Gary S. Moak

Treatment of Late-Life Mental Disorders in Primary Care: We Can Do a Better Job

Health care services provided to older adults today are not as effective as they should be. The quality of care for late-life mental disorders often falls short of desired standards. The growth of the elderly population makes it imperative for the health care system to address late-life mental disorders more effectively. Intervention strategies based in primary care settings show the most promise, but effectiveness will depend on solving the geriatric psychiatry workforce crisis. Collaborative care is one promising model for improving geriatric mental health care delivery in primary care. Diffusion of collaborative care into the health care system and integrating geriatric psychiatry into other models such as geriatric medical homes will require redesign of the organization and financing of primary care and psychiatry to overcome current barriers. Public policy should reflect the essential role of psychiatry in geriatrics and promote the integration of geriatric psychiatry with primary care.

Alois Alzheimer on Presenile Dementia

The work of Alois Alzheimer on presenile dementia is a landmark in the history of psychiatry not fully appreciated by contemporary psychiatrists. In this paper, the history of his landmark work is reviewed in the context of the growing importance of psychiatric involvement in Alzheimers disease. Annotated excerpts from Alzheimers second paper (1911), never before translated into English, are presented. The historical significance of Alzheimers findings vis-a-vis Krae pelinian psychiatry and the relationship of his investigations to modern psychiatric research in primary degenerative dementia of the Alzheimer type are discussed. (J Geriatr Psychiatry Neurol 1988;1:199-206).

Psychogeriatric specialization in state mental hospitals: A nationwide survey

Despite deinstitutionalization and transinstitutionalization, psychogeriatric patients continue to be served in state mental hospitals. This paper reports data from a national survey of state hospitals describing the current status of geriatric services and specialists in these facilities. The data indicate that nearly three-quarters of hospitals serving elderly patients have geriatric units, but many hospitals, including those maintaining such units, have few or no psychogeriatric specialists. It is proposed that clinical training and education programs need to be expanded in order to meet the demand for specialists in this area.