During the past several years, and after a long period of institutional isolation, psychiatry has become well established in the field of private practice. Facilities for such practice in general hospitals are widespread throughout the country and have increased public demand for psychiatric care on the same terms as care provided in physical illness. This has undoubtedly brought about certain reorientations causing physicians to adopt a more optimistic attitude toward both treatment and prognosis in many patients hitherto regarded as unfavorable candidates for intensive, short-term therapy. In the setting of a general hospital the psychiatrist often finds himself the center of strong pressures exerted by the referring physician and relatives to treat an older patient for whom he may offer only the most guarded prognosis. Under these circumstances we have had under our care in the psychiatric unit of a general hospital a series of 300 patients over the age