May 21, 2001 -- As America continues to get grayer, much
research is looking at ways to increase seniors' quality of life through
physical means, such as weight-resistance training and Tai Chi. But a growing
group of professionals are concerned for the mental health of seniors and the
question of who will care for them if they develop a psychiatric condition.
"With medical advances and improvements in lifestyle and
public health, many more people are entering old age and experiencing problems
that weren't as prevalent in years past," says Joseph D'Afflitti, MD,
medical director of the Mount Auburn Hospital Wyman Center in Cambridge,
Brenda Della Casa had been seeing her primary care physician for two years
and had brushed off her concerns about getting rushed care - until she had a
health scare she couldn’t ignore. She told her doctor she was experiencing
terrible back pain and stomachaches. Her doctor checked her, said she was fine,
and sent her on her way.
Five days later, Della Casa, an author and dating coach in Chicago, was
traveling and had pains so severe she could barely move. When she received a
"The prevalence of dementias is much greater now because we
are exposed to degenerative changes in the brain as we age," he says.
"We are also better able to define, diagnose, and describe psychiatric
disorders including dementias, depression, and delirium."
Is There a Specialist in the House?
According to the American Association for Geriatric Psychiatry
(AAGP), nearly 20% of those who are over 55 years old experience mental
disorders that are not part of normal aging. The most common disorders are
anxiety, impaired thinking ability, and mood disorders. Several studies show
that mental disorders in older adults are underdiagnosed.
Alarmingly, those who do have psychiatric conditions often
don't receive treatment. A 1997 study from the National Institutes of Mental
Health found that only half of older adults who acknowledge mental health
problems receive treatment from any healthcare provider, and only a fraction of
them receive specialty mental health services. Most receive mental health care
from their primary care physicians.
"Never would we say that older people should only see a
geriatric psychiatrist," says Gary Kennedy, MD, president-elect of AAGP.
"Most will do just fine with a generalist. But we are not training enough
Specialists in geriatric psychiatry are necessary, he says, to
sustain faculty that can provide training to others and to engage in research.
Geriatric psychiatrists are also invaluable team players who work closely with
primary care doctors on complex cases.
"Treating older adults is more complicated because of
coexisting medical conditions. They are more sensitive to medications and their
side effects, and they are taking multiple medications, increasing the risk of
drug-drug interactions," explains D'Afflitti, a clinical instructor of
psychiatry at Harvard Medical School.
Older Americans, according to the AAGP, account for only 7% of
all inpatient mental health services and 9% of private psychiatric care, even
though they currently represent 13% of the population -- a number that is
expected to grow significantly in the coming decades. The association says this
underutilization is in large part due to the stigma of mental illness, denial
of a problem, barriers to access, funding issues, and shortages of appropriate