Psychiatric Care for an Aging Parent: Geriatric Psychiatry, Memory and Medications

A geriatric psychiatrist is a psychiatrist who completed an extra year of accredited fellowship training in the mental health of older adults and passed the American Board of Psychiatry and Neurology (ABPN) subspecialty exam, on top of board certification in general psychiatry. That added training is most useful when an aging parent has several problems at once: mood symptoms plus memory changes, a long medication list, or behavior changes linked to dementia.

Many older adults do well with a general adult psychiatrist working closely with their primary care doctor. This guide helps you sort out what is going on, which medications deserve a second look, how capacity and a health care proxy work in New York, and who should be on the team.

Is it depression, dementia, or something else?

Families usually call because something has changed: a parent who stopped seeing friends, repeats questions, sleeps all day or seems confused. Several very different problems can look alike at first, and some are treatable.

Depression is common, but not a normal part of aging

The National Institute on Aging (NIA) is clear that depression is common among older adults but is not a normal part of aging, and that most people improve with treatment. It can be hard to spot. Some older adults do not report sadness; instead they feel numb, lose interest in activities, or are less willing to talk about feelings. Trouble concentrating, remembering or making decisions is itself a symptom of depression, which is one reason depression and early dementia get confused.

Dementia and depression overlap

Depression is common in people with Alzheimer's disease and related dementias, dementia can cause some of the same symptoms as depression, and depression can be an early warning sign of possible dementia. In practice that means an evaluation should look at both, rather than assuming one explains everything.

Treatable causes of memory problems

The NIA lists factors other than dementia that can cause memory problems, which often improve once the cause is treated:

• Medication side effects
• Thyroid, kidney or liver problems
• Low vitamin B12 or poor nutrition
• Depression, anxiety and other mental health conditions
• Alcohol or drug misuse
• Sleep problems
• Head injury, or blood clots, tumors or infections in the brain

Major stressful events, such as retirement or the death of a spouse, can also leave people confused or forgetful for a while. The guide to medical conditions to rule out before a psychiatric diagnosis covers the workup in more detail.

The NIA also flags asking the same questions repeatedly, getting lost in familiar places, and no longer bathing or eating properly as signs it is time to talk with a doctor. A sudden change over hours or days, rather than months, needs prompt medical attention rather than a routine appointment.

Start with primary care and Medicare's cognitive checks

For a parent on Medicare, the yearly wellness visit includes a cognitive assessment to look for signs of dementia and a review of current prescriptions. If the provider suspects a problem, Medicare Part B covers a separate, more thorough visit to review cognitive function, examine the medication list, identify caregivers and supports, create a care plan, help with advance care planning and refer to a specialist if needed. A family member can attend to help answer questions.

That visit is often the best first step because it brings in labs, imaging decisions and the full medical picture. It also sets up the right referral, whether to a neurologist, a geriatrician, a geriatric psychiatrist or a general psychiatrist. The NIA notes that a provider may recommend a neurologist when memory problems need further evaluation.

Medications: the Beers Criteria and polypharmacy

The American Geriatrics Society (AGS) Beers Criteria is a widely used list of potentially inappropriate medications that older adults should usually avoid, or use only with care, in certain situations. The 2023 update applies to adults 65 and older in outpatient, hospital and long-term care settings, but not hospice or end-of-life care, and the AGS stresses that it supports rather than replaces shared decision-making with a clinician. Several entries involve common psychiatric and sleep medications.

The criteria also warn about combinations. For someone with a history of falls or fractures, they advise avoiding antidepressants, antiepileptics, antipsychotics and benzodiazepines unless safer alternatives are not available, and they flag taking three or more central nervous system-active drugs together. Drug interactions on the list include lithium with certain blood pressure medicines (ACE inhibitors, ARBs and ARNIs) or loop diuretics, and warfarin with SSRIs.

Antipsychotic labels, including quetiapine's (Seroquel), carry an FDA boxed warning that elderly patients with dementia-related psychosis treated with antipsychotic drugs are at increased risk of death. One antipsychotic, brexpiprazole (Rexulti), is FDA-approved for agitation associated with dementia due to Alzheimer's disease; it carries the same boxed warning and is not approved for as-needed use.

