Citizen Kane as senior citizen. A mental health perspective.
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Biomedical subjects
Publications and source records attributed to G D Cohen.
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Most dementias in old age are characterized by a progressive course with interindividual variability in pattern and rate of progression. Developing a system for staging such dementia poses a challenge in capturing this variability in a system that will afford comparisons among individuals and predictions of future change. Several core questions underlie the development of such systems: (1) Is there a definable order in which abilities are lost? (2) Which skills and functions should be considered essential for the staging of dementia and what is their relative weight? (3) Can the different skills be captured within one staging system? (4) How is the whole range of function captured, and are the differences between stages clearly defined? (5) Which populations can be rated with each staging system? The determination of this last question is based on understanding which other medical conditions may interfere with the course of dementia and how prior characteristics, such as education, affect ratings on specific scales for the staging of dementia. Several systems for staging dementia in older adults are described. These include the Clinical Dementia Rating, the Global Deterioration Scale/Brief Cognitive Rating Scale/Functional Assessment Staging System, the Six Clinical Phases of Cognitive Decline, the Hierarchic Dementia Scale, and the Functional Capacity Scale. Some aspects of the utility of these systems are reviewed, and the issues for further research are discussed.
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The public debate on health care, as reported and carried on in the popular media, is frequently framed in terms of age. The assumption is that old age can be equated with high health care costs, and that increases in health care costs are determined solely by the growing numbers of older people in our society. A variety of studies suggest, however, that high-tech, high-cost care is not inevitably associated with advancing age. The public debate on health care must stop confusing demographic issues with health care cost issues, and focus instead on the real and complex problems of rising health care costs.
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