025)

PubMed ID: 41125467

DOI: 10.1016/j.bbr.2025.115883

This summary was generated using AI to make recent geriatrics and frailty research more accessible. Please refer to the original article for complete details.

# Could a Nasal Spray Improve Social Skills? New Study on Children May Hold Clues for Aging Adults

While this study focused on children with attention problems, its findings have interesting implications for older adults experiencing social difficulties due to cognitive decline, dementia, or late-life psychiatric conditions. Many seniors struggle with understanding others’ emotions and perspectives—skills collectively called “theory of mind”—which can lead to social isolation and relationship problems. Understanding how oxytocin, often called the “bonding hormone,” affects these abilities in younger people may eventually help develop treatments for older adults facing similar challenges as their brain chemistry changes with age.

In this small pilot study, eight children diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD) received either oxytocin or an inactive placebo through a nasal spray. The children then switched treatments in what’s called a crossover design, allowing each participant to experience both conditions. Testing showed that when children received oxytocin, they became faster and more consistent at recognizing emotions and understanding what others might be thinking or feeling. Importantly, no side effects were reported, suggesting this approach was safe for the participants. In a second phase, oxytocin was combined with the children’s regular ADHD medications, helping researchers understand whether this hormone could work alongside existing treatments.

For geriatric care, these preliminary findings raise intriguing possibilities. Older adults with conditions like Alzheimer’s disease, frontotemporal dementia, or late-life depression often experience similar difficulties reading social cues and connecting emotionally with loved ones. If oxytocin can help improve these social cognitive abilities, it might eventually offer a gentle, non-invasive option to complement existing treatments for aging patients. Families caring for elderly relatives who have become withdrawn or struggle with empathy might someday have additional tools to help maintain meaningful relationships during the later years.

However, caution is warranted. With only eight participants, this proof-of-concept study represents just the earliest step in scientific investigation. Much larger trials specifically involving older adults are essential before intranasal oxytocin could become part of geriatric psychiatric care. Still, the research opens an important door, reminding us that brain chemistry affecting social connection spans the entire lifespan—and interventions developed for one age group may eventually benefit another.

Source Information

Original Title: The effect of intranasal oxytocin on theory of mind in children with attention deficit/hyperactive disorder.

Authors: Saker T, Blechman S, Dror C, Ravona-Springer R, Ganem H

Journal: Journal of psychiatric research (Oct 2025)

PubMed ID: 41138507

DOI: 10.1016/j.jpsychires.2025.10.031

This summary was generated using AI to make recent geriatrics and frailty research more accessible. Please refer to the original article for complete details.

# Understanding Medication Safety for Older Adults with Dementia and Mental Health Conditions

Older adults living with dementia and mental health conditions often take multiple medications to manage various health problems simultaneously—a situation known as polypharmacy. Despite being common in everyday medical practice, these vulnerable populations are rarely included in clinical drug trials, leaving doctors with limited evidence about which medications work best or are safest for them. This creates a significant gap in knowledge that affects the quality of care millions of older people receive.

NHS electronic health records—the digital databases that store patient information across the UK healthcare system—offer a promising solution to this problem. These databases contain detailed, long-term information about medication prescribing patterns in both specialist mental health services and general practice settings. Because the NHS provides comprehensive care to defined geographic populations, these records can track patients over many years, revealing how medications perform in real-world conditions among older adults who would typically be excluded from research studies. The databases capture important information about what combinations of drugs people actually take, how long they stay on medications, and what health outcomes follow.

However, realizing this potential requires overcoming significant challenges. Care for older people with dementia and mental health conditions typically involves multiple healthcare settings—memory clinics, psychiatric services, hospitals, and general practice—each with its own database system. Currently, linking information across these different systems remains difficult, making it hard to see the complete picture of a patient’s medication journey. Improving these data connections is essential to fully understand medication safety and effectiveness in this population.

For families, caregivers, and healthcare providers supporting older adults, this work represents an important step toward evidence-based prescribing decisions. Better use of existing NHS data could help identify which medications genuinely help, which combinations should be avoided, and which groups of patients are most at risk for adverse effects—ultimately leading to safer, more personalized care for older people with dementia and mental health conditions.

Source Information

Original Title: The use of NHS databases to identify and manage pharmacotherapy in people with dementia and/or late-life mental disorders.

Authors: Sondh HK, Mueller C, Bishara D, Stewart R

Journal: Expert review of clinical pharmacology (Oct 2025)

PubMed ID: 41100343

DOI: 10.1080/17512433.2025.2576102

This summary was generated using AI to make recent geriatrics and frailty research more accessible. Please refer to the original article for complete details.

