Psychiatric Assessment and Diagnosis in Older Adults

There is some confusion in the psychiatric literature regarding the incidence, prevalence, and illness course of psychiatric disorders in late life. This can be partly attributed to a paucity of studies focused on determining the epidemiology of psychiatric illnesses in older adults (2). Moreover, there is a common belief (and some empirical evidence) that psychiatric disorders (except dementia) are less prevalent in older adults than in younger populations (3). Yet, these studies have certain limitations. Behavioral and neurovegetative symptoms of psychiatric illness frequently overlap with those of general medical conditions, and increasing age is generally accompanied by increased medical comorbidity, which creates diagnostic conundrums in the evaluation of older adults. In addition, agerelated changes in the body and brain, as well as cohort effects, can lead to atypical manifestations of psychiatric illness, resulting in inaccurate or overlooked psychiatric diagnosis (4). Increasingly, however, it is recognized that special care needs to be given to psychiatric assessment of the older patient. Awareness and subsequent clinical recognition of the differences in symptoms between older and younger age groups may help reduce both psychiatric and medical comorbidity. Table 1 outlines age-related differences in the clinical features of several major psychiatric illnesses. Estimates of incidence and prevalence as well as prognosis and illness course are included.