reduced physical health, increased mortality, suicide, high rates of hospitalization and nursing home placement, and high costs. The committee identified 27 MH/SU conditions that can have substantial negative effects on a person’s emotional well-being, functional and self-care abilities, and quality of life (Box S-2). Although available data do not support definitive prevalence estimates, the committee concluded that at least 5.6 million to 8 million older adults have one or more of these conditions—about 14 to 20 percent of the overall elderly population. Depressive disorders and dementia-related behavioral and psychiatric symptoms are the most prevalent. Serious mental illness—including schizophrenia and bipolar disorder—is less common, but has significant implications for the workforce and care delivery.

Many older adults who have MH/SU conditions also have acute and chronic physical health conditions, and some have cognitive and functional impairments. The interaction of physical health conditions, cognitive and functional impairments, and MH/SU conditions is a defining feature of the geriatric mental health and substance use fields and has critical implications for the workforce. The interaction of these conditions also results in difficult caregiving situations for families, physicians, and other health care professionals, and residential care and home- and community-based service providers. For example:

•   Age-related changes in the metabolism of alcohol and drugs, including prescription drugs, can cause or exacerbate alcohol and drug use conditions and increase an older person’s risk of dangerous overdoses, even for people who have used alcohol and drugs at the same dose and frequency for many years without serious negative effects.

•  Loss and grief are common in old age. The death of a spouse, partner, close relative, or friend can trigger or exacerbate depression and lead to severe, debilitating symptoms. Providers may find it difficult to distinguish major depression and grief when a patient is in the midst of a significant loss.

•  Medications to treat common acute and chronic physical health conditions in older people can cause and exacerbate MH/SU conditions and, conversely, medications to treat MH/SU conditions can cause or worsen their physical health conditions.

•   Cognitive and functional impairments can complicate the detection and diagnosis of MH/SU conditions. Cognitive impairment can also reduce an older person’s ability to comply with treatment recommendations, including medications prescribed for the person’s MH/SU and physical health conditions.

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