Doctors say old age
can be fun and productive

But geriatric experts are advised
to watch for signs of mental ills

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By Helen Altonn
haltonn@starbulletin.com

Geriatric psychiatry leaders say seniors will outnumber children worldwide by midcentury, making mental disorders in the aged a serious public health concern.

"Doctors typically emphasize the disease state, but what we'd like to do is talk about some positive aspects of aging," Dr. Anand Kumar, president-elect of the American Association for Geriatric Psychiatry, said in an interview.

"It's true we acquire more medical problems as we grow old, but a lot of people do really well and good things happen. ... There is much to be said about having a large elderly population that's viable, robust and active."

Good physical health is more closely related to good mental health than doctors previously thought, he said, advising people to remain physically, intellectually and socially active as they age.

More than 1,000 geriatric psychiatrists met last week at the Hilton Hawaiian Village and the Hawai'i Convention Center, addressing problems of mental disorders in a growing aging population.

"The aging process is not necessarily a downward spiral," said Kumar. "A lot of people function quite well."

But it is important for physicians and families to recognize early signs of dementia or mood disturbances because a lot of help is available once they are properly diagnosed, he said.

A major theme of the association's meetings was use of research findings to improve care, said Kumar, a psychiatry professor who runs a geriatric ambulatory program at the University of California-Los Angeles.

Dr. Gary Kennedy, of the Albert Einstein College of Medicine's Monteflore Medical Center, noted significant advances from research and care of dementia and psychosis to outreach and caring for families.

"It's important to also acknowledge that this year's meeting is taking place during frightening, difficult times," he said. "But we don't want to forget the contributions of our seniors; we don't want to forget the needs of our older citizens in a time of crisis."

Among speakers at the conference, March 1 through Wednesday, were Dr. Thomas Insel, new director of the National Institute of Mental Health; Tipper Gore, nationally recognized mental health care advocate, and Amy Tan, author of "The Joy Luck Club" and "The Bonesetter's Daughter."

Kumar said a lot of research is going on to try to understand the aging process and mental illness and to use the findings to improve access to better care, fight stigmas and educate families, physicians and policy-makers.

"In the absence of information, folklore tends to flourish," he said, listing a few beliefs that are not necessarily true: "Old age by definition is an unhappy time; depression is a normal part of aging; memory loss is an invariable part of aging, and it's not a disease."

Kumar said 1 percent to 2 percent of people above age 65 have major depression; 2 percent to 5 percent have minor but clinically significant depression; and 85 percent have no serious mental problems.

He said fear of what others will think keeps a lot of people from seeking help when symptoms occur. There is a tendency to minimize them unless they are extreme and tell people to "cope with it," he said. "That is a mind-set we'd like to discourage."

He said mood and anxiety disorders and substance abuse in seniors should be treated like any medical disorders because there are effective treatments. "When one has diabetes or arthritis, we don't say, 'Cope with it.'"