# Safer Lithium Monitoring Needed for Older Adults with Bipolar Disorder

Lithium has been a cornerstone treatment for bipolar disorder for decades, helping to stabilize mood and prevent episodes of mania and depression. However, this medication requires careful monitoring through blood tests because the difference between an effective dose and a toxic dose can be narrow—especially in older adults. As people age, changes in kidney function, body composition, and how medications are processed can make them more vulnerable to lithium toxicity, which can cause serious side effects including confusion, tremors, and kidney damage.

A group of psychiatric specialists in the UK has raised important concerns that current national guidelines may not provide adequate safety guidance for monitoring lithium levels in older people. The existing NICE (National Institute for Health and Care Excellence) guideline for bipolar disorder uses the same recommended blood level ranges for all adults, regardless of age. However, the authors argue that older adults need lower target ranges to reduce the risk of toxicity while still maintaining the medication’s effectiveness. They recommend that UK laboratories adopt the more age-appropriate guidance from the International Society for Bipolar Disorder, which recognizes the unique vulnerabilities of older patients.

This call for updated monitoring standards has important implications for the many older adults who rely on lithium to manage their bipolar disorder. Lower recommended ranges would provide an additional margin of safety, potentially preventing hospitalizations and serious complications from lithium toxicity. For families and caregivers, this means being aware that older loved ones on lithium may benefit from more conservative dosing approaches. Healthcare providers, particularly those in primary care who often oversee lithium monitoring, should be alert to the fact that older patients may need different target levels than younger adults. While waiting for official guideline changes, clinicians can already discuss with their older patients whether adjusting their lithium levels within a lower, safer range might be appropriate for their individual circumstances.

Source Information

Original Title: The importance of safe lithium plasma monitoring in older people.

Authors: Rubinsztein JS, Willis S, Birgi H, Sachdev K, Southwell C

Journal: BJPsych bulletin (Oct 2025)

PubMed ID: 41126762

DOI: 10.1192/bjb.2025.10163

This summary was generated using AI to make recent geriatrics and frailty research more accessible. Please refer to the original article for complete details.

# Smoking and Mental Health in Older Adults with Bipolar Disorder

Bipolar disorder doesn’t disappear with age, and understanding how lifestyle factors like smoking affect older adults living with this condition is crucial for providing effective care. While we know that smoking is linked to various health problems in younger people with bipolar disorder, very little research has examined these connections in people over age 50. This international study involving nearly 1,000 older adults with bipolar disorder helps fill this important gap by examining how smoking history relates to both mental health symptoms and physical health conditions in this age group.

The study compared three groups: people who never smoked (35%), former smokers (23%), and current smokers (42%). The findings revealed several concerning patterns. Both current and former smokers experienced more depression than those who had never smoked, even after accounting for age and sex differences. Current smokers were more likely to be taking antipsychotic medications and had higher rates of substance use disorders throughout their lives. Former smokers showed higher rates of cardiovascular disease compared to never smokers—though interestingly, this may actually motivate some people to quit smoking. Among participants without heart or lung disease, those who never smoked showed better overall functioning than current smokers.

These findings have important practical implications for everyone involved in the care of older adults with bipolar disorder. For healthcare providers, the results suggest that smoking history should be a key consideration when assessing patients, as it appears linked to more severe illness and greater depression risk. The connection between smoking and antipsychotic use hints that smokers may have a more challenging disease course. For patients and families, this research underscores the value of smoking cessation at any age—not just for physical health, but for mental health outcomes as well. Importantly, the relationship between smoking and depression persisted regardless of whether someone had heart or lung problems, suggesting that the mental health benefits of quitting extend to all older adults with bipolar disorder, not just those with existing medical complications.

Source Information

Original Title: Relationship Between Smoking and Psychiatric and Somatic Comorbidities in Older Age Bipolar Disorder: Lien entre le tabagisme et les affections psychiatriques et somatiques concomitantes chez les personnes âgées atteintes de trouble bipolaire.

Authors: Howland M, Mahajan A, Chen P, Almeida O, Altınbaş K

Journal: Canadian journal of psychiatry. Revue canadienne de psychiatrie (Oct 2025)

PubMed ID: 41129665

DOI: 10.1177/07067437251387658

This summary was generated using AI to make recent geriatrics and frailty research more accessible. Please refer to the original article for complete details.

# Dementia Care in Old Age Psychiatry: 50 Years of Progress and Future Directions

As our global population ages, dementia has become one of the most pressing mental health challenges affecting older adults and their families. Old Age Psychiatry (OAP) has evolved over the past five decades specifically to address this growing need, developing specialized approaches to care for elderly patients dealing with both mental health conditions and the complex changes that come with aging. This comprehensive review examines how far dementia care has come and where it needs to go next, particularly in light of exciting recent advances in early detection and treatment.