A flagged medication is not automatically wrong for your parent; the list itself says it should be applied thoughtfully. The safest move is a full review with the prescriber, never stopping a medication on your own, because continued use of some, including benzodiazepines, can lead to clinically significant physical dependence, so any change needs a plan. The guide to sleep medications compared discusses alternatives, and the checklist for preparing a medication history works well for an older parent: bring every bottle, including over-the-counter sleep aids and supplements.

Capacity, consent and a New York health care proxy

New York law defines capacity to make health care decisions as the ability to understand and appreciate the nature and consequences of those decisions, including benefits, risks and alternatives, and to reach an informed decision. Memory problems do not automatically remove that ability, and a parent who can still decide keeps the right to do so.

The time to plan is while your parent can still choose. Under New York's health care proxy law, any competent adult can name a health care agent (and an alternate) by signing in front of two adult witnesses; no lawyer or notary is needed, and the agent cannot be a witness. The agent starts deciding only after the doctor determines the person can no longer make health care decisions. A proxy does not cover finances; that needs a separate document such as a power of attorney.

If there is no proxy and your parent loses capacity, New York's Family Health Care Decisions Act sets a surrogate priority list for decisions about care in a hospital or nursing home and about hospice care: a court-appointed guardian with health care authority, then a spouse (if not legally separated) or domestic partner, an adult child, a parent, an adult sibling and a close friend. That can produce conflict among siblings, which a proxy avoids. The guide to psychiatric advance directives and health care proxies in New York explains the details. This is general information, not legal advice; an elder law attorney can help with guardianship, finances and complex family situations.

What clinicians can tell you

Under HIPAA, when an adult patient is present and has capacity, a clinician may share relevant information with family members involved in their care if the patient does not object. When the patient is not present or is incapacitated, the clinician may share what is relevant if, in their professional judgment, it is in the patient's best interest. Ask your parent, while they are well, to tell their doctors that you may be involved.

Who should be on the team

Whatever the mix, the clinicians need to talk to each other. The guide to how a psychiatrist and primary care doctor should work together covers releases, shared medication lists and lab results. To confirm a clinician's subspecialty, see how to check a psychiatrist's license and board certification.

Safety comes first

Older adults with depression may not say they feel hopeless, and the NIA warns that untreated serious depression can lead to suicide; suicide attempts may also increase in people recently diagnosed with dementia. If you are thinking about suicide or are in crisis, call or text 988 (the 988 Suicide & Crisis Lifeline) or go to the nearest emergency room. The same applies if your parent says they want to die, has a plan, or is suddenly confused and unsafe. Firearms and stockpiled medications in the home deserve a direct conversation.

Support for you as the caregiver

The NIA lists caregiver stress among the factors linked to depression. Arranging appointments, managing pills and absorbing a parent's changes is real work. Practical steps:

• Use the federal Eldercare Locator from the Administration for Community Living, or call 1-800-677-1116, to find local Area Agencies on Aging and services that help older adults stay at home.
• Split tasks among siblings in writing: one person handles medications, another finances, another appointments.
• Keep one up-to-date medication list and share it with every clinician and the pharmacy.
• Get your own support. The practice's article on vicarious trauma and protecting a caregiver's mental health is written for people in this role.

If your parent is reluctant to see anyone, the guide to helping an adult family member start psychiatric care offers ways to raise it without a standoff.

Questions to ask any psychiatrist for an older parent

• Do you have geriatric psychiatry training or regularly treat people in their seventies, eighties and beyond?
• Will you review the whole medication list, including drugs from other doctors, against the Beers Criteria?
• How will you tell depression from early dementia, and what tests or referrals do you use?
• How will you communicate with the primary care doctor and with family?
• What non-drug approaches do you use for sleep, anxiety or agitation?
• Do you see patients by telehealth if travel is hard, and are you in network with Medicare?

