Late Life

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May, 2017. In 1999, a group of experts in geriatric psychiatry published a “Consensus statement on the upcoming crisis in geriatric mental health,”1 forecasting that the number of people older than 65 years with psychiatric disorders in the United States will have increased from about 4 million in 1970 to about 15 million in 2030, a rise of 275%. Higher risks of anxiety and depression are expected, and the authors of this statement argued that the “current health care system serves mentally ill older adults poorly and is unprepared to meet the upcoming crisis in geriatric mental health.”(p848)
One year later, this journal published (posthumously) a wonderful article by the late Heinz Lehmann on “Successful cerebral aging,”2 in which he stated that “all successful aging is cerebral” and that a “dysfunctional brain is an exclusion criterion for successful aging.”(p33) Lehmann, though warning about “chronic stress dysphoria” and the increased risk for depression in the elderly, made the delightful argument that “the mind is the great compensator for the inevitable decline of the organism” and that “the mental function of the brain—the mind—ages least and matures best in the human organism … often reaching a pinnacle of experience, judgment, and wisdom in old age.”(p34) In my opinion, Lehmann exemplified this principle, remaining active until his death at age 89, and he was among the pioneers encouraging us to focus not just on pathology but on wellness and resilience. Today, almost 20 years later, there is growing recognition of the crucial need to adapt to the life cycle with acceptance and even optimism. One recent example of this recognition is the development of standardized scales to measure wellness, such as a new scale called the Multidimensional Individual and Interpersonal Resilience Measure being developed by Jeste and colleagues.3 The Multidimensional Individual and Interpersonal Resilience Measure assesses the following items: (1) self-efficacy, (2) access to support network, (3) optimism, (4) perceived economic and social resources, (5) spirituality and religiosity, (6) relational accord, (7) emotional expression and communication, and (8) emotional regulation.
In this issue of the journal, Shrestha and colleagues present the design and a progress report on a study called “Calmer Life,” described as a hybrid effectiveness-implementation trial for late-life anxiety. This well-designed study aims squarely at one of the prominent problems in late life, and its focus is on low-income communities that are underserved by mental health providers and services. The authors point out that, although anxiety disorders are common in older adults, they often go unrecognized, perhaps particularly so in underserved populations. In response to recommendations from the National Institute of Mental Health and the Institute of Medicine, the study emphasizes the use of nontraditional mental health care providers, and carefully measured assessment of the effectiveness of these providers will be very important to potentially increase access to mental health care. The Calmer Life study is person-centered, involves partnerships with community organizations, and includes attention to basic unmet life needs that interfere with resilience, coping, and successful aging.
It is a also a pleasure in this issue of the journal to present the winning paper in the journal’s annual resident paper competition. Fryml and colleagues report a series of 3 cases of withdrawal from a dopamine agonist, amantadine, which is selectively used in the treatment of conditions such as Parkinson disease, neuroleptic malignant syndrome, and drug-induced extrapyramidal reactions.
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