The field has made remarkable strides in understanding that psychiatric symptoms—such as anxiety, depression, agitation, and behavioral changes—often appear early in dementia, sometimes even before memory problems become obvious. These neuropsychiatric symptoms are now recognized as crucial warning signs that can help identify dementia earlier. Recent breakthroughs have brought new hope: improved diagnostic tools can now detect Alzheimer’s disease at earlier stages, and newly developed amyloid targeting therapies (medications that address the abnormal protein buildup in the brain) represent the first treatments that may actually slow disease progression rather than just managing symptoms. These developments mark a significant turning point after decades of limited treatment options.

For elderly patients and their families, these advances mean the possibility of earlier intervention and better management of the challenging behavioral and emotional symptoms that accompany dementia. Old Age Psychiatry specialists are uniquely positioned to help navigate this new landscape, as they understand both the psychiatric aspects of dementia and the complex medical needs of older adults. The field recognizes that effective dementia care extends far beyond prescribing medication—it requires addressing the psychological wellbeing of both patients and family caregivers throughout the entire journey of the disease.

Looking ahead, the future of dementia care lies in collaborative approaches that bring together medical specialists, technology experts, and social service providers. Old Age Psychiatry clinicians will play a central role in coordinating comprehensive care that supports people living with dementia and their families at every stage, from the earliest warning signs through advanced disease. This holistic vision represents a significant shift from viewing dementia care as simply providing social support or medication, instead offering integrated, personalized care that adapts to changing needs over time.

Source Information

Original Title: Dementia care in old age psychiatry over 50 years.

Authors: Lam LCW, Chan WC, Ikeda M

Journal: International review of psychiatry (Abingdon, England) (Oct 2025)

PubMed ID: 41131676

DOI: 10.1080/09540261.2025.2577393

This summary was generated using AI to make recent geriatrics and frailty research more accessible. Please refer to the original article for complete details.

# New Genetic Study Sheds Light on Achalasia: An Important Swallowing Disorder Affecting Older Adults

Achalasia is a progressive disorder that affects the ability to swallow, as the esophagus gradually loses its ability to move food toward the stomach. While it can occur at any age, many patients are diagnosed later in life, and the condition has important implications for geriatric care. Difficulty swallowing can lead to malnutrition, weight loss, aspiration pneumonia, and social isolation—all critical concerns for older adults’ physical and mental well-being. Despite decades of clinical observation, the root causes of achalasia have remained largely mysterious. This first-ever large-scale genetic study of 4,602 patients with achalasia offers groundbreaking insights: the condition appears to be driven primarily by immune system dysfunction rather than being simply a mechanical problem.

The study identified several genetic variations that significantly increase achalasia risk, with the strongest effects found in genes that control immune system function. The most important discovery involves the HLA system—a group of genes that help the immune system distinguish the body’s own cells from foreign invaders. A specific genetic variant in the HLA-DQB1 gene more than doubles a person’s risk of developing achalasia. Beyond this, variations in genes called PTPN22, TNFSF8, TNFSF15, and TNC—all involved in immune regulation—also contribute to disease risk. Particularly revealing was the finding that a specific type of memory immune cell (CD8+ T-cells) appears to play a central role in attacking the nerve cells in the esophagus. Additionally, achalasia shares genetic similarities with Crohn’s disease, another immune-mediated condition, further supporting the immune connection.

For older adults with achalasia and their healthcare providers, these findings represent an important paradigm shift. Understanding that achalasia has an immune basis opens new avenues for treatment beyond the current approaches, which focus solely on managing symptoms through procedures that stretch or bypass the malfunctioning esophageal valve. Geriatric psychiatrists and mental health professionals should be aware that patients experiencing progressive swallowing difficulties may face anxiety, depression, and reduced quality of life related to eating and social situations. The genetic insights may eventually lead to earlier diagnosis through genetic risk screening and potentially immune-targeted therapies that could slow or prevent disease progression. For families and caregivers, understanding the immune-mediated nature of achalasia may reduce self-blame and provide context for why standard dietary modifications alone aren’t sufficient.

Looking forward, the ability to calculate an individual’s genetic risk for achalasia could help identify high-risk individuals before symptoms become severe. This is particularly relevant for older adults who may already face multiple health challenges and for whom early intervention could prevent the cascade of complications associated with chronic swallowing difficulties. As our understanding of the immune mechanisms deepens, there is hope for developing targeted treatments that address the underlying cause rather than just managing symptoms—a potential game-changer for improving both physical health and psychological well-being in affected older adults.

Source Information

Original Title: First genome-wide association study reveals immune-mediated aetiopathology in idiopathic achalasia.

Authors: Grover S, Gockel I, Latiano A, Mokrowiecka A, Dasmeh P

Journal: Gut (Oct 2025)

PubMed ID: 41136183

DOI: 10.1136/gutjnl-2024-334498

This summary was generated using AI to make recent geriatrics and frailty research more accessible. Please refer to the original article for complete details.

