Advanced Search

FOCUS, VOL. 7, No. 1

FROM THE GUEST EDITOR | December 01, 2009

From the Guest Editor

Barry Lebowitz, Ph.D.

FOCUS 2009;7:1-1.

Article

References

text A A A

Our population is growing older. Major investments in public health, sanitation, and therapeutics added nearly 30 years of life expectancy in the 20th century. When coupled with lower birth rates, this increase has led to the expectation that the proportion of older persons in the population (by convention, those aged 65 and older) will reach 20% by midway through the 21st century. Moreover, the older population itself is growing older, with people aged 85 and older representing the fastest growing segment. The same dynamic that has resulted in this remarkable growth of the older population in general has also contributed to the increase in prevalence of chronic conditions, leading to the worldwide pandemic of chronic disease and disability forecast by the psychiatric epidemiologist Ernest Gruenberg (1) three decades ago.

Much has been made of this demographic story and of the extreme heterogeneity of the older population. Social analysts discuss stresses on families and other societal institutions while at the same time they describe the robustness of intergenerational familial support. Pension systems and health insurance programs are described as being in danger because of the projected population increase, yet good health and affluence characterize many in the older population.

The biological processes of aging are, surprisingly, not well understood. One thing is clear, however: aging brings important changes, and some of these changes are often difficult to distinguish from the pathophysiologically based signs and symptoms of diseases common in older persons. Age of onset, always an important clinical consideration, assumes greater importance in diagnosis in older patients to differentiate acute exacerbations of long-standing illnesses from first-ever onset of a new illness.

Comorbidity of psychiatric illness with a broad range of chronic and acute physical illnesses and other brain disorders represents a second area of clinical significance. Multiple co-occurring conditions and the effects of complex and interacting polypharmacy regimens complicate diagnosis and treatment strategies and may compromise prognosis and long-term outcome.

Care of the older patient represents a special challenge because of the need to involve the family in the planning and delivery of the care. Geriatric specialists will typically report that they spend as much time with the family as with the patient. Family members, typically spouses or adult children, provide important clinical information and are essential in adherence to treatment. Psychoeducation and supportive interventions with the family often have beneficial effects for the patient (although reimbursement for such intervention can be difficult).

These demographic and clinical phenomena contribute to the challenge and to the excitement of caring for older patients with psychiatric illnesses. In this issue some important factors in approaching the older patient are addressed.

References

Gruenberg EM. The failures of success. Milbank Mem Fund Q Health Soc . 1977 Winter; 55( 1): 3— 24. PMID: 141009
[PubMed][CrossRef]

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.

Submit a Comments

Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of JBJS editorial staff.

* = Required Field

Comment Author(s)*(if multiple authors, separate names by comma)

Example: John Doe

Affiliation & Institution*

Comment Title*

Comment*

Cancel

Print
PDF
E-mail

Recipient(s) will receive an email with a link (good for 72 hours) to 'From the Guest Editor' and do not need to have FOCUS: The Journal of Lifelong Learning in Psychiatry account to access the content.
Your Name:*
Example: John Doe

Email Address:* CC Me:
Enter your valid email address. Example: jdoe@example.com

Recipient's Email Address:*
Separate multiple email address with semi-colons (up to 5).

Subject:* 's FOCUS: The Journal of Lifelong Learning in Psychiatry: 'From the Guest Editor'
Subject for your email.

Message:
(Optional, message will truncate at 1000 characters)

Processing your request... Please Wait...

Copyright © in the material you requested is held by The American Psychiatric Association (unless otherwise noted). This email ability is provided as a courtesy, and by using it you agree that you are requesting the material solely for personal, non-commercial use, and that it is subject to The American Psychiatric Association's Terms of Use. The information provided in order to email this topic will not be used to send unsolicited email, nor will it be furnished to third parties. Please refer to The American Psychiatric Association's Privacy Policy for further information.

Copyright © American Psychiatric Association. All rights reserved.
Share
Get Citation

Barry Lebowitz; From the Guest Editor. FOCUS: The Journal of Lifelong Learning in Psychiatry. 2009 Dec;7(1):1-1.

Download citation file:

RIS (Zotero)

EndNote

BibTex

Medlars

ProCite

RefWorks

Reference Manager

Copyright © American Psychiatric Association. All rights reserved.
Reprints