COMMENTARY

February 2003: Geriatrics -- Myths and Perspectives, Special Guest Editorial

Gary J. Kennedy, MD

Disclosures

February 11, 2003

Introduction

As advancements in medicine and preventive health continue, our life span becomes extended. The number of older persons in our society is increasing, and the resulting costs offer challenges both on a personal and a healthcare policy level. It is helpful to view the practice of geriatrics as complex work in progress that changes as we gain new insights into the science of aging and as our clinical expertise grows to better understand this dynamic population.

There are a number of myths about aging.[1] Of note, they are shared by practitioners, patients, and policy makers alike. These are:

(1) Age is an illness; (2) genetics determines illness and disability; (3) disability is inevitable and increasing among seniors; (4) loss of social ties leaves the older adult alone and isolated; (5) most elderly are depressed, demented, or dependent; (6) in a chronic illness, social factors are less important in late life; (7) old age leads to physiologic and social homogeneity (ie, seniors generally have the same needs and potentials); (8) advances in biotechnology and pharmacology are the most important elements in reducing late life dependency; (9) projections based on present data are sufficient for social policy planning over the next decades; (10) aging and mortality are synonymous; and (11) the older the patient, the greater the cost.

Primary care practitioners rather than mental health specialists provide the diagnosis and pharmacologic treatment of mental illness among most Americans. This is even more the case for older adults.[2] Despite an increase in subspecialty geriatric training in internal medicine, family practice, and psychiatry, instruction in the recognition and treatment of mental illness in seniors remains less than ideal in the health professions.[3] Moreover, the prevalence of both mental and physical disability increases with advanced age because illnesses that occur late in life are persistent, less lethal, and thus accumulate.

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