Dr. Jeste Replies

To the Editor: I want to thank Dr. Cohen for his beautifully written personal account. I agree wholeheartedly about the need for increasing relevant geriatric material both in APA publications and at APA meetings. There has been a welcome trend in that direction over the past decade; it must be enhanced in the years to come.

Dr. Cohen also makes an interesting point that elderly psychiatric patients generally use their psychiatrists as their primary care physicians and, therefore, receive better, continuing, comprehensive care than many younger adults. A competent geriatric psychiatrist is, by necessity, one with expertise not only in psychiatry but also in medicine and neurology as well as in psychosocial management. Of course, this is true for any psychiatrist but is especially important for a geriatric psychiatrist, given the high prevalence of medical and psychosocial comorbidity in elderly psychiatrically ill persons.

The most illuminating point in Dr. Cohen’s letter refers to the role of psychiatrists who are themselves older. This should be a group of vital importance to all psychiatrists. The experience and wisdom of these colleagues can be of immense benefit to younger professionals. In today’s society, which emphasizes youth and in which chronological “old age” tends to be equated with retirement, we should take the lead in changing the attitude toward aging. Fortunately, APA’s Council on Aging (presently chaired by Ken Sakauye) has been active in this area.

In 1992 Elliott Stein proposed the formation of a Committee on Senior Psychiatrists. One of the missions of this committee (currently chaired by Irving Cohen) is to investigate continued work among “older” (defined as those age 60 and older) psychiatrists, including gathering descriptions of successful and unsuccessful models, and disseminating this information to APA’s membership. Notably, approximately one-third of all APA members are age 60 or over. There is also a group called the Lifers that comprises APA Life Members and Life Fellows, who number about 700. Although the Committee on Senior Psychiatrists and the Lifers have somewhat different aims, they often work together. Finally, in response to Dr. Cohen’s hope that “my chronologic psychiatric peers and I continue to learn, grow, and treat with zest the assorted woes that we will find in DSM-XXI,” I can only say, “Amen.”