Mood Disorders in Later Life PDF

Preface

The high prevalence, frequent recurrence, and serious consequences of mood disorders among young and middle-aged adults are well recognized. The effects of mood disorders on older adults, however, have been less widely appreciated. Although demographic studies indicate a low-point prevalence of major depressive disorder and even lower prevalence of bipolar disorder among communitydwelling elderly cohorts, the clinical significance of mood symptoms is high among the elderly, especially in medical and institutional settings. Mood disorders represent a major disease burden in later life, contributing to suffering, functional impairment, medical disability, and excess mortality. Not only suicide risk but also morbidity and mortality appear to be increased in the presence of late-life mood disorders.

Given the aging of the American population and the enhanced survival of medically compromised elders, it is increasingly important that clinicians know how to evaluate and treat late-life mood disorders. At present, however, even recognition of these conditions is too limited. Seniors may minimize their psychologic distress and focus more directly on somatic or cognitive concerns, inadvertently obscuring the correct psychiatric diagnosis. Primary care clinicians-the health care providers likely to see the greatest number of affected elderly individuals and therefore most in need of evaluation and management skills cognizance-frequently miss the correct diagnosis. Even when the proper diagnosis is made, elderly patients who present mood symptoms to a primary care physician are less likely than younger ones to receive appropriate treatment and adequate follow-up care. Mental health specialists, too, have shown a limited degree of recognition of mood disorders among older patients. The need is apparent, therefore, for greater clinician awareness of the spectrum of unipolar and bipolar disorders in the elderly, from milder to more severe syndromes, as well as for education of the public, with particular focus on the family members and caregivers of older adults suffering from mood disturbances.

The literature on treatment of late-life depression has grown to include many treatment studies, while the literature on late-life bipolar disorder is still sparse. For both types of disorder, our therapeutic approaches still contain many areas of uncertainty. Treatments for mood disorders among the oldest old, the medically ill, or the demented, for example, have received much less attention than treatment of younger, medically healthier older adults. Beyond effects on symptom alleviation, we still know too little about how treatment affects quality of life. Furthermore, we need to understand more about how to integrate somatic therapies with psychotherapeutic approaches, now recommended by experts as an important treatment modality for late-life depression and bipolar disorder.

With invaluable contributions from noted experts, we have tried in this volume to present a comprehensive and current picture of late-life mood disorders. This collection of essays is intended for use by all clinicians who evaluate and treat elderly individuals with clinically significant mood symptoms. Psychiatrists and other mental health specialists as well as primary care clinicians should find in its pages information that is both up-to-date and practical. In addition, we along with the other contributing authors have attempted to present these important illnesses and their treatments in a larger context, highlighting currently available and evolving approaches to treatment and identifying areas in need of further investigation. It is our earnest hope, through the publication of this book, to increase professional and public awareness of late-life mood disorders, to disseminate the most current knowledge, to help identify areas for further inquiry, and ultimately to add our work to that of others dedicated to improving quality of life in the later years.