Senior Mental Health Q&A With Dr. Jason Schillerstrom

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May is Mental Health Month and AARP Texas is focusing on people’s mental health as they age. We asked Dr. Jason Schillerstrom, an associate professor at UT Health San Antonio, about what people should know about mental health and the aging process.

Schillerstrom, who is also director of the center’s Geriatric Psychiatry Clinic, says the conditions they most commonly see are depression, dementia and anxiety. But he says that people should not think of these as coming naturally with aging.

We also talked with Schillerstrom about senior mental health in Texas, the most pressing issue in the field of geriatric psychiatry, and what people should focus on as they age in terms of their mental health.

The questions and responses below were edited for length and clarity.

AARP Texas: What do you think people should know about mental health as it relates to seniors?

Dr. Jason Schillerstrom: I think people should know that the majority of seniors are in good mental health. I also think that people should know that dementia or depression or anxiety are illnesses that can be treated and they shouldn’t be considered just a normal part of aging. It’s not normal for older persons to be depressed or anxious. If they’re having symptoms of depression or anxiety, they should seek treatment and not just write it off as old age.

AARP: Do you think that people conflate depression and dementia with just being part of the aging process?

Schillerstrom: There may be a view among some that as you age, it’s natural to become depressed or demented, and it’s just a part of aging, it’s a part of normal human physiology. But in fact it’s not. In fact, there are studies that show the diagnosis of depression is actually less common in older persons than younger persons.

AARP: What do you think it is that makes people think there’s a connection between old age and mental illness?

Schillerstrom: It’s probably just stereotypes and misplaced projection. I think younger people say, “Well, if I was 80 and I wasn’t working anymore and I was maybe more mobility impaired, I would be depressed and so they must be depressed, too.” Perhaps it’s a misplaced empathy.

AARP: What sort of impact is there to have a co-occurrence of mental health issues with other symptoms?

Schillerstrom: There’s a strong link between heart disease and depression. There’s a strong link between sleep apnea and cognitive impairments. The more vascular risk factors someone has, so if someone has diabetes, high blood pressure, high cholesterol, these are all risk factors for dementia. In sum maybe, a way to prevent depression and dementia and anxiety is good physical health.

AARP: How big of an impact does loneliness have on seniors’ mental health?

Schillerstrom:  It certainly has an impact. Increased social isolation certainly makes a difference. Honestly, probably one of the bigger challenges in my clinic is that, geriatric psychiatry is largely family psychiatry. Most of my patients become my patients because a family member became concerned and brought their loved one to see me. But, if someone is socially isolated, not only do they have limited social engagement and activity, but they also have less ability to have someone take them to a physician or someone identify a problem and take them to receive care. There’s also literature out there about just being touched. Just wanting to be touched in a friendly, caring way. A hand on their shoulder type of a thing, and how that can not only help with mental health symptoms but also help with agitation. When elders become demented, sometimes agitation will emerge and how that can help calm them down, minimize the need for medicine.

AARP: What would you say are the most pressing issues right now in the field of geriatric psychiatry?

Schillerstrom: The most pressing issue is that the United States population is becoming more and more gray, and the number of doctors going into geriatric medicine and geriatric psychiatry has pretty much remained stable. The most pressing issue now is that there just aren’t enough physicians with sub-specialty training to adequately care for our elders. So then what that means is that more elders are going to be cared for more and more by non-specialist providers, either primary care doctors, general adult psychiatrists, or physician assistants and nurse practitioners.

AARP: Is that the case in Texas, too?

Schillerstrom: Oh absolutely. In a good year, in a really good year, the state of Texas gets three new geriatric psychiatrists. That’s it.

AARP: Why do you think it’s important seniors are able to see a geriatric psychiatrist specifically rather than a generalist?

Schillerstrom: Our primary care doctors manage most of the mental health needs of the geriatric population. General adult psychiatrists manage a large chunk as well. And for many of the disorders, it’s fine and it works well and in fact it’s how the system should work. But there are just certain conditions that primary care physicians and general adult psychiatrists are just less knowledgeable and less comfortable managing. And the conditions that they’re less comfortable managing are the dementia disorders like Alzheimer’s, vascular dementia. The management of memory loss isn’t that difficult. What’s difficult are the comorbidities. It’s the agitation, the psychosis, the sleep-wake reversal, the caregiver burden. That’s what’s hard.

AARP: Is there anything in Texas specifically that you think that people should be paying attention to in terms of seniors’ mental health?

Schillerstrom: I might just be biased by my region, but we certainly have a larger Hispanic population. The older, senior Hispanics are more likely to be Spanish-speaking only. Because they’re more likely to be Spanish-speaking only, they have even a bigger challenge accessing health care with providers who they can communicate their concerns to.

AARP: What do you think that people should pay attention to as they age in terms of their mental health?

Schillerstrom: There’s just no substitute for healthy lifestyle habits, either for preventing or even treating many of these conditions. People ask me all the time, “What can I do to prevent depression or prevent dementia?” The answer is always exercise. There’s just nothing shown to prevent depression and dementia in older adults as effectively as exercise. Just healthy lifestyle habits, good primary care, exercise, that’s what it’s about.

AARP: Is there an issue in terms of senior mental health that you believe deserves more attention than it’s getting? Is there anything that we didn’t ask you about that we should be asking you?

Schillerstrom: Another strength of many seniors is their faith and their spirituality. Older Texans, if I’m just painting with large brushstrokes here, do seem to be more integrated with their churches or their place of faith. As we had talked about earlier with loneliness and social isolation, I do think that that’s an incredible resource. When patients come to me and tell me they have depression, one of the questions I always ask is, “When you weren’t depressed, how was your life different? What were you doing differently when you weren’t depressed?” I can just tell you that the two things they always tell me are, “Well, I was exercising and I was going to church.” And so then I tell them, “Well, I think I need to have you start exercising and going to church.” I think that is perhaps unique to aging. Another big problem with mental health in Texas is their vulnerability to exploitation and neglect. I think elders struggling to take care of themselves, protect their health, their safety, their financial interests is another big problem in Texas.

For more information, check out AARP's resources for mental health and  AARP Foundation's Connect2Affect project.