"Most people think that when you get older you're miserable, but depression actually goes down with age," says Dr. Lilian Thorpe, a geriatric psychiatrist with Saskatoon Health Region.
"Often, as we age, we accept ourselves much better than we have when we're younger, we're less self-conscious and we've learned adaptive skills. I know I'm happier now than I was in my teens," she adds.
Dr. Lilian Thorpe
Like many, Dr. Thorpe's teenage years were not lacking in excitement. At the age of 15, she moved across the world, from Australia to Canada, with her family when her father got a teaching job at the University of Regina. She would go on to complete an undergraduate degree in physics and math at the same university, followed by a Master of Physics and then a medical degree at the University of Toronto.
In medical school, she initially planned a career in pediatrics, but over time her interests evolved and she ended up in geriatric psychiatry, recently completing a term on the national sub-specialty committee. Today, Dr. Thorpe is fortunate to be part of a small but dedicated group of geriatric psychiatrists in the province who work with this challenging but rewarding part of the population.
"The types of patients I see are quite complex," Dr. Thorpe says, explaining that geriatric psychiatry is not just about diagnosing and treating mental disorders in people who have grown older. "In addition to cognitive impairment, the elderly patients I see have physical co-morbidities like heart disease, lung disease, arthritis, mobility challenges and hypothyroidism. I generally don't see an 80-year-old with depression and no physical problems, but I do see someone who, at 55, has early onset dementia.
"It's a very rewarding specialty," she adds," because it's often extremely successful in improving people's quality of life."
She recalls one patient who she met in hospital who appeared to have end-stage dementia until her team was able to meet with the patient and make a diagnosis.
"This person had recently had surgery, was taking a lot of medications, was not speaking to people and was hardly eating," she says. "One of my residents spent a lot time with her, and we discovered that she was depressed. We prescribed an antidepressant and made changes to the medication she was taking. Within two weeks, she was talking, walking and eating. She came off the long-term care list and went back into independent living."
For Dr. Thorpe, it's not uncommon for a single patient assessment to take up to a few weeks to complete in order to meet with the patient, usually for two to three hours; review their chart, which could be up to 200 pages long; and consult with nurses, physicians, family members and other care providers about the patient's current state, prior to making a diagnosis and developing a treatment plan.
Of particular interest to Dr. Thorpe is the relationship between intellectual disabilities and ageing. In 2013, she completed a 16-year longitudinal study throughout the province about age-related changes in adults with intellectual disabilities like Down syndrome.
"I wanted to study this group because there's not much in terms of long-term follow up of people with intellectual disabilities throughout the ageing process," she says. "It's currently a big issue because people with intellectual disabilities are living longer and group homes are not set up to deal with their medical co-morbidities (for example, Down syndrome and Alzheimer's in the same person) as they age."
Dr. Thorpe says that one of the most unexpected lessons she learned from the study was that friendships are probably the most important part of life for all people, including those with intellectual disabilities.
"We're social beings," she says, "so when you move someone from a group home, where they've lived for a long time, to a long-term care facility, where they don't know anybody, it impacts their quality of life. I already knew that there would be increased mortality in people with intellectual disabilities, but learning about the importance of friendship and the challenge of trying to maintain that throughout the ageing process was really interesting."
Shortly before beginning the study, Dr. Thorpe realized that she required more training in data and statistical analysis, so she completed a PhD in Community Health and Epidemiology while the study was ongoing.
"I like knowing that my brain is growing. It's a wonderful thing to be learning new things all the time," she says. "Right now I'm very interested in medical assistance in dying and how we can make it work."
Dr. Thorpe currently sits on the ethics subcommittee for medical assistance in dying (MAID) and teaches staff about this new process.
"We've been doing a lot of workshops both within the acute care system with doctors and nurses, and in other areas. It's been quite effective. People in our health region are starting to have a much better idea of what it's all about," she says, adding, "The most important lesson I teach is that medical assistance in dying is part of a continuum of care – it's just one of many possibilities at the end of life."
Dr. Thorpe says her motivation for becoming involved in MAID was "to make sure that it would be done in a really ethical way that respects the rights of people, including those who have disabilities."
Her interest in ethics is a direct result of having grown up with parents who lived in Germany during the Holocaust, where it was rare for anyone not to have experienced the state-sanctioned murder in death camps of someone close to them.
"Hitler's Germany designed a lot of those camps for people with disabilities and mental illnesses who it was thought would never get better – and this went on to include Jews and others – so I grew up very preoccupied with the awful things people can do to each other."
"I've always felt very strongly that to be in medicine, we have to stay in touch with our ethics," she continues. "We have to be willing to consider what we're doing, to have dialogue about it and to have it questioned. My father has always said that you should never believe anything so strongly that you're not willing to change your mind when the right evidence presents itself."
Dr. Thorpe says that being involved in MAID has changed her on a fundamental level.
"It's impacted me as a person in a very emotional way that I don't think anything else ever has," she says. "You connect with people at a visceral level when they're looking at dying. You can't separate yourself from that, and you start to look at your own mortality – what it means to be alive, what it means to die. If I were to die in 20 days, what would be important to me? Is it earning more money? Having a bigger house? Is it how long I live? Or is it how I live? Often, there are no easy answers to these questions."
For Dr. Thorpe, being able to interact with people – her family, patients, colleagues and students – is what gives meaning to her life.
"I like having that connection with patients and students," she says. "Teaching is very two sided – I learn as much from my students as they do from me.
"I always want my brain to be open to learning new things the way my father still is," she continues. "He's 86 and very lively. He can still give lectures about the life of oceans and everything to do with the environment. He reads every day. He's on the Internet and communicates with people in all kinds of places. It's important to keep learning, because that's the way your mind stays fresh – is by staying open to new experiences."
Dr. Thorpe says that one of the most important things we can do to keep our minds intact as we age (dementia is caused by brain cell deterioration) is to be physically active and to eat a healthy diet throughout life.
"There's sophisticated imaging of the brain showing that those who exercise have more regeneration of brain cells in their hippocampus," she explains. "Obesity leads to Type II diabetes, and Type II diabetes is associated with dementia, so having reduced rates of obesity and being more physically active is probably going to do more for decreasing dementia rates than anything else.
Dr. Thorpe says that for her, the key to happiness is living in the moment.
"Every phase of life I'm in is always the best. I love what I'm doing, and I'm willing to change what I'm doing if it's not giving me pleasure. I'd like to be better at computer programming," she says as an example of a new initiative she'd like to take on.
"I also might get involved in community orchestra again," she adds, explaining that she played a penny whistle in an Irish band for many years because of her love for the Chieftains, a traditional Irish band formed in Dublin.
"Music has always been a big part of my life. I sung in an orchestra when I was younger, and all my kids took music lessons," she says of her three daughters, who, among them, have played the piano, obo, clarinet, classical guitar and taken voice lessons.
"My husband and I are blessed to have three healthy, happy kids who are all ethical human beings who care about the world and people, and are doing really worthwhile things," she says proudly of her daughters – her eldest is a nurse who works with people with intellectual disabilities, the middle is studying to be a pediatrician and her youngest is an actor and social activist.