James Sabin


A New Direction for Geriatric Psychiatry: Wellness

In his farewell address in May as the outgoing president of the American Psychiatric Association, Dr. Dilip Jeste emphasized the need for a “positive psychiatry of aging.” Until recently, psychiatry has largely conceptualized health and well-being as the absence of illness and symptoms. In Jeste’s view, “quality of life and psychosocial functioning depend less on […]

Retirement and Dementia

On Monday, July 15, at 4:00 PM at the Alzheimer’s Association International Conference in Boston, Carole Dufouil, director of research in neuroepidemiology at the Institut National de la santé et de la recherché médicale at the Bordeaux School of Public Health in France, presented her research on the relationship between retirement and dementia. In less […]

The Benefits of Phased Retirement

Until relatively recently, employees in the U.S. typically transitioned directly from full time work to full time retirement. That practice had at least four major drawbacks: Some employees wanted to stop working full time but for financial reasons felt a need to continue earning. Some employees found their work meaningful apart from the income it […]

Why the Elderly Should Support Health Care Rationing

On the face of it, it would seem preposterous to argue that the over 65 population should support health care rationing. After all, both Democrats and Republicans regularly pledge to protect Medicare from any changes and attack the other party for threatening the program. And in a 2012 Pew Foundation poll, over 65ers by a […]

“Still Alice” and the Ethics of Dementia

Several friends had urged me to read “Still Alice,” a novel by Lisa Genova about a 50 year old Harvard professor and mother of three who develops early onset Alzheimer’s disease. I’ve finally read it. My friends were right. I’d urge you to read it as they had urged me.

Two Common Sources of Overtreatment

Experts, most recently former CMS administrator Don Berwick, tell us that no less than 20% – 30% of medical care is “waste.” At the very least, “waste” is harmful to all those who pay for Medicare. But often it’s directly harmful to the patient as well. I recently saw a friend at a party. Since […]

Job Loss and Mortality

In my clinical practice some years back I saw “Mr. A,” a man in his early 50’s who had become profoundly depressed after losing his job. We had a good relationship and he was very cooperative in his treatment, which involved medications, different forms of psychotherapy, and environmental manipulations. Despite all our efforts, nothing worked. […]

Suing Your Children

During a recent teaching trip to Singapore I learned about the country’s fascinating Maintenance of Parents Act, which went into effect in 1996.  The law allows Singapore residents over 60 who are unable to maintain themselves adequately to claim maintenance from their children, either in a lump-sum payment or in the form of monthly allowances. […]

Mental Health Care for the “Silver Tsunami”

On January 23 the New England Journal of Medicine published “The Underside of the Silver Tsunami – Older Adults and Mental Health Care.” The article draws on an Institute of Medicine report on the mental health workforce for older adults that Peter Brown, executive director of the Institute for Behavioral Healthcare Improvement, discussed here on […]