The United States faces a critical healthcare problem as the number of mentally ill older Americans is steadily increasing, while the number of psychiatrists trained to care for them is too low to meet the demand.
With a $450,000 grant from the John A. Hartford Foundation*, the University of California, San Diego (UCSD) School of Medicine and the VA San Diego Healthcare System will create a Center of Excellence in Geriatric Psychiatry to train a new generation of geriatric psychiatrists and physician-researchers to meet the needs of older persons with illnesses ranging from depression to psychotic disorders such as schizophrenia.
The Hartford Foundation is a committed champion of training, research and service system innovations that promote the health and independence of America’s older adults. Through its grantmaking, the Foundation seeks to strengthen the nation’s capacity to provide effective, affordable care to the rapidly increasing older population.
"The Hartford Foundation grant will greatly help UCSD recruit and train geriatric psychiatrists and researchers with an interest in mental health problems of the elderly," said Edward W. Holmes, UCSD Vice Chancellor for Health Sciences.
According to a Surgeon General’s Report, “disability due to mental illness in individuals over 65 years old will become a major public health problem in the near future because of demographic changes.” The number of psychiatrically ill elderly is expected to rise by 275 percent, from 4 million in 1970 to 15 million in 2030. Epidemiologic studies suggest that 18 to 28 percent of the elderly population has significant psychiatric symptoms. At the same time, of 39,000 psychiatrists in the United States, only 5,000 list “geriatric psychiatry” as one of their three primary interests.
“With the Hartford Foundation grant and establishment of the Center for Excellence in Geriatric Psychiatry, we will be able to provide positive role models for promising psychiatric researchers, develop award programs and affinity groups, share resources, make programs sensitive to trainees’ practical needs, and assist individuals with the transition to an academic career,” said the Center’s director Dilip Jeste, M.D., Estelle and Edgar Levi Chair in Aging and professor of psychiatry and neurosciences, chief of the UCSD Division of Geriatric Psychiatry, director of the UCSD Sam and Rose Stein Institute for Research on Aging (SIRA), and a geriatric psychiatrist with the VA San Diego Healthcare System.
An internationally known expert in geriatric psychiatry, Jeste and his team are uniquely qualified to train geriatric psychiatrists and researchers. The UCSD Division of Geriatric Psychiatry includes National Institute of Mental Health (NIMH)-supported programs such as an Advanced Center for Interventions and Services Research in Geriatric Psychiatry, a T-32 Research Fellowship program, and a Summer Research Institute in Geriatric Psychiatry**.
The mentally ill elderly present a unique challenge to healthcare providers and geriatric researchers, Jeste noted. “These include, but are not limited to normal age-related changes in brain structure and function, co-existing diseases in one individual, multiple medications, cognitive impairment, issues of classification and measurement of symptoms and diagnosis, and difficulties in long-term follow-up.”
Noting that new researchers constitute the lifeblood of scientific infrastructure, Jeste said the need to attract and train new investigators is a critical priority for geriatric mental health. Unfortunately, the current healthcare environment contributes to the difficult of training new investigators. Post-residency psychiatrists are under increasing pressure to generate their salaries and be clinically productive, with very little time devoted to research. It has also become increasingly difficult to obtain independent federal grant support for young investigators, thus forcing them to maintain and increase their clinical responsibilities. Even among individuals who participate in fellowships, 68 percent spend less than 10 percent of their time in research.
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* Founded in 1929, the John A. Hartford Foundation is a committed champion of training, research and service system innovations that promote the health and independence of America’s older adults. Through its grantmaking, the Foundation seeks to strengthen the nation’s capacity to provide effective, affordable care to this rapidly increasing older population by educating “aging-prepared” health professionals (physicians, nurses, social workers), and developing innovations that improve and better integrate health and supportive services. The Foundation was established by John A. Hartford. Hartford, and his brother, George L. Hartford, both former chief executives of the Great Atlantic & Pacific Tea Company, left the bulk of their estates to the Foundation upon their deaths in the 1950s. Addition information about the Foundation and its programs is available at www.jhartfound.org.
** UCSD’s Geriatric Psychiatry program was established by Dr. Dilip Jeste in 1986 with a primary focus on research, clinical and academic training, and comprehensive care of elderly patients. One of the largest geriatric psychiatry programs in the U.S., the UCSD Division of Geriatric Psychiatry includes inpatient, outpatient and community-based programs. See http://geropsych.ucsd.edu.
Additional geriatric psychiatry programs at UCSD include the following:
- The UCSD Advanced Center for Interventions and Services Research in Geriatric Psychiatry is the only National Institute of Mental Health (NIMH)-supported Clinical Research Center in the country specifically devoted to studying older patients with psychotic disorders, especially those living in community settings. This Center partners with the San Diego County Public Mental Health System that serves approximately 36,000 seriously mentally ill adults, with a goal of developing and testing treatments that will impact the patients in the real world.
- Since 1993, the NIMH has also supported the UCSD Division of Geriatric Psychiatry with Institutional T-32 Research Fellowships in Geriatric Psychiatry, which have been awarded to 51 individuals, 16 of whom are still in training. The Division also trains two post-residency Fellows each year in clinical geriatric psychiatry.
- The Summer Research Institute in Geriatric Psychiatry is an NIMH-funded national-level research training program under Jeste’s direction that involves a week-long program for 25-30 promising post-residency (M.D. or D.O.) and post-doctoral (Ph.D., Psy.D. or Pharm.D.) fellows and junior faculty interested in developing a research career in geriatric mental health.
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