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While estimates of the incidence and prevalence of mental disorder in the elderly vary, the consensus is that the need for services will remain unmet in the foreseeable future and geriatric mental health programs will continue to be seriously underfunded. Because of this, older people in general are treated in more restrictive and less appropriate settings than are younger mentally disturbed persons. The coming of DRGs and R UGs, the new prospective methods of health care reimbursement, are likely to compound this potentially lethal situation. It has been suggested that the implementation of these systems will produce an underfunding of psychiatric care that will create strong incentives to limit further both in- and outpatient mental health services to older people. The manner in which this may occur is the main focus of the article. Alternative models to acute care and DRGs for mental health care of the elderly, and their respective assets and liabilities, are also presented.

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Recently Sarason (1972) and Wine (1971) discussed the negative effects of test anxiety within an attentional framework. Wine suggested that in evaluative situations high-testanxious (HTA) persons divide their attention between task-relevant and task-irrelevant information, for example, self-stimuli such as worry. Sarason focused on HTA subjects' attention to relevant and irrelevant situational cues. In the present research several implications of these attentional theories of test anxiety were investigated.The hypothesis that HTA subjects divide their attention between task-relevant and task-irrelevant information in evaluative situations was assessed by testing low-testanxious (LTA) and HTA children in an incidental learning task under either game or test instructions. We hypothesized that HTA subjects would have higher incidental and lower central learning scores than LTA subjects. Wine's (1971) suggestion that manipulations forcing attention to task-relevant stimuli should improve HTA subjects' performance was tested by requiring half the subjects to label the central stimuli as they were exposed. Labeling was expected to attenuate the performance differences between LTA and HTA subjects.Forty-eight children, 24 males and 24 females, from each of three grade levels were the subjects. The mean ages were 7.6, 9.9, and 11.9 years for the second, fourth, and sixth graders, respectively. Half were HTA and half LTA as determined by their scores on the Test Anxiety Scale for Children. The Requests for reprints and for an extended report of this study should