Aging
Adjustment Disorders and Personality Disorders in the Aged
Manuel Straker, M .D., F.A .P.A. (L. )*
Busse conducted a survey of socially well-adjusted "young-old" (60 years and older) volunteers and reported that at least 25 per cent suffered from neuroses, while an additional 20 per cent had mixed neurotic and psychotic difficulties . 8 The diagnoses refer to the DSM-II classification. Under the new DSM-III classification system, neurotic disorders are included in the affective, anxiety, somatoform, dissociative, and psychosexual disorders . A series of British studies established that functional psychiatric disorders are found in one of every three persons over the age of 65. The predisposing factors were identified as previous mental illness , social isolation, separation or divorce, and loss of a parent in childhood. 30. 33 Clearly, the elderly have a great need for mental health services, yet those with minor emotional disorders comprise a markedly underserved population . When a major psychosis is present, sufficient personal disorganization or societal stress mobilizes therapeutic interventions, including hospitalization. Although only 5 per cent of the population over age 65 is institutionalized, mental health workers focus their major efforts on this visible group. By contrast, a small number of older persons seek help from psychiatrists in private practice , or from professionals at mental health clinics. 2 A national survey of private psychiatric office practice revealed that only 4 per cent of this cadre of patients are over the age of 60. 29 Even more revealing are the data from an admission room survey at the Brentwood Medical Center. Among veterans applying for services, slightly over one per cent were found to be over age 65. 40 This older population is clearly underrepresented both in seeking and obtaining mental health services.
PSYCHODYNAMIC ISSUES Psychopathologic issues are discussed elsewhere in this issue . It is useful, however, to mention some psychodynamic issues that can provide the clinician with a conceptual framework to approach the assessment and management of elderly patients.
'Chief of Staff, Veterans Administration Medical Center Brentwood ; Professor of Psychiatry, University of California at Los Angeles School of Medicine, Los Angeles, California
Psychiatric Clinics of North America-Vol. 5, No.1, April 1982
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