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Review explores changing field of geriatric psychiatry

Changing mental health treatments for older adults in the United States are due to the aging population, shifting diagnostic criteria and new health care policies, according to an editorial in the Harvard Review of Psychiatry.

“Both workforce shortages and fiscal pressures have presented obstacles to caring for the behavioral health needs of our elderly. Furthermore, older adults have tended to seek mental health treatment in primary care rather than specialty care services, creating a need for greater psychiatric expertise in these settings,” James Ellison, MD, MPH, of Christiana Care Health System, Wilmington, Delaware, and Brent Forester, MD, of McLean Hospital, Belmont, Massachusetts, wrote.

A special issue of the Harvard Review of Psychiatry addresses the transformation of the field of geriatric psychiatry, including the following topics:

• changes in health care landscape, including 9 initiatives that create opportunities to assess and treat older adults with mental health disorders and for funding outcomes-based research;
• the role of telehealth, smartphone health apps and social media in improving outcomes while reducing costs;
• new diagnostic criteria, particularly the recently revised DSM-5 and an in-depth look at the new category of mild neurocognitive disorder;
• age-related differences in prevalence and characteristics of anxiety disorders;
• approaches that address late-life depression;
• causes of psychosis, which are often related to underlying medical or neurological conditions; and
• management of behavioral and neuropsychiatric symptoms among older adults with Alzheimer’s disease or other neurocognitive disorders, including alternatives to antipsychotic medications.

“As the age of our population continues to increase, the mental health needs of the elderly will become a matter of clinical importance not only for the scarce specialists in geriatric psychiatry but also for other psychiatrists, primary care providers, and geriatricians. This special issue provides a brief, but insightful, glimpse into the evolution of an increasingly important area of clinical care, with evidence-based and practical guidance,” Ellison and Forester wrote. – by Amanda Oldt

Disclosure: Please see the full study for a list of all authors’ relevant financial disclosures.