This interview is with Barbara Sparacino, MD, FAPA, Physician at The Aging Parent Coach, LLC.

Barbara Sparacino, MD, FAPA, Physician, The Aging Parent Coach, LLC

Barbara, could you please tell us a bit about yourself and your journey to becoming an expert in aging psychiatry?

I am a triple-board-certified physician, certified in adult and geriatric psychiatry by the American Board of Psychiatry and Neurology, as well as in addiction medicine by the American Board of Preventive Medicine. I currently reside in Miami, FL, with my family. I work for the Miami Veterans Administration Medical Center, where I am the medical director of a residential program, have a small private practice exclusively treating geriatric patients, and also am The Aging Parent Coach, helping adult children of aging parents navigate the transition from child to caregiver. I completed residency training in adult psychiatry at Temple University in Philadelphia and went on to complete a fellowship in geriatric psychiatry at the University of Miami.

What initially drew you to this specific field and the senior population?

I chose psychiatry knowing that I would subspecialize in geriatric psychiatry. I have always had a special connection to older adults, starting with my grandparents. Maybe it was because I was an only child, or maybe it was because my grandparents were educators, or both. I truly enjoy hearing older adults narrate stories of their lived experiences, and it is a privilege that they share them with me. This is an often-underserved and overlooked demographic. Many think of geriatric psychiatry and think of dementia, and while I do treat many patients & families who struggle with this, there are also many other concerns and problems to be addressed. Many times, they have more complex medical histories and presentations, and yet we all have a common and shared humanity.

Can you share a particularly rewarding experience you've had while working with an aging patient that highlighted the importance of addressing mental health in seniors?

One patient, who was struggling with what appeared to be early stages of dementia, came to me to address co-occurring anxiety. In treating the severe anxiety and what was later revealed to be depression, her functionality and quality of life significantly improved. This was what we call pseudodementia. Though she remains at increased risk to later develop dementia, she was able to fully re-engage in her life.

Many seniors face age-related cognitive changes. What is one practical tip you often give to family members to help them communicate effectively with a loved one experiencing these changes?

The most practical approach for communicating with folks struggling with cognitive changes is to limit conflict and limit overcorrection. It is not helpful to say, "Don't you remember I said this?" nor "You told me that already." It is very important to foster compassion with families and help them with understanding their aging family member's perspective and how scary and confusing cognitive losses can feel.

You mentioned providing written summaries for your patients. What other strategies have you found helpful in supporting patients with cognitive impairments who might struggle with traditional talk therapy?

I find that encouraging patients and families to maintain structure in their schedule helps them stay grounded and secure longer. Also, it is important that patients remain in their homes unless they are no longer able to live independently, as many times there is a brisk decompensation when they leave familiar surroundings. It is also important to avoid alcohol, benzodiazepines, cannabinoids, and other mood-altering substances as much as possible.

Caregiving can be demanding. What advice would you give to caregivers to prioritize their own mental well-being while caring for a loved one with age-related mental health concerns?

Caregivers have been identified as having high rates of burnout and depression. It is imperative that they make sure to not discount their own needs while supporting their aging family member. I offer tips for managing daily caregiving tasks and information on recognizing when professional help is needed.

There's often stigma surrounding mental health, especially among older generations. How can seniors overcome this stigma and seek help when needed?

We can help seniors overcome the stigma of seeking mental health assistance by providing education, as many may associate it with weakness rather than as a medical issue. It is important to normalize issues like depression, anxiety, and cognitive decline while using relatable language and emphasizing that seeking help is a strength, not a weakness. Illustrating how treatment can help them enjoy their favorite activities, maintain relationships, and remain independent can motivate them to seek care. Seniors, like all of us, are more likely to take advice from people they trust, such as family members, friends, or their primary care physician. Given that many seniors fear losing their independence, it is paramount to approach the subject of mental health in a way that respects their autonomy and emphasizes that seeking help is a proactive way to maintain control over their health and life.

Technology is rapidly evolving. Are there any technological advancements or resources that you believe are particularly beneficial for seniors' mental health, and how can they access them?

Recent studies suggest that prioritizing exercise is what is most impactful in delaying cognitive decline. Activity trackers can be a good way to motivate folks to move more. Also, these or other forms of trackers can be helpful in reassuring families of patients who are at risk for wandering. Also, the advancement and increased use of telepsychiatry has significantly decreased barriers to treatment for patients, particularly those who may be homebound.

Looking towards the future of aging psychiatry, what are you most hopeful about, and what advancements or changes do you hope to see in the field?

I am most hopeful about the newer medications in the treatment and postponement of dementia. The emerging data is quite positive. This, coupled with what we know about the value of exercise, can help folks decrease their risk of dementia.

Thanks for sharing your knowledge and expertise. Is there anything else you'd like to add?

Aging adults face unique challenges that often leave families feeling uncertain and stressed. Nearly 60% of seniors report feeling isolated, which can lead to a decline in mental and physical health. And 70% of aging adults worry they'll become a burden to their families.⁠⁠ I focus on strategies that help manage care logistics and also foster meaningful connections. When families come together with a plan that prioritizes both practical needs and emotional well-being, everyone benefits.⁠ It is important to create a support system that empowers our aging loved ones and brings peace of mind to the family.