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Technology, Geriatric Practice, and the Future of Psychiatry

July 2007 269 The ability to work with new information and communication technologies and apply new clinical interventions arising from systems neuroscience may enable psychiatry to take a position of leadership in future medical practices. Today’s healthcare system is “in shambles”1 and in dire need of radical restructuring;2–4 yet it faces even further strain from the expansion of techniques and options in diagnosis and treatment, the increased intensity of healthcare services,5 rising consumer expectations, the imminent “silver tsunami” of aging baby boomers,6 and the extension of expected lifespan, with the “old old” being especially heavy consumers of healthcare services. Technology will be a key factor in system reform.7 In the coming rearrangement of roles and elaboration of new practice models, psychiatry has the opportunity to emerge from its relatively marginalized niche to take a central role in bridging the “quality chasm.”8 Pervasive reorganization of ambulatory care may first emerge in general geriatric practice, where closer adherence to practice guidelines, improved doctor-patient relations, and a multidisciplinary approach to the “neglected epidemic” of chronic disease9 are most clearly needed.