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Rehabilitation and mental health practices for an aging population in the U.S.. (Editor's Comment).

Individuals in the U.S. are living longer due to technological advancements, improved medical care, and general improvements in the standards of living. Persons age 85 and older constitute the fastest growing segment of the U.S. population and are projected to double to more than 70 million by 2030 (Administration on Aging, 2002). Racial minority persons, who constitute the fastest growing segment of the elderly population, are expected to increase more than 500% by the middle of the 21st century (Scharlach, Fuller-Thomson, & Kramer, 1999). Along with the increased life expectancy of many U.S. citizens come concerns and issues regarding the future of the aging population and increased incidence of disabilities among persons who are aging. A large portion of the literature regarding aging Americans have focused on the impending retirement of the "baby boom generation" and the impact of their retirement on various aspects of American life (i.e., social security, employment, long term care, etc). However, limited attention is given to the mental health of this population.

Aging Americans are very heterogeneous, possessing significant within and between group differences. For example, the elderly of today and those of tomorrow constitute substantially different cohort groups across race and ethnicity, historical oppression, immigration and migration status, and various lived experiences. Historical and contemporary realities that these cohorts have experienced and will experience will play a major role in shaping their perceptions of the important issues, and also will directly relate to their ability to deal with such issues. A keen awareness of within and between group differences is paramount in understanding the impact that current issues will have on the lives if aging Americans, particularly those with disabilities, and is essential to the development of adequate and appropriate service planning and delivery.

The field of rehabilitation may be confronted with a consumer population that is older, remaining in the workforce for longer periods of time, and require more services across different venues. An aging consumer population ushers in new and unique challenges for public and private sector rehabilitation agencies, rehabilitation educators and researchers, and rehabilitation practitioners. Therefore, dedicating a special issue of the Journal of Rehabilitation is timely, and offers information to a wide readership within rehabilitation (e.g., counselors, consumers, supervisors, and students) and related disciplines (e.g., counseling, mental health, and social work).

In their article on contemporary issues facing aging Americans, Charlotte Dixon, Michael Richard and Carolyn Rollins explore varied and complex issues including financial instability, employment concerns, long-term care issues, grand-parenting issues, victimization and abuse, and mental health issues. In addition, the authors explore the role of rehabilitation and mental health counseling professionals in meeting the needs of aging Americans. In the next article, Elizabeth Sweet and Malachy Bishop describe three prevalent mental health problems among older consumers: cognitive functioning, depression, and anxiety disorders. Also, the authors identify the scope of the problem of mental health, mental illness, and aging. Finally, Sweet and Bishop provide recommendations for serving this population.

Susan Kelly addresses prevalent mental health disorders and issues of comorbidity and functional disability in the aging population. Prevalent psychopathologies such as cortical and subcortical dementias, depression and related mood disorders, anxiety and phobias, and substance abuse are discussed. Among the implications for rehabilitation professionals, Kelly stresses that rehabilitation counseling programs must integrate information about serving the aging population into their respective curricula.

Vivian Larkin, Reginald Alston, Renee Middleton, and Keith Wilson discuss underrepresented ethnically and racially diverse aging populations with disabilities. As part of the discussion, these authors familiarize rehabilitation practitioners with relevant rehabilitation legislation, and present information within the framework of aging ethnic and racial minorities with disabilities. In addition, Larkin et al. offer recommendations for improved service delivery. In a continuation of the discussion of meeting the service needs of the aging population, Debra Harley, Chandra Donnell, and JoAnne Rainey introduce a rationale for inter-agency collaboration across professional bridges among rehabilitation counselors, mental health counselors, and social workers. In this article, the authors address barriers to collaboration and common areas of overlap for collaboration. Harley et al. offer recommendations regarding public policy and service coordination.

In the sixth article, John Finch and Mona Robinson examine aging and late-onset disability as an important factor in the workplace. The authors identify some of the key issues affecting older persons and, subsequently offer some recommendations for rehabilitation professionals to facilitate maximum adjustment to employment and other important life areas. Finally, Finch and Robinson emphasize that research in the area of late-onset disability is limited and should be encouraged.

John Benshoff, Shane Koch, and Laura Harrawood present information on the unique issues and concerns of substance abuse among the elderly. The authors discuss substance abuse among the elderly as being divided into two cohorts: early and late onset. Also, information is presented on abuse moderating factors including cohort effects, socioeconomic status, and frail health; and exacerbating factors including discretionary income, status as a hidden population, and caregiver complicity. Finally, Benshoff et al. address the need for screening instruments to be tailored to the unique needs of the elderly population.

The final article, by Ray Doyle, Charlotte Dixon, and Corey Moore, discusses expanding rehabilitation services to meet the legal needs of the aging population. In this article, the authors contend that future healthcare planning and resource management once traditionally addressed by attorneys and other legal practitioners are now beginning to be offered by other professionals. Given this occurrence, Dixon et al. discuss ways in which rehabilitation professionals can begin to meet the legal needs of the aging population.

Each of these articles offers a unique perspective on mental health among aging populations in the U.S. A number of salient issues face rehabilitation professionals as they prepare to meet the needs of aging persons with disabilities, and as they establish a unified agenda for addressing the needs of the aging community with disabilities. Individually and collectively, these articles provide recommendations for practice, research, and personnel preparation in the field of rehabilitation.
Guest Editors

Debra A. Harley, Ph.D.
University of Kentucky

Charlotte G. Dixon, Rh.D.
University of South Florida

Corey Moore, Rh.D.
Langston University
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Article Details
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Author:Moore, Corey
Publication:The Journal of Rehabilitation
Article Type:Editorial
Geographic Code:1USA
Date:Apr 1, 2003
Words:1019
Previous Article:Significant disability: issues affecting people with significant disabilities from a historical, policy, leadership, and systems perspective.
Next Article:Contemporary issues facing aging Americans: implications for rehabilitation and mental health counseling. (Contemporary Issues in Aging).
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