Roughan P A
Hillcrest Hospital, Gilles Plains, South Australia.
Clin Geriatr Med. 1993 Feb;9(1):173-90.
An increase in the number and diversity of resources designed to optimize psychosocial function in people and especially women over age 65 is inevitable in the next decade as both the size and political influence of this group increase. The successful implementation of such programs is dependent on widespread change throughout society, involving many disparate groups, including older people themselves, politicians, health care administrators, and researchers from a range of disciplines. Clinicians in medicine and allied professions have a pivotal role in this regard. At present there are many reversible causes of psychiatric morbidity in the elderly, including depression, anxiety, cognitive defects, sensory impairment, malnutrition, and adverse effects of alcohol abuse and polypharmacy that are often not recognized or treated appropriately. It is therefore essential that family practitioners receive both undergraduate and postgraduate training to recognize and manage the wide range of psychosocial disorders prevalent in older women. Intervention may require little more than an opportunity for the women to ventilate concerns or obtain information and advice about community resources. In other circumstances in which there are complex interactions of physical, social, and psychological factors, optimal management may involve interventions that require specific skills beyond the scope of the individual practitioner. Referral to a psychogeriatric team is likely to be helpful in such situations. The team, with its access to a full range of health professionals and community resources, is well placed to deal economically with complex issues. The special care units are best equipped to manage the tertiary care of the chronically ill who do not have adequate community-based support available. Increased information derived from research relating to the spectrum of mental ill health and mental health is essential to adequately address the causes, correlates, and treatments of illness, and to answer questions about the positive aspects of mental health that may have implications for all age groups and both sexes. For example, it is intriguing that older women maintain a high level of psychological health despite greater social disadvantages than any other major section of the community. It is likely that psychological factors, such as better coping skills and ability to adapt to stressful life events, influence both the quality of life in older women and possibly also its duration. Alternatively, it is possible that the commonly held view that the life expectancies of women and men will converge as women undertake more of the roles and activities currently the province of men may occur.(ABSTRACT TRUNCATED AT 400 WORDS)
在未来十年，随着65岁以上人群尤其是女性的规模扩大及其政治影响力增强，旨在优化人们尤其是65岁以上女性心理社会功能的资源数量和种类必然会增加。此类项目的成功实施依赖于整个社会的广泛变革，涉及许多不同群体，包括老年人自身、政治家、医疗保健管理人员以及来自一系列学科的研究人员。医学及相关专业的临床医生在这方面起着关键作用。目前，老年人精神疾病有许多可逆转的病因，包括抑郁症、焦虑症、认知缺陷、感官障碍、营养不良以及酒精滥用和多种药物并用的不良影响，而这些往往未得到充分认识或恰当治疗。因此，家庭医生接受本科和研究生培训以识别和管理老年女性中普遍存在的各种心理社会障碍至关重要。干预可能只需为女性提供一个倾诉担忧或获取有关社区资源的信息及建议的机会。在其他存在身体、社会和心理因素复杂相互作用的情况下，最佳管理可能涉及需要超出个体从业者范围的特定技能的干预措施。在这种情况下，转介到老年精神科团队可能会有所帮助。该团队能够接触到全方位的健康专业人员和社区资源，有能力经济高效地处理复杂问题。特殊护理单元最适合管理那些没有足够社区支持的慢性病患者的三级护理。从有关精神疾病谱和心理健康的研究中获取更多信息，对于充分解决疾病的病因、相关因素和治疗方法，以及回答可能对所有年龄组和两性都有影响的心理健康积极方面的问题至关重要。例如，有趣的是，尽管老年女性比社区中任何其他主要群体面临更大的社会劣势，但她们仍保持着较高的心理健康水平。心理因素，如更好的应对技能和适应压力性生活事件的能力，可能既影响老年女性的生活质量，也可能影响其寿命。或者，随着女性承担更多目前男性所从事的角色和活动，人们普遍认为女性和男性的预期寿命将趋于一致的观点可能会出现。（摘要截选至400字）
