Evidence-Based Geriatric Psychiatry: An Overview

Despite unparalleled developments in medical science and a health care budget that spends more on health care for each person than any other coun-try in the world, the American health care system is failing. As determined by the 2001 landmark study by the Institute of Medicine ‘‘Crossing the Quality Chasm,’ ’ the American health care system is plagued by high expenditures for unnecessary procedures, varies widely in quality, fails frequently to pro-vide basic treatments supported by scientific evidence, and is ‘‘in need of fun-damental redesign and reform’ ’ [1]. The more recent President’s New Freedom Commission onMental Health made a similar determination based on a study of the mental health system, concluding, ‘‘America’s mental health service system is in shambles’ ’ [2] and that ‘‘State-of-the-art treatments, based on decades of research, are not being transferred from research to community settings. Meanwhile, many outdated and ineffective treatments are currently being actively supported’ ’ [3]. The Subcommittee on Older Adults similarly has identified serious concerns regarding quality, access, and workforce ca-pacity, and recommended the dissemination and implementation of evi-dence-base practices (EBPs) as one of the most important initiatives for improving quality of care for older persons with mental disorders [4]. This article provides an overview of evidence-based medicine (EBM) and EBPs in the treatment of psychiatric disorders in older adults. The following topics are address: Psychiatr Clin N Am 28 (2005) 763–784 Why an evidence-based approach is important to improving outcomes for older persons with mental disorders * Corresponding author