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PROGNOSIS FOR PSYCHIATRIC ILLNESS IN THE AGED
M. STRAKER
Am J Psychiatry 1963;119:1069-1075.
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Psychiatrist, Jewish Hospital of Hope, Montreal, Canada.

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Abstract

The review and analysis of 100 patients aged 60 and older, examined and treated in private psychiatric practice, has served to clarify a number of important questions regarding geriatric patients. An impoverished social life and retirement from the job often set the stage for the development of illness. Forty-six percent presented a special emotional vulnerability. The reaction to separation threats or realities, retirement, personal illness and family conflicts emerged as critical environmental stresses. Fifty percent presented physical diseases, primarily cardiovascular or degenerative in nature. Cerebral organic contaminants were present in 39%. Although these factors tended to reduce the recovery rate, they did not prevent recovery in many patients. The predominant psychiatric diagnosis was the depressive group of reactions. In the consideration of this particular group, the possibilities for improvement are excellent, especially when the pretreatment illness period is not protracted. Many complicating factors which now retard treatment or which in the first instance lead to breakdown are potentially preventable. This will occur through progress and advances in medical knowledge, through greater understanding of the problems of the aged person, and ultimately through the introduction of restorative interventions at the community level.Treatment measures, although empiric in nature, resulted in an overall 55% recovery or improved rate. The older patient can be treated with all the psychiatric techniques now available. When treatment is pursued energetically and with optimism, reversal of serious psychiatric illness in the aged person results, and chronic illness and deterioration is prevented, or postponed. The willingness of the therapist to become involved in the problem, to remain interested, and to search for answers to unknown processes, is critical to the success or failure of treatment in meeting psychiatric illnesses of the aged.Community resources must be developed in imaginative ways. Active treatment centers for chronic illness are an essential need, to provide hospital care and day center care. The development of psychiatric units in general hospitals must be supported. The six weeks in, six weeks out program for geriatric patients described by Delargy(13) is an intriguing therapeutic concept. Development of home care programs, the greater use of visiting homemakers and the development of post-retirement employment facilities can benefically influence the medical, social and psychiatric aspects of the aging process.

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