THE RESEARCH MAGNIFICENT IN LATE-LIFE - PSYCHIATRIC EPIDEMIOLOGY AND THE PRIMARY HEALTH-CARE OF OLDER ADULTS

Objective: Primary care occupies a strategic position in the evaluatio n, treatment, and prevention of the mental disturbances of later life. This article highlights four themes that are crucial to understanding mental disturbances among older adults: 1) subsyndromal depression, 2 ) coexisting depression and anxiety, 3) comorbidity of depression and chronic medical conditions, and 4) risk factors for cognitive impairme nt. Method: The literature was selectively reviewed for each theme to ask the central question,''What can primary care physicians learn abou t mental disturbances of their older patients from epidemiologic and c ommunity studies?'' Results: The primary care setting itself is an imp ortant venue for an examination of aging issues and mental health. Wor kers in the ''middle ground of psychiatric epidemiology''-primary heal th care-have not yet reached a full appreciation for the value of rese arch in the primary care setting for enhancing our understanding of th e mental disturbances of late life, and how these intersect with other salient factors. Conclusions: Primary care physicians and others who work in primary care should advocate for further mental health integra tion and research in primary care. Research is needed that will lead t o new ways of maximizing the health and quality of life of older adult s and their families.