# Understanding the Safety of Psilocybin Therapy: What We Know About Side Effects

As mental health treatment options expand for older adults struggling with depression, anxiety, and other psychiatric conditions, psilocybin—a naturally occurring compound found in certain mushrooms—has emerged as a promising therapy. For elderly patients who may not respond well to conventional treatments or who experience intolerable side effects from traditional antidepressants, understanding the safety profile of this alternative approach is crucial. This comprehensive review examined safety data from 42 clinical studies involving over 1,000 participants who received psilocybin therapy, providing valuable insights into what side effects occur and how they can be managed in clinical settings.

The findings offer reassuring news about psilocybin’s safety when administered in controlled, supervised environments. The most commonly reported side effects were relatively mild and temporary: headaches, brief increases in blood pressure, and nausea that typically resolved without medical treatment. Serious adverse events were rare, occurring in only 2 of the 42 studies reviewed, and were limited to participants who already had underlying depression—these included suicidal thoughts or behaviors requiring hospitalization. Importantly, when medical intervention was needed for side effects, such instances were uncommon. These results suggest that with proper screening, preparation, and monitoring, psilocybin therapy can be administered with an acceptable safety profile comparable to many existing psychiatric treatments.

For older adults and their families considering emerging treatment options, this research provides important context. While psilocybin shows promise, it’s not without risks, particularly for individuals with severe depression. Healthcare providers working with geriatric populations should note that all studies reviewed had limitations in their ability to fully blind participants (since the effects of psilocybin are quite noticeable), which means safety data should be interpreted with appropriate caution. The controlled clinical setting—with trained professionals monitoring participants throughout the experience—appears to be essential for safety. As research continues, these findings help establish guidelines for how to safely conduct psilocybin therapy and what monitoring protocols should be in place, paving the way for potentially offering this treatment option to carefully selected older adults who might benefit from alternative approaches to managing treatment-resistant mental health conditions.

Source Information

Original Title: Adverse event reporting and management in psilocybin therapy clinical trials: A systematic review to guide clinical and research protocol development.

Authors: Bukovsky D, Amaev A, Song J, Kyte S, Carmona-Torres E

Journal: Progress in neuro-psychopharmacology & biological psychiatry (Oct 2025)

PubMed ID: 41138900

DOI: 10.1016/j.pnpbp.2025.111541

This summary was generated using AI to make recent geriatrics and frailty research more accessible. Please refer to the original article for complete details.

# New Brain Scan Finding May Help Explain Memory Problems in Older Adults

Understanding why some older adults experience cognitive decline while others maintain sharp minds remains one of the most pressing challenges in geriatric mental health. This Japanese study sheds light on a previously underappreciated brain structure that may play an important role in memory and thinking abilities. The research focused on small, fluid-filled spaces near the top of the brain called ACES cysts (Arachnoid Cuff Exit Site cysts), examining whether their presence relates to cognitive performance in people undergoing evaluation for dementia.

The study included 112 older adults aged 66 to 94 years who received brain MRI scans as part of dementia screening. Using the Mini-Mental State Examination (MMSE)—a widely used test that assesses memory, attention, and thinking skills—researchers compared cognitive function between those who had ACES cysts and those who didn’t. The findings were striking: ACES cysts were present in roughly half of participants, and those with these structures scored significantly lower on cognitive tests. Perhaps most intriguing, the presence of ACES cysts emerged as a strong independent predictor of lower cognitive scores, meaning this association held true even after accounting for other factors. In people without these cysts, cognitive scores declined predictably with age, but in those with ACES cysts, the relationship between age and cognition was disrupted, suggesting these structures may interfere with normal brain aging processes.

For families and healthcare providers working with older adults experiencing memory concerns, these findings offer a potential new piece of the puzzle in understanding cognitive decline. While more research is needed to understand exactly how ACES cysts might affect brain function, their detection on routine MRI scans could eventually help clinicians better assess dementia risk and tailor care approaches. This research highlights the importance of detailed brain imaging in geriatric psychiatric evaluations and may eventually lead to more personalized strategies for supporting cognitive health in aging populations.

Source Information

Original Title: Association between the Presence of the Parasagittal Cyst-like Structures and Cognitive Function.

Authors: Ohashi T, Ito R, Yamamoto R, Ukai K, Naganawa S

Journal: Magnetic resonance in medical sciences : MRMS : an official journal of Japan Society of Magnetic Resonance in Medicine (Oct 2025)

PubMed ID: 39581589

DOI: 10.2463/mrms.mp.2024-0138

This summary was generated using AI to make recent geriatrics and frailty research more accessible. Please refer to the original article for complete details.