Education and training in geriatric psychiatry.
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Biomedical subjects
Publications and source records attributed to G D Cohen.
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The convergence of the biologic and psychodynamic arenas relevant to aging have ramifications for research, services, and aging policy. A few models pertaining to mental health aspects of physical health and illness in the elderly are given. Related research is noted and case examples illustrate the dynamic interplay between mental and physical factors.
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There is probably no area in which there has been more misinformation, inconsistency, and stereotyping than in discussions about the role and efficacy of psychotherapy with the elderly. In this paper the author attempts to lay the foundation for an improved perspective on psychotherapeutic work with older people. He reviews concepts, techniques, process, and historical views as they relate to psychotherapy in later life.
Burgeoning interest in geriatric psychiatry has created a challenge of optimally fitting geriatric content into already crowded psychiatric residency curricula. The authors review general considerations in geriatric psychiatry training and describe a brief clinical rotation for working with the elderly. The brief rotation is not presented as the ideal way of imparting geriatric psychiatry skills, but as an effective use of limited time to improve one's approach to the older patient. The clinical rotation enables the resident to learn more about psychiatric issues in later life, as well as to acquire a better perspective on other parts of the life cycle and on other aspects of psychiatry.
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The author examines mental health issues related to the elderly from the perspective of the options for immediate impact on treatment. He stresses the potential for creative collaboration between public and private mental health care systems. Myths, stereotypes, and misinformation about the aged are discussed, as are the positive. The author also describes an innovative model of service delivery in the treatment of older individuals.
The authors identify certain essential elements and processes within the milieu therapy approach that could provide the basis for reimbursement of this treatment modality under insurance. They also examine a philosophical framework, various guidelines, and a mechanism for accountability in the use of this form of treatment.
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Racial, ethnic, and cultural factors influencing mental health in later life are important to study in their own right. However, they also offer an opportunity to expand our understanding of mental health and mental illness in older adults independent of race, ethnicity, or culture. Any time an opportunity arises to examine a problem from a different perspective, chances increase that new light will be shed on the problem. For example, while suicide is greatest in older Americans compared with any other US population group, it is less frequent in older blacks than older whites. Why? Among the different theories that have been advanced, one holds that older African Americans in reaching later life have surmounted more threats to self-esteem (compared with whites) and are thereby better adapted to new challenges associated with aging. Still, the discrepancy in suicide rates between older blacks and whites remains an important research question. In studying suicide with attention to racial and ethnic variables, the opportunity presents itself to gain a more fundamental understanding of suicide itself--to the benefit of all older adults, indeed to the benefit of all age groups. This paper focuses on some African American issues pertinent to geriatric psychiatry and identifies areas for further research. In addition to a selected literature review, the author draws on his own research from a 20-year longitudinal study, initiated in 1971, of a senior citizens' apartment building in Washington, DC, with a predominantly African American population.(ABSTRACT TRUNCATED AT 250 WORDS)