first, to describe what is known about the prevalence of mental health and substance use (MH/SU) conditions in older adults and their related service needs, and second, to consider the impact of population trends, particularly the aging of the baby boomer cohort and growing population diversity, on the makeup of the older population and future needs for MH/SU services.

The first two sections of the chapter describe the MH/SU conditions that occur in older adults and present the best available information about the proportion and number of older adults that have one or more of the conditions. The third section provides information about prevalence rates for important subgroups of the older population, including racial and ethnic groups and veterans. Later sections describe the coexisting physical health conditions and cognitive and functional impairments that shape the MH/SU service needs of older adults; review the impact of MH/SU conditions; and discuss the available data on use of MH/SU services by older adults and factors that could affect their future MH/SU service needs. The last section summarizes the chapter findings about the current and future MH/SU service needs of the older population. Unfortunately, much of the information required to analyze their MH/SU service needs and plan for a workforce capable of meeting those needs is not available. Additional information needed for these purposes is discussed.


The Institute of Medicine committee identified 27 MH/SU conditions for attention in this report because of their importance in older adults and their implications for service needs and workforce requirements. Fifteen of the conditions, including two substance use conditions, are defined by explicit criteria in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR) (APA, 2000), the accepted source for diagnostic classification of MH/SU conditions in the United States. These conditions are referred to as mental disorders in this report. The other 12 conditions are symptoms or clusters of symptoms not classified as mental disorders in DSM-IV-TR. These conditions are referred to as other MH/SU conditions in the report.

Two of the 15 DSM-IV-TR mental disorders, bipolar disorder and schizophrenia, constitute the core of a category of mental health conditions usually referred to as serious mental illness (SMI). SMI is often defined to include severe forms of other DSM-IV-TR mental disorders, such as major depression, but it does not include substance use conditions.

Box 2-1 describes each of the 27 MH/SU conditions identified by the committee, focusing primarily on symptoms. Descriptions of the 15 DSM-IV-TR mental disorders are taken from the DSM-IV-TR manual. Descriptions

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