Mental Disorders in Older Adults: Fundamentals of Assessment and Treatment

Abstract

STEVEN H. ZARIT AND JUDY M. ZARIT, Mental Disorders in Older Adults: Fundamentals of Assessment and Treatment. New York, The Guilford Press. 1998, 418 pp., $38.95, ISBN 1-57230-368-9. Mental Disorders in Older Adults is an excellent source book that covers just about every topic in the area of mental disorders affecting the elderly. The approach is multidisciplinary, largely psychosocial but not neglecting the biological. The bulk of the book discusses the nature of normal aging and the major cognitive and functional disorders, followed by assessment and treatment. The last section consists of a sensitive chapter on family caregiving, and a good chapter on consultation in institutional settings. The work ends with a survey of ethical issues. The authors were selective in what they covered, but thorough in what they did select. The text is enhanced by enlightening anecdotes and examples. The many positive features of the volume were evident from page 1, where the authors point out that the elderly respond to psychotherapy, that there is growth as well as decline with age, and that people are not only living longer but living better, longer. They support independent living, and maintaining the elderly at home, as much as possible. They discuss how the increase in the number of elderly people also means an increase in the number of those with mental disorders, the resulting need for more geriatric professionals, and for adequate professional training. They write approvingly of outreach measures. Their clinical examples provide a model of commitment, empathy, and respect for elderly patients, no matter how disturbed or demented. However, the authors are inconsistent. They say that assessment measures should be devised specifically for the elderly, because the usual measures are based upon patterns from younger people; but they unquestioningly accept cognitive measures, such as the Intelligence Scales, that have been devised mainly to evaluate academic learning abilities, job training, and other roles and activities that have too little relationship to the cognitive needs and tasks of the elderly. I had occasion to speak with David Wechsler, who himself believed that his tests were inadequate for the elderly. He was working on the Wechsler Intelligence Scale for the Elderly, or WISE, but unfortunately died before completion of that task. The review of assessment measures is careful and thorough although family assessment is touched upon superficially The review of psychotherapy is also thorough in its presentation of the behavior, cognitive behavior, and interpersonal therapies that have been intensively researched with the help of the National Institute of Mental Health. …