Psychiatric Issues in Older Adults with Gastrointestinal Disorders

The “mind-body” hypothesis has gained widespread acceptance. Studies suggest a bidirectional causality, with psychiatric illnesses such as anxiety, depression, psychosis, substance abuse, and cognitive impairment having a role in both the causality and the perceived and actual severity of physical illnesses, including gastrointestinal (GI) diseases, while such illnesses may also play a role in worsening symptoms of psychiatric disorders. The focus of this chapter is more specifically on the “brain-gut” connection, focusing on an elderly population where multi-morbidities may be the rule, rather than the exception. Medication side effects and drug-drug interactions can affect management of both gastrointestinal and psychiatric illnesses and the effect of these interactions may be magnified in the elderly due to aging related changes in pharmacokinetics and pharmacodynamics as well as the increased frequency of polypharmacy in this age group. Awareness of these multiple levels of physical and psychiatric interactions in a potentially fragile older patient population can contribute to more comprehensive care.