Helping people deal with the big questions of death and loss of identity, when those concerns are complicated by depression, requires a certain expertise, doctors say.
That specialized knowledge can come from a geriatric psychiatrist.
Among the newest fields of medical science, geriatric psychiatry involves working with families, primary care physicians, senior center workers, adult day care providers and others to improve the mental health of older adults.
The American Board of Neurology and Psychiatry has only recognized geriatric psychiatry in the last 10 years, said Dr. Geoffrey Shaw, a member of the board and a geriatric psychiatrist at Advocate Lutheran General in Park Ridge.
"What's happening is the population is getting older, and people are also recognizing depression as a true medical illness," Shaw said.
Geriatric psychiatry units and training programs have emerged at Northwestern University, Weiss Memorial Hospital in Chicago, Rush Presbyterian-St. Luke's Medical Center in Chicago and other hospitals throughout Illinois and across the country.
Hospitals say their goal is to focus on the unique approaches required to help seniors.
Doctors say they're using different therapy methods for a group whose mental illnesses are complicated by social stigma, physical ailments, medical misdiagnoses and years of history.
"There comes a point with many of these people that they've had more stress, more change than they can deal with," said Dr. Sandra Swantek, medical director of the Older Adult Behavioral Unit at Weiss Memorial Hospital in Chicago.
Swantek also is a member of the American Association of Geriatric Psychiatry and wrote the "Depression in Late Life" brochure distributed at hospitals to let seniors know that depression is not something to be accepted as simply a part of aging.
"The reason we need a specialty is because there is a body of information that applies to older people that doesn't apply to younger people," Swantek said.
Many of today's seniors lived through World War II, the Great Depression and the Korean War.
They've seen their retirement savings balloon exponentially and then deflate to abysmal depths.
They've buried their parents, seen their siblings die, watched their children move away - and coped with it all. They're not likely to complain when loss of mobility and loss of independence compounds it all and plunges them into depression.
"They're not just going to walk in and say, 'Hey, I'm really down in the dumps and I feel bad,'" said Dr. Andrew Ripeckyj, clinical director of the Geriatric Psychiatry Unit at Rush Presbyterian-St. Luke's Medical Center in Chicago.
Ripeckyj said a proud spirit among seniors - coupled with their memories of a time when the mentally ill were labeled as "crazy" - means geriatric psychiatrists have to listen for different clues when diagnosing senior citizens.
The challenge, though, is to get seniors to the therapist's couch in the first place.
The vocabulary seniors use to avoid talking about emotional problems often results in missed diagnoses from their primary care doctors, and a missed opportunity to get treatment.
"If they're older, it's more likely that they'd say they feel nervous, they're having trouble concentrating, they can't pay attention to their favorite program," Ripeckyj said. "You may have to dig a lot harder."
In many ways, geriatric psychiatry is similar to general psychiatry in its use of therapy and prescription medicine to treat mental illness, doctors said.
A key difference is the therapist must walk a fine line between preventing seniors from longing too much for the past and stemming fears of an uncertain future.
"Geriatric psychiatrists help seniors rediscover their strengths," said Dr. Maria Caserta, a geriatric psychiatry specialist at the University of Chicago. "A lot of us try to think about how to incorporate them into a more active lifestyle, to join a group and give back to others their wisdom, which, if they are depressed, they don't think they can do."
Not until the mid 1970s did psychiatrists begin to recognize the importance of a science to deal specifically with life changes affecting older adults.
A group of doctors formed the American Association for Geriatric Psychiatry in 1978 to prepare for an explosion in the population of aging baby boomers.
Association board member Swantek said there now are 2,000 members of the association nationwide, but the number continues to grow slowly.
"Frankly, it costs a lot to go through medical school, and then you set up your practice and now you discover that your livelihood depends on insurance."
The availability and the practice of geriatric psychiatry could become more widespread in future years, as the next generation gains a better understanding of depression.