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American Association for Geriatric Psychiatry March 14-17 2008

American Association for Geriatric Psychiatry

The American Association for Geriatric Psychiatry's annual meeting took place March 14-17 in Orlando, Fla., and attracted about 900 attendees. The conference theme -- "Meeting the Needs of a Diverse Aging Population," recognized that minorities will comprise 21 percent of the elderly population by 2020, and will commonly be affected by psychiatric disorders that are less likely to be detected or treated.

"Thirteen of the 40 symposia which were submitted and accepted specifically addressed this issue," said program chair Maria D. Llorente, M.D., of the University of Miami and Miami VA Healthcare System. "Some of the most impressive presentations addressed the inherent differences, biases, cultural values and belief systems that affect how people view diseases and treatments, and how they can engage within the health care system."

As examples, Llorente cited research showing that people from India believe that red-colored pills have higher potency, and that some Asian cultures consider liquids and injections to be more effective than any pill. "That can affect patient adherence to treatment and trust in providers, which can have a significant impact down the road," Llorente said.

Consuelo H. Wilkins, M.D., of the Washington University School of Medicine in St. Louis, presented a session entitled "Cognitive Impairment and Osteopenia in Older African Americans with Vitamin D Deficiency," which suggested that African Americans with vitamin D deficiency have worse cognitive performance and lower bone mineral density compared to those with normal vitamin D levels.

"These findings will significantly affect practice because health care providers may start screening for vitamin D deficiency if people are complaining about memory problems," Llorente said. "I would like to see older African Americans routinely screened for vitamin D deficiency. Darker-pigmented skin does not produce as much vitamin D as lighter skin even at lower latitudes. For example, black kids in Mississippi have lower vitamin D levels than white kids in Massachusetts."

Much discussion at the meeting revolved around public policy and workforce issues, according to Gary Moak, M.D., president of the American Association for Geriatric Psychiatry, and of the Moak Center for Healthy Aging in Westborough, Mass. "Our association has been increasingly concerned that the numbers of older Americans are growing rapidly and our health care system is not set up to meet their needs," Moak said. "In many ways, this is a global warming story. Our window of opportunity to address it is rapidly closing."

Moak expressed concerns that budget cuts in federal spending for training, research and clinical services will adversely affect the expanding elderly population because there will be a shortage of geriatric specialists. "What's at risk is a whole generation of clinicians, teachers and researchers who need to be supported through various federal funds," he said. "Our concern is that they're not going to be there when these older Americans need them."

Moak also pointed to an impending 10 percent cut in Medicare fees, which will go into effect July 1, 2008 unless there is congressional action. "If that happens, doctors all over the country will start seeing fewer and fewer Medicare patients," he said. "It's a huge, complex challenge. There's no easy, quick fix for it. Ultimately, it requires more fundamental reform in the health care delivery system. But our concern is that in the short run it will have a chilling effect on the entry of younger people into the field. It puts a whole generation at risk because a whole generation of educators and clinicians won't be available for elderly patients."

Many presentations at the meeting emphasized the need for treating late-life depression, according to Moak. "Depression has a negative impact on their risk of stroke, heart attack, diabetes and cancer. Treating depression can save a lot of money in other health care costs. Increasingly, there are studies that show the benefits of newer, more effective treatments for depression, and newer ways to deliver the service."

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