How this practice fits

Dr. Lewis is board certified in adult psychiatry, child and adolescent psychiatry and integrative medicine; the practice does not describe a geriatric psychiatry specialty. Its ongoing care includes psychiatric evaluation, medication management, psychotherapy and lab testing, which can suit an older adult whose main problem is mood or anxiety and who already has a primary care doctor managing memory concerns. All of the practice's clinicians are out of network with all insurance plans, including Medicare and Medicaid, so a parent relying on Medicare should read Medicare and out-of-network psychiatrists and the insurance and payment page first. If you need care that is in network with your plan, ask the team on the discovery call about options. For other settings and specialists, return to the guide to choosing psychiatric care.

Frequently asked questions

What is the difference between a geriatric psychiatrist and a geriatrician?

A geriatric psychiatrist is a psychiatrist with extra training in older adults' mental health, including depression, anxiety, psychosis and behavior changes in dementia. A geriatrician is an internal medicine or family medicine doctor who specializes in the overall medical care of older adults. They often work together.

My mother takes diphenhydramine every night for sleep. Should she stop?

Do not stop or change anything without her prescriber. The AGS Beers Criteria lists first-generation antihistamines such as diphenhydramine as medications older adults should generally avoid, so it is a good question to raise at her next visit, along with alternatives.

Can depression make my father seem like he has dementia?

Depression can cause trouble concentrating, remembering and making decisions, and the two conditions overlap. Depression can also be an early sign of dementia. A careful evaluation looks for both, and for medical causes such as thyroid problems, low vitamin B12 or medication side effects.

Can I make medical decisions for my parent if they become confused?

Only if you have legal authority. In New York, a health care proxy signed while your parent still had capacity names an agent who decides once a doctor finds they cannot. Without one, for care in a hospital, nursing home or hospice, the law sets a priority list of surrogates. Financial decisions need separate documents.

Does Medicare pay for a memory evaluation?

Medicare's yearly wellness visit includes a cognitive assessment, and Part B covers a separate, more detailed cognitive assessment and care planning visit if a problem is suspected. Costs depend on the provider and your coverage, so ask before the visit.

Is telehealth reasonable for an older parent?

It can be, especially for follow-up visits, if someone can help with the technology and the parent can speak privately. A first memory evaluation usually needs in-person examination and testing, often through primary care or a specialist clinic.

Sources

1. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society (PubMed 37139824), 2023. pubmed.ncbi.nlm.nih.gov
2. Depression and Older Adults. National Institute on Aging, 2025. nia.nih.gov
3. Memory Problems, Forgetfulness, and Aging. National Institute on Aging, 2023. nia.nih.gov
4. SEROQUEL (quetiapine) prescribing information, boxed warning. U.S. FDA label via DailyMed, 2025. dailymed.nlm.nih.gov
5. REXULTI (brexpiprazole) prescribing information. U.S. FDA label via DailyMed, 2026. dailymed.nlm.nih.gov
6. Geriatric Psychiatry: Subspecialty Certification. American Board of Psychiatry and Neurology, 2026. abpn.org
7. Cognitive assessment & care plan services. Medicare.gov (CMS), 2026. medicare.gov
8. Yearly "Wellness" visits. Medicare.gov (CMS), 2026. medicare.gov
9. Health Care Proxy: Appointing Your Health Care Agent in New York State (Form 1430). New York State Department of Health, 2022. health.ny.gov
10. New York Public Health Law Section 2980: Definitions. New York State Senate (NY statutes), 2026. nysenate.gov
11. HIPAA Privacy Rule and Sharing Information Related to Mental Health. U.S. Department of Health and Human Services, Office for Civil Rights, 2026. hhs.gov
12. Eldercare Locator. Administration for Community Living (HHS), 2026. eldercare.acl.gov
13. New York Public Health Law Section 2994-D: Health care decisions for adult patients by surrogates. New York State Senate (NY statutes), 2026. nysenate.gov
14. New York Public Health Law Section 2994-B: Applicability; priority of certain other surrogate decision-making laws and regulations. New York State Senate (NY statutes), 2026. nysenate.gov

Educational information, not medical, tax or legal advice. Decisions about diagnosis, medication and treatment belong with a clinician who knows your history.