Subspecialty Training and Certification in Geriatric Psychiatry: A 25-Year Overview.

The Institute of Medicine estimated that by 2030, from 10.1 to 14.4 million Americans aged 65 years or older will have mental health or substance use disorders. This article reviews the history and current status of training, certification, and practice in geriatric psychiatry against the backdrop of this "silver tsunami." The American Board of Psychiatry and Neurology (ABPN) administered the first subspecialty examination in geriatric psychiatry in 1991, and through 2015 3,329 certificates were awarded. The Accreditation Council for Graduate Medical Education approved the training requirements in 1993. After a surge in programs and fellows, the numbers appear to have stabilized at about 57 programs and 60-65 trainees per year with fewer than half of the positions filled each year. The majority of graduates seeks and obtains ABPN certification, and the majority of those who were fellowship trained have maintained certification. Despite the unprecedented demand for mental health services for older adults, it must be acknowledged that not enough geriatric psychiatrists can be prepared to meet the needs of an aging U.S. POPULATION: Strategies for addressing the shortage are discussed, including undertaking subspecialty training in the fourth year of psychiatry training, increasing the time devoted to the care of older adults in undergraduate and graduate medical education, and developing alternative training pathways such as mini-fellowships. It is not clear whether more favorable Medicare reimbursement rates for those certified in geriatric psychiatry would increase the numbers seeking fellowship training.

Impaired recognition of facial expressions of emotion in Alzheimer's disease.

Recognizing facial emotions is an important aspect of interpersonal communication that may be impaired in Alzheimer's disease (AD). The authors examined facial emotion matching, facial emotion labeling, and same--different emotion differentiation in AD patients, healthy elderly volunteers, and elderly, nondemented psychiatric outpatients. Compared with both control groups, AD patients were significantly impaired on all three measures. AD patients were also impaired on a facial identity matching task. Using facial identity matching scores as a covariate provided evidence suggesting the facial emotion processing deficit may be independent of impairment in nonemotional face processing. AD patients also had selective impairment in labeling facial expressions of sadness. The authors conclude that patients with AD have deficits in recognizing facial emotions, which may be independent of their impairment in recognizing nonemotional features of faces.