Head of the Geriatric Psychiatry Services at NIMHANS in Bangalore and a professor of psychiatry at the National Institute of Mental Health. moc. oohay@grav. tamFind articles by.
Head of the Geriatric Psychiatry Services at NIMHANS in Bangalore and a professor of psychiatry at the National Institute of Mental Health. moc. oohay@grav. tamFind articles by.
The population of elderly persons is growing with extraordinary rapidity. According to the 2011 Indian census, more than 8%20% of the population was over 60 years old. This means that there are an estimated 1 million people in India who are over 60 years old. Although the majority enjoys good health, many older people suffer from multiple illnesses and significant disability. They often have illnesses that show up in strange or unclear ways, major cognitive, affective, and functional problems, are socially isolated and poor, and are at a high risk for being institutionalized too soon or in the wrong way. Patients in this group are also more likely to be hurt by medical mistakes. Almost 45 percent of older people have some kind of chronic illness, and many of them have two or three physical illnesses along with a mental disorder. There are between 20% and 30% of older people who have a mental disorder. Depressive disorders (10%) and dementia (3% of those affected) are the most common. Because of this, it is very important to understand how big the problem is, since India has the second-highest number of older people with mental disorders in the world. Because of this, we need to plan ahead for geriatric care in both the health system and in families and the community.
Interviewing for a geriatric psychiatrist position can be intimidating You need to demonstrate not only your medical knowledge and clinical skills, but also your passion for working with the elderly population. As a geriatric psychiatrist, you’ll be dealing with complex mental and physical health issues that require compassion, patience, and expertise
To help you prepare for your interview, I’ve compiled this list of 10 common geriatric psychiatrist interview questions along with tips for crafting strong responses. Read on to learn how to highlight your qualifications and land your dream job.
1. Why did you decide to pursue geriatric psychiatry?
This is often one of the very first questions asked in an interview. The interviewer wants to understand your motivations for choosing this specialty. When answering:
-
Share when you first became interested in geriatric psychiatry. Was there a specific experience that sparked your interest?
-
Discuss what you find uniquely rewarding about working with elderly patients. Focus on your desire to improve their quality of life.
-
Demonstrate your passion for the field. Convey sincere enthusiasm and commitment to caring for this population.
For example: “I became fascinated with geriatric psychiatry during my medical school rotation. I found great fulfillment in getting to know my elderly patients and uncovering their intricate mental and physical health histories. I’m deeply committed to improving quality of life for the elderly by diagnosing and treating psychiatric illness through a patient-centered, compassionate approach.”
2. How would you handle a situation where an elderly patient disagreed with your diagnosis or treatment recommendations?
Geriatric patients often have firm ideas about their health based on a lifetime of experiences. As a psychiatrist, you must balance respect for your patients’ perspectives with your medical expertise. When answering this question:
-
Emphasize your commitment to shared decision-making. Avoid an authoritarian stance.
-
Discuss strategies like motivational interviewing to align on goals without dictating terms.
-
Share how you would educate patients and explain the rationale for your clinical recommendations.
-
Highlight your ability to admit when you don’t have all the answers, and your openness to integrating patients’ insights.
For example: “I would start by sincerely listening to the patient’s concerns rather than dismissing them outright. I would attempt to understand their perspective and provide additional education on my clinical rationale if appropriate. Ultimately, I respect the patient’s autonomy in decision-making, and I would look to find common ground and agree on a path forward that respects both of our viewpoints.”
3. How do you handle the emotional stresses of working with elderly psychiatric patients?
Geriatric psychiatry can be emotionally heavy at times. Interviewers want to know that you have healthy coping strategies to avoid burnout. When responding:
-
Share how you maintain work-life balance, whether it’s through hobbies, exercise, meditation, or quality time with family and friends.
-
Discuss the importance of professional connections. For example, peer support groups, mentors, and engaging in a team approach to patient care.
-
If applicable, you can mention utilization of professional mental health services like counseling or therapy. However, be mindful of oversharing personal health details.
-
Convey genuine passion for your work. The fulfillment that comes from helping your patients can be incredibly rewarding.
For example: “To manage the stresses and emotional weight of this work, I make it a priority to maintain a healthy work-life balance. I set clear boundaries with my time and make sure to unwind with loved ones, get outdoors, and engage my mind in activities other than psychiatry. I also feel very fortunate to work closely with a dynamic team of fellow psychiatrists, nurses, and social workers who provide invaluable support.”
