Introduction: preparing for the future.

Abstract

The United Nations has declared 1999 the International Year of Older Persons, which should come as no surprise. The past century has witnessed a greater increase in average longevity than any other period in the history of mankind. The average life span grew from 20 years in ancient Greece to 30 years in medieval Europe to 47 years in the United States in 1900. Today, the average life span in the U.S. is more than 75 years (1). The rest of the world is also experiencing a phenomenal rise in the number of elderly persons. Thus, between the years 1985 and 2025, the number of individuals over age 65 will increase by 238 percent in China and by 264 percent in India (2). As the overall number of elderly persons in the population at large increases, the number of elderly persons with mental illnesses will increase. Moreover, individuals with psychiatric disorders such as dementia, schizophrenia, and mood disorders, which have long been associated with reduced longevity, should be able to have relatively normal life spans in the future, thanks to the expected advances in pharmacological and other treatments. The anticipated explosion in the number of elderly persons with chronic mental illness has major implications. The country will face an unprecedented growth in expenditures for the care of these patients. Critical issues of quality of life and quality of care for elderly psychiatric patients and their caregivers must be addressed. As a preliminary step toward addressing issues pertinent to the future of mental health and aging, we organized a closed workshop in San Diego on March 11 and 12, 1998. The invited participants came from academic institutions, professional organizations, advocacy groups, government agencies, and the pharmaceutical industry. The formal scientific presentations were followed by a broad-ranging discussion. A consensus statement based on those deliberations is being published elsewhere (3). This special section of Psychiatric Services includes eight of the individual papers presented at the workshop, which have been peer reviewed for publication. The papers address topics ranging from major psychiatric disorders such as dementia, depression, schizophrenia, and substance use disorders to broader issues such as epidemiology, psychotherapeutic and behavioral interventions, health care services delivery, and training in geriatric mental health. These topics represent only a portion of the overall field of mental health and aging. For example, no papers on anxiety disorders or personality disorders in elderly persons are included. The effort represented here should be viewed as one step in a long process. Multipronged efforts on various fronts, including an increase in public education, reforms in health care financing, expansion of the research portfolio, and improvement in training at all levels, are urgently needed. ♦