I’ll try to answer the “who should care?” question in 2 ways. First, there is a national and global imperative to ensure the optimal mental health of older adults. This is because of an unprecedented demographic shift: most of us are living longer, and we are having fewer children. The result is that people 60 years and older will become an enormous segment of our global society. By 2050, they will be one-third of the population of developed nations and one-fifth of developing nations. This adds up to 2 billion seniors worldwide by 2050.
The implications of this demographic change for the importance of mental health care are staggering. On the one hand, if older adults are disabled, burdensome to caregivers, and frequent users of health care (which occurs when they are depressed, anxious, psychotic, or demented), the net burden on society will be tremendous. On the other hand, this demographic shift need not be a painful one. If effective mental health treatments help prevent or provide remission of mental health symptoms associated with aging, we can look forward to an era of productive old age.
For the second answer to “who should care?” my answer is “look in the mirror.” You’ll spot someone who (hopefully) will someday join the ranks of older adults, and (sadly) face illness, disability, and grief. Therefore, you may have to fend off or get treated for anxiety disorders, depression, dementia, and the like. It is thus a personal imperative to see that good geriatric mental health care is available.
Unfortunately, as the articles in this 2-part Special Report highlight, we are a long way from ideal care. Dr Meeks confronts the problems associated with atypical antipsychotics in older adults, problems that exemplify the clini-cian’s concern “am I doing more harm than good with these treatments?” These concerns in older adults have recently extended to SSRIs and similar antidepressants, in which elevated bone loss and fall risks seen in observational studies remind us that we cannot simply rely on data from industry studies done with young, healthy, and entirely unrepresentative samples.
We need to remember that depression, anxiety disorders, and psychosis, while different in many ways in older adults, are just as treatable as their corresponding disorders in young adults. As Dr Karp’s article illustrates, we are in a palliative and rehabilitative, not a curative, profession: we cannot cure, but we can and should bring our patients to remission!
For those still looking in the mirror with dread, we should remember that there are many positive mental aspects of aging. Older adults are the demographic with the highest levels of happiness. In Part 2 of this Special Report, to be published in the September issue, Dr Lavretsky reminds us that most seniors have resilience in the face of major life stressors, and we need to reassure our older patients that they have significant strengths (such as wisdom, a lifetime of experience, beliefs, and social support) that can be used when they need mental health care. As Drs Kiosses and Ravdin point out, problem-solving therapy and other therapies adapted for older adults can often help optimize these resilience factors.
Finally, cognitive dysfunction is considered to be a late-life consequence of type 2 diabetes. Dr Okereke discusses the 3 diabetes-related risk factors—obesity, insulin resistance, and the metabolic syndrome—that may be responsible for cognition difficulties in the elderly.
This Special Report gathers articles from talented clinicians/scientists who make up the present and the future of geriatric mental health research. Although the aging trend is described as “graying,” we should feel that the future in aging is bright.
