MENTAL HEALTH SERVICES

There is growing interest in the older person's use of mental health services, with some researchers noting that older persons seem to use fewer mental health services than do younger persons (German et al., 1985; Leaf et al., 1985; Borson et al., 1986; German et al., 1987; Goldstrom et al., 1987; Lurie and Swan, 1987). The need to understand the older person's use (or nonuse) of mental health services is important for several reasons: (1) the high incidence of dementia in the older population, (2) the high prevalence of mental impairment of older persons in nursing homes, and (3) the high prevalence of alcohol abuse or dependency among older persons admitted to county or state mental hospitals. In the community 10 to 25 percent of older persons have some degree of mental impairment. Among men, the incidence of suicide dramatically increases with age. In short, mental illness is common in older persons, but often is untreated. Research is needed to investigate how older persons use mental health services and why. Of particular interest are the effects of race, gender, and social status on service utilization.

Alzheimer's disease is widely recognized as the major mental health problem of the older population, but little is known about its epidemiology and treatment. Of particular interest is the delineation of risk factors associated with dementia. Depression is another common problem of late adulthood; yet because there is little agreement on the definition of this condition, depression in older people may not be recognized widely. From a health services perspective, innovative methods for the treatment of depression that are acceptable to older persons should be developed and evaluated.

Our understanding of the less common clinical problems of aging—schizophrenia, bipolar disease, and other psychotic conditions—is very limited. Research is needed to examine both those who develop a psychotic condition, such as paranoia, in older age and those who were diagnosed with such disorders earlier in life. Even where our knowledge base is firm, clinicians providing the bulk of services to older persons may not recognize the signs and symptoms of major mental illness.

Investigation is critically needed on mental illness in special populations of older persons. Little is known, for example, about the mental health status or needs of older persons who are members of minority groups. Of the older population, those who are institutionalized have the least understood but highest prevalence of mental disorders (National Institute of Mental Health, 1988). We do not know what services are available to this group, nor do we know what services are needed or how they should be financed. Research also is



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