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    Age-Old Medicine

    Matters of the Mind

    WebMD Feature

    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, Mass.

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    "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."

    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 health professionals.

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