Wednesday, August 28, 2019

Psychiatrists Offer Recommendations to Help Older Adults With Mental Disorders

As the percentage of U.S. adults older than 65 years continues to grow, so too does the need for preventing mental illness among older adults as well as improving clinical services and outcomes for older patients with psychiatric disorders. So said psychiatrists Warren D. Taylor, M.D., M.H.Sc., of Vanderbilt University Medical Center and Charles F. Reynolds III, M.D., of the University of Pittsburgh in an article published today in JAMA Psychiatry.

“There will never be enough geriatricians, so we need collaborative approaches that allow us to improve treatment and reduce disease burden,” Taylor and Reynolds wrote. “Research in these areas requires transdisciplinary and translational team-based science, where psychiatrists and psychologists work with geroscientists, implementation scientists, and social scientists.”

They outlined several areas of emphasis for research that could help reduce the burden of psychiatric illness in older adults:

  • Expand suicide prevention efforts, including early identification of those at greatest risk. Despite a rise in suicide rates in other populations, older adults have the highest risk of suicide completion, they noted.
  • Develop strategies to prevent the recurrence of psychiatric disorders such as mood and anxiety disorders, which are common in older populations. “While we have substantial information about the acute treatment of these disorders, we know far less about how to keep someone well and avoid future episodes,” they wrote.
  • Determine best ways to treat older patients for substance use disorders. This includes careful consideration of possible untreated general medical conditions and risk of cognitive impairment in these patients.
  • Continue to investigate the impact of mental illness on general medical disorders. “Beyond addiction, other mental disorders negatively affect the outcomes of medical disorders, including cardiovascular disease and diabetes. Further research is needed to elucidate the biological mechanisms underlying these observations and to identify specific targets where intervention may improve both mental and physical prognosis,” they wrote.
  • Elucidate the contribution of mental disorders to cognitive decline and dementia risk. Depression and other mental disorders accelerate cognitive decline and increase risk of dementia. The mechanism underlying this relationship remains unclear, which complicates efforts to reduce this risk and preserve long-term cognitive function in this population, they wrote.

Although “these challenges are daunting … [w]e have a moral obligation to care for the most vulnerable in our society,” Taylor and Reynolds concluded. “We need better research and clinical services focused on mental disorders in the elderly, along with integrated interventions promoting resilience, wellness, and successful aging.”

For related information, see The American Psychiatric Publishing Textbook Of Geriatric Psychiatry, Fifth Edition and the Psychiatric Services article “Gold Award: Providing Accessible, Affordable, and Stigma-Free Behavioral Health Care for Older New Yorkers.”

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