Aging as a complicated and all-comprising degenerative process can induce multi-faceted changes in all tissues and organs including the brain. It may be intrincically predetermined, but in most cases the real aging phenomena are those co-decided by extrinic factors. Mental aging is, in its essence, of dynamic nature, oscillating between an aging-accelerating and -exaggerating tendency and an aging-inhibiting and -compensating striving, which are basically correlated with the style of living. Successful aging, that is well-agedness plus well-living in the age, is considered to presuppose to be free from any biological troubles. However, to be healthy human being does not mean to be biologically well, but it means that one can enjoy successful aging, in extreme cases, despite of or regardless of existing diseases and infirmities.

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[in Japanese]

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Various physiological functions decline with age at various speeds. The decline is significantly different in individuals. Some physiological functions that are well maintained under the resting condition, often can not adapt with severe. changes in individual's environment or hard exercise in the aged. Individual's numerous physiological functions act with intimate cooperation among them. It is necessary for the aged to accept the age-related decline of those functions. Otherwise, the aged will receive those declines as the stressors, and consequently the age-related decline of physiological function will be accelerated. Therefore, it is necessary for the aged to recognize precise mechanisms of their age-related physiological function, and to respond properly to these declines.

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Elderly Japanese aged 65 years and older accounted for 13% of the total population in 1992,but suicides among the same age group constituted 27% of all suicides. Reports from many other countries world-wide have also indicated high suicide rates among the elderly. Furthermore, Japan's elderly population is expected to grow to 240% by the year 2020. Therefore, elderly suicide, which is already a significant problem in Japan, may become a more serious social issue in the future. In addition to general risk factors for suicide, there are a number of typical features of suicidal elderly. This paper discusses the characteristics of their psychopathology relevant for detection of the risk at an earlier stage and for starting intervention for those at risk. The topics discussed are : various kinds of loss experienced by the elderly, suicidal threats or suicide attempts, physical illness, psychiatric disorders, accident proneness (chronic self-destructive behavior) , inadequate support systems, risk of suicide pact or cluster suicide, and typical personality traits. lssues of somatization developed by suicidal elderly are discussed in detail. Japanese suicidal elderly tend to show various amorphous physical symptoms rather than clear-cut depressive symptoms. They themselves firmly believe that they are suffering from some forms of physical illness, not psychological problems or psychiatric disorders, partly because they have a strong sense of shame about seeking help from mental health professionals ; instead, they consult general practitioners who specialize neither in psychiatry nor psychiatric disorders in the elderly. Therefore, intervention to initiate proper treatment is often so late that preventable suicide unfortunately occurs. Not much attention has been focused on elderly suicide so far. In order to understand the risk of elderly suicide and prevent it, the risk should be examined comprehensively from psychosocio-biological viewpoints. To achieve this goal, accurate knowledge about warning signs in suicidal elderly persons and the characteristics of their psychopathology should be obtained not only by mental health professionals, but also by the elderly themselves, their family members and medical professionals in general. In addition, well organized social support networks should be established for those at risk in the community, without depending too much upon family mem- bers, who used to carry much of the burden in the past.

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The elderly population is increasing in Japan both in absolute numbers and as a faction of the whole population. The use of medications also increases significantly with age. However the physiological characteristics of elderly patients contribute to an increased risk of adverse reactions of various drugs. These are paticularly likely to occnr with drugs that act on the central nervous system, such as neuroleptics, antidepressant agents and anxiolytic sedative-tranquilizer. A higher incidence of adverse reactions in the elderly may be the result of exessive blood or end organ level of drug due to the alteration of pharmacokinetic profile in the aged patients. In various physical factors in the aged, a chronological aging was considered to be important to alter the pharmacokinetic profile. On the other hand, it has bacome apparent that nonspecific morbid conditions such as acute infection and malnutrition are also an important factor in decreasing the hepatic metabolism of drug. From these view points, this paper intends to discuss the effect of age on the pharmacokinetics of various psychotropic drugs including neuroleptics, antidepressant and benzodiazepine drugs. In addition, the author suggests that multimorbidity frequently accompanied with aging process may suppress the hepatic drug metabolism in the elderly patients with psychiatric disorders.

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1. The increase of patients. At present there are approximately one million people suffering from age-associated dementia in Japan. In the future this number is expected to grow substantially. By the year 2035,the number of patients is expected to be around 3. 12 million. As the population of senior citizens increases, the occurance of this sickness will also increase. Therefore, we must give serious consideration to a comprehensive approach to caring for these people. 2. Dealing with maladjustment. Presently, 75% of patients with age-associated dementia are cared for at home. Therefore, we must look at a care system from a point of view which includes support for family members. The main focus of a care system is how to deal with these patients' maladjustment to daily life. In many cases the maladjustment is caused by various stresses which occur due to intellectual impairment. Therefore, it is vitally important to remove the various stresses by improving the environment in which the patients live. Furthermore, it is important that all kinds of people take part in caring for these patients as much as possible which helps to create a better quality of life for them. 3. Supporting family caregivers. In caring for people with age-associated dementia at home, family caregivers face problems such as feelings of stress, anxiety, and the feeling of being overburdened. The purpose of providing support to these caregivers is to lighten or remove these negative feelings. Family support also aims to help the caregivers maintain their own health and prevent them from becoming isolated. Social services or counseling may provide useful help to these family caregivers. A family member who single-handedly looks after a patient with age-associated dementia usually needs family counseling which provides comfort and the opportunity to exchange information with other families . 4. The most effective treatment. At the present time, an absolute treatment for people suffering from this sickness has not been developed. Therefore, support for these patients and for their family members who care for them is quite limited. The most effective way to deal with these cases is to recognize the disease at a very early stage and then provide the most appropriate support and service to these people and their families.

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