Mohammed T. Abou-Saleh

98 PRINCIPLES AND PRACTICE OF GERIATRIC PSYCHIATRYand participating in valued activities help maintain both mentaland physical function. Many nursing homes fail to give thesesocial aspects adequate attention, and patients spend much oftheir time in isolation and uninvolved. Nursing care may be thebest treatment context for some patients who are seriouslyincapacitated and require a broad range of services difficult toprovide in the home or in other community settings, but mostimpaired elderly benefit from settings that are more successful insustaining independence and social engagement.The capacity to cope effectively with mental illness depends onthe organization of kinship groups and households, and theexisting social institutions in a society. The growing prevalence ofdivorce, single-person households, small families, high femaleparticipation in the workforce, geographic mobility and othertrends make it difficult to put increasing reliance on informalsocial networks for caretaking. Developing alternative structuresthat are financially viable and humane constitutes a growingchallenge everywhere.REFERENCES1. Mechanic D. Mental Health and Social Policy: The Emergence ofManaged Care, 4th edn. Boston: Allyn and Bacon, 1999.2. Wells KB, Sturm R, Sherbourne CD, Meredith LS. Caring forDepression. Cambridge, MA: Harvard University Press, 1996.3. Lipton HL, Lee PR. Drugs and the Elderly: Clinical, Social, and PolicyPerspectives. Stanford: Stanford University Press, 1988.4. Cohen, CI. Outcome of schizophrenia into later life: an overview.Gerontologist 1990; 30: 790–7.5. Castle DJ, Murray RM. The epidemiology of late-onsetschizophrenia. Schizophr Bull 1993; 19: 691–700.6. Riecher-Roessler A, Loeffler W, Munk-Jorgensen P. What do wereally know about late-onset schizophrenia? Eur Arch Psychiat ClinNeurosci 1997; 247: 195–208.7. Blazer D. Depression in the elderly: myths and misconceptions.Psychiat Clin N Am 1998; 20: 111–19.8. Unutzer J, Katon W, Sullivan M, Miranda J. Treating depressedolder adults in primary care: narrowing the gap between efficacy andeffectiveness. Milbank Q 1999; 77: 225–56.9. Alexopoulos, GS, Young RC, Meyers BS, et al. Late-onsetdepression. Psychiat Clin N Am 1988; 11: 101–15.10. Yassa, R, Nair NP, Iskandar H. Late-onset bipolar disorder. PsychiatClin N Am 1988; 11: 117–31.11. Dohrenwend BP, Dohrenwend BS. Sex differences and psychiatricdisorders. Am J Sociol 1976; 81: 1447–54.12. Newmann JP. Sex differences in symptoms of depression: clinicaldisorder or normal distress? J Health Soc Behav 1984; 25: 136–59.13. Mechanic D. Medical Sociology, 2nd edn. New York: Free Press,1976, 214–21.14. Dohrenwend BP, Levav I, Shrout PE et al. Socioeconomic status andpsychiatric disorders: the causation-selection issue. Science 1992; 255:946–52.15. Brown G, Harris T (eds). Life Events and Illness. New York:Guilford, 1989.16. Cohen CI. Aging and homelessness. Gerontologist 1999; 39: 5–14.17. Berk ML, Schur CL, Cantor JC. Ability to obtain health care: recentestimates from the Robert Wood Johnson Foundation NationalAccess to Care Survey. Health Aff 1995; 14: 139–46.18. Pescosolido BA, Boyer CA. How do people come to use mentalhealth services? Current knowledge and changing perspectives. InHorwitz AV, Scheid TL, eds, A Handbook for the Study of MentalHealth: Social Contexts, Theories, and Systems. New York:Cambridge University Press, 1999, 392–411.19. Swartz MS, Wagner HR, Swanson JW et al. Administrative update:utilization of services. I. Comparing use of public and private mentalhealth services: the enduring barriers of race and age. Commun MentHealth J 1998; 34: 133–44.20. Kessler RC, Walters EE, Forthofer MS. The social consequences ofpsychiatric disorders, III: probability of marital stability. Am JPsychiat 1998; 155: 1092–6.21. Leff J, Vaughn C. Expressed Emotion in Families. New York:Guilford, 1985.22. Falloon IRH, Boyd JL, McGill CW. Family Care of Schizophrenia.New York: Guilford, 1984.23. Brown GW, Birley JL. Crises and life changes and the onset ofschizophrenia. J Health Soc Behav 1968; 9: 203–14.24. Kessler RC, Davis CG, Kendler KS. Childhood adversity and adultpsychiatric disorder in the US National Comorbidity Survey. PsycholMed 1997, 27: 1101–19.25. Thoits PA. Conceptual, methodological, and theoretical problems instudying social support as a buffer against life stress. J Health SocBehav 1982; 23: 145–59.26. Idler EL, Kasl SV. Religion among disabled and non-disabledpersons II: attendance at religious services as a predictor of the courseof disability. J Gerontol 1997; 52B: S306–16.27. Stein LI, Test MA. The Training in Community Living Model: ADecade of Experience. San Francisco, CA: Jossey-Bass, 1985.28. Rosenfield S. Services organization and quality of life among theseriously mentally ill. In Mechanic D, ed., Improving Mental HealthServices. San Francisco, CA: Jossey-Bass, 1987, 47–59.29. Rodin J. Aging and health: effects of the sense of control. Science1986; 233: 1271–6.30. Mechanic D, Angel R, Davies L. Risk and selection processesbetween the general and the specialty mental health sectors. J HealthSoc Behav 1991; 32: 49–64.31. Mechanic D, McAlpine DD. Use of nursing home in the care ofpersons with severe mental illness: 1985 to 1995. Psychiatric Services2000; 51: 354–8.32. Bishop CE. Where are the missing elders? The decline in nursinghome use, 1985 and 1995. Health Aff 1999; 18: 146–55.