Mental health and older women.

The number of elderly women is growing in absolute numbers and in proportion to the U. S. population. Current epidemiologic research indicates that the most frequent psychiatric disorders among older women are phobias, severe cognitive impairment, dysthymia, and major depressive episode without grief. The rates of all of these disorders, except for cognitive impairment, are lower for older than for younger women. The rates of psychiatric disorders in older women are higher than in older men, except for alcohol abuse-dependence, which is higher in men. Depression is a common psychiatric problem in older women. The differential diagnosis includes other medical disorders, drug effects, normal grief, and early dementia. Older depressed women may present with physical complaints rather than complaints of depression, and thus be misdiagnosed. Treatment consists of psychotherapy, antidepressant medication, and activities to improve self-esteem. Dementia affects 4 percent of elderly women over age 65, and 20 percent of those over age 85. The most common cause is Alzheimer's disease. Current research is focusing on abnormalities in the cholinergic system in the brain. A careful psychiatric evaluation may identify medical conditions, including depression, which can be treated and can lead to improvements in the patient's functioning.