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 evaluation, 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 impairment. Method: The literature was selectively reviewed for each theme to ask the central question, 'What can primary care physicians learn about mental disturbances of their older patients from epidemiologic and community studies?' Results: The primary care setting itself is an important venue for an examination of aging issues and mental health. Workers in the 'middle ground of psychiatric epidemiology' - primary health care - have not yet reached a full appreciation for the value of research in the primary care setting for enhancing our understanding of the 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 integration and research in primary care. Research is needed that will lead to new ways of maximizing the health and quality of life of older adults and their families.