4. How would you handle a situation where you believe an elderly patient is at risk of self-harm or suicide?
Suicide risk increases dramatically for certain subsets of the elderly population. Interviewers will gauge both your clinical knowledge and your compassion when asking about suicide prevention. In your response:
-
Demonstrate your in-depth knowledge of suicide risk factors, warning signs, and red flags specific to geriatric patients.
-
Discuss your meticulous approach to suicide risk screening and safety planning.
-
Share your commitment to maintaining patient privacy and dignity even in high-risk scenarios.
-
Emphasize that you will consult peers and utilize all available resources to keep patients safe.
For example: “If I had any suspicion a patient was at risk, I would immediately conduct thorough suicidal ideation screening. I would ask directly about suicidal thoughts while also carefully observing their mood, affect, and other risk factors. If I determined acute risk was present, I would consult closely with my colleagues to enact a safety plan, which could include increased monitoring, restricting access to lethal means, or emergent psychiatric hospitalization if necessary. Throughout the process, I would be sure to preserve the patient’s autonomy and dignity while keeping their safety as my number one priority.”
5. How would you evaluate and manage a geriatric patient exhibiting signs of dementia?
Your interviewers want to know that you can differentiate between various types of dementia, perform the necessary diagnostic exams, and thoughtfully design a treatment plan. In your response:
-
Demonstrate your clinical knowledge related to the stages of dementia, common causes, and typical symptom presentation.
-
Discuss your approach to conducting cognitive exams to evaluate memory, orientation, judgment and problem solving.
-
Share how you sensitively communicate about dementia with patients and family members.
-
Mention multidisciplinary coordination of care, lifestyle changes, therapies, and medications as appropriate for the patient’s needs.
For example: “If I suspected possible dementia, I would perform thorough screening like the Mini Mental Status Exam to assess their cognitive function. I would also order imaging scans to aid in narrowing down potential neurodegenerative causes. I would have an open yet sensitive discussion with the patient and family about the diagnosis, making sure to respect the patient’s dignity throughout the process. From there I would develop an individualized treatment plan which could involve occupational therapy, mental stimulation activities, cholinesterase inhibitors if applicable, and ongoing support for the family.”
6. How do you prioritize treatment when a patient presents with both psychiatric and physical health issues?
Geriatric patients frequently contend with multiple intersecting health issues. Interviewers want to know you can triage competing priorities. When answering this question:
-
Discuss how you thoroughly gather information from all care providers and across domains of health to identify the issues most acutely affecting quality of life.
-
Share how you coordinate specialty care and consult other providers as needed while maintaining continuity of care.
-
Convey your patient-centered approach to balancing physical and mental health interventions.
For example: “I would start by comprehensively evaluating the patient’s full range of psychiatric and physical health issues and how each condition interacts and impacts the others. I would identify which symptoms and impairments are most severely impacting their safety, functioning, and quality of life in the present moment. From there, I would determine whether intensive psychiatric or medical intervention is more urgently needed while also laying the groundwork to address the other issues in a phased approach. Throughout the process I would coordinate closely with the patient’s entire care team.”
7. How do you involve family members and caregivers in the treatment of geriatric psychiatric patients?
Family involvement is crucial when treating elderly patients. When addressing this question:
-
Emphasize how you solicit caregiver perspectives while respecting the patient’s privacy and autonomy.
-
Discuss including family members in psychoeducation and counseling to equip them to support the patient.
-
Share how you help families access respite care, support groups, and other resources to prevent burnout.
-
If applicable, mention your experience mediating family conflict related to the patient’s care.
For example: “I actively engage family members as collaborators while obtaining the patient’s consent to share information. I provide caregivers with education and counseling to help them understand the psychiatric illness and how best to assist the patient with issues like medication compliance and lifestyle changes. I also aim to empower families with resources like support groups and respite care options to maintain their own mental health, which ultimately benefits the patient.”
8. What experience do you have collaborating with nurses, social workers, and other colleagues as part of a geriatric mental health team?
Interdisciplinary collaboration is essential when caring for complex geriatric patients. Interviewers want to know you can work effectively as part of a care team. Highlight that you:
- Proactively communicate with team members to get their insights and share your own.
- Recognize the unique expertise and roles of each discipline.
- Resolve any team conflicts smoothly by communicating respectfully.
- Engage team members in united efforts to provide coordinated, patient-centered care.
For example: “In my training thus far, I have cherished the opportunity to work with nurses, social workers, therapists and colleagues across disciplines as part of providing comprehensive geriatric psychiatric care. I recognize the invaluable and distinct perspectives each brings. I make it a priority to foster a collaborative spirit on the care team by clearly and frequently communicating, resolving any conflicts quickly through open dialogue, and uniting around shared patient-centric goals.”
9. What experiences have you had interacting with elderly patients and their families?
Hands-on experience caring for geriatric patients is hugely
BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS
The Neuropsychiatric Inventory (NPI) evaluates a wider range of psychopathology than comparable instruments (Cummings et al, 1994). It records severity and frequency separately, may help tell the difference between different types of dementia, and only takes 10 minutes to give. The NPI assesses ten domains: delusions; hallucinations; dysphoria; anxiety; agitation/aggression; euphoria; disinhibition; irritability/lability; apathy; and aberrant motor behaviour. It takes longer to give the test if the answers are positive, but a screening strategy cuts down on the time it takes to do so. It is scored from 1 to 144 and severity and frequency are independently assessed. The NPI has been translated into many languages and it is now used widely in drug trials.
The BEHAVE-AD (Reisberg et al, 1987) is given by a clinician and takes 20 minutes. It was made to be useful for prospective studies of behavioral symptoms and in drug trials to record behavioral symptoms in Alzheimer’s disease patients. The BEHAVE-AD is the original behaviour rating scale in Alzheimers disease. It has two parts: the first part is about the symptoms, and the second part asks for a global rating of the symptoms on a four-point scale of how bad they are. Paranoid and delusional thoughts, hallucinations, activity problems, aggression, changes in mood, and anxieties and phobias are some of the things that are talked about.
Cornell Scale for Depression in Dementia:
The Cornell Scale (Alexopoulos et al., 1988) is used to measure depression in people with dementia and is given by a trained professional. It takes 20 minutes with the carer and 10 minutes with the patient. It is different from other depression scales not in how it is used but in how it looks at the different types of symptoms seen in people with dementia who are depressed compared to people who are depressed alone (Purandare et al, 2001). There are three levels on the 19-item scale: “absent,” “mild or intermittent,” and “severe.” If the score can’t be rated, a note is written next to it. A score of 8 or more suggests significant depressive symptoms. It is the best scale available to assess mood in the presence of cognitive impairment.
THE MENTAL STATUS EXAMINATION:
An important part of diagnosing a mental illness in an older person is checking their mental health. Many of these signs can be seen in a thorough history-taking interview. The MSE may be evaluated on the standard format used which covers the following areas:
- General appearance & behavior (including psychomotor activity)
- Language and thought disorders
- Mood
- Perception
- Cognitive functions- focusing on orientation, attention, concentration, memory, intelligence
- Judgement and insight
1. The way the patient looks, how well he grooms himself, and how he dresses all show how well they can take care of themselves. When a person is depressed, crazy, or showing signs of psychosis, the way they look may help with the diagnosis. It would be possible to tell from the patient’s face and how well they get along with the examiner if the patient is psychotic or just having a mild illness. The associated bodily movements and posture of the patient would give further clues to the underlying psychopathology. It is possible to tell if a person is depressed, manic, has psychoses, delirium, dementia, or generalized anxiety by looking at their psychomotor activity (whether it is fast or slow), general agitation and fidgetiness, aimless pacing, or ability to get distracted.
2. Having trouble with language and thoughts: The most common problems people with depression, psychoses, and sometimes dementia have are problems with the content and flow of their thoughts. Quite often, older people who are depressed think negative thoughts like nihilism, worthlessness, pessimism, or being too focused on their health problems. People who are psychotic or have dementia may have somatic delusions or think that family members are stealing their things. People who have both anxiety and depression often worry or obsess over small things and think about the same things over and over again. Perseveration, confabulation, or other speech disorders seen in organic disorders can sometimes cause people to talk over and over again. The speech may become irrelevant or incoherent with seeming disorders in associations or form. Difficulty with respect to language may be the initial feature in patients with dementia. Also, patients with stroke can have aphasia or slurring of speech.
It is very important to not miss asking for and assessing suicidal ideas. Though thoughts of death are common in late life, elders do not readily express ideas of suicide. So, it’s a good idea to gently and directly ask about thoughts that life isn’t worth living, a desire to die, or specific plans or even attempts. There is a very high risk of suicide among older people, and many psychiatrists have lost patients to suicide when they least expected it. Because the risk is so high, it is important to check if the patient has easy access to the tools and methods needed for DSH.
3. If you watch the patient during the interview, ask them to describe their feelings, and look at the flow and content of their thoughts, you can figure out their mood and affect. Keep in mind that older people may not be able to show as much sadness as younger people would because their emotional range may be limited. On the contrary, they may exhibit apathy instead of anxiety or sadness. Labile affect can be noted in patients suffering with dementia.
4. Perceptual disorders in the elderly quite commonly can occur in all the five realms. A lot of people have auditory and visual hallucinations or illusions. A lot of people also have tactile, olfactory, and gustatory sensations, especially when they have a physical illness or a psychosis. Patients with depression may also experience bad taste and odors like that of putrefaction.
5. Cognitive functions and Memory are most accurately assessed by formal psychological testing. However, the psychiatric interview of the older adult must include a reasonable bedside assessment of cognitive functions. To test cognitive functions, you should start with orientation, then move on to attention and concentration, and finally memory and higher cognitive functions like intelligence, abstraction, and judgment. This order should be followed because tests of memory and other higher functions would need people to be able to focus, pay attention, and find their way around. A mental illness (like depression or psychosis) can make it easy to mistake a problem with attention, concentration, orientation, or lack of interest for dementia if the person isn’t properly tested.
Attention and concentration is tested by the digit span test (digit forward and backward). In illiterate elders, we could use days of week forward and backward or the 20-1 test. Serial subtraction (100-7 or 40-3) is a test for concentration and immediate memory and intelligence. A very easy way to see if a patient is oriented is to ask them to name the time (hour, day, date, month, etc.), the place (where, town, address, etc.), and the person (self, family, bystanders, etc.).
Memory is tested in the domains of immediate, recent and remote memory. Testing of memory is based on three essential processes of registration, retention and recall. To test a person’s memory, you teach them three or five things and then ask them to remember them after some time has passed. Another good way to test someone’s recent memory is to have them remember an address with five different parts. Remote memory can be tested by asking the subject to recall important local events in the past. This could be the name of a political leader, the date of independence, or the time of a festival. It’s not very useful to ask about meals eaten or events that happened in the last day, but asking about the order of events in the last few days could be a sign of problems with timing and space. Since autobiographical memory is lost last, it could be used to test people who are moderately demented.
Registration is usually not impaired except in patients with a moderate to severe dementia. However, retention can be impaired by both psychic distress and brain dysfunction. For instance, it will be clear that the patient doesn’t remember unimportant information if you ask them to remember three things for five minutes. If they don’t want to do the task, they will likely score a deficit.
6. Judgement, abstraction and Insight:
To test abstract thinking, people are asked to explain what a common proverb means and how it is used. Alternately for illiterate elders we could use the similarities and differences test. The patient may be asked to describe what he would do in different scenarios, such as the letter test, the fire in the house test, or what to do when it rains. This can be used to check his judgment and understanding.
To test insight, you can ask the person why they’ve come in for a consultation or if they think they have a sickness and what that sickness is. People who have depression, anxiety, or milder forms of illness or mild cognitive impairment would have insight, but people who have dementia, florid psychosis, or delirium would not.
Qualities of a geriatric psychiatrist & tips for effective communication:
Most older people who come to a clinic are just stressed out and tired. They may also have trouble seeing or hearing, which could make them confused or not do well on a test. Examiners must have a lot of patience and compassion when dealing with older people, and they must treat the older person with respect and care. Because some people may have trouble hearing or seeing, it’s important to speak slowly and clearly and repeat what you say. As well as talking to the elder, being close to them, touching them, or helping them get around the clinic are all forms of nonverbal communication that would help them cooperate with the long and difficult exam.
The geriatric psychiatrist needs to be able to laugh, be patient, be willing to listen, look at all the options, and not jump to conclusions. They also need to like working with older people. Working with families is a key part of geriatric work. Also, the person must believe that older people with mental health problems do get better and can live a fuller, happier life. The person should be interested in psychiatry, medicine, and neurology, and they should know about all the complicated biopsychosocial factors that can cause psychiatric problems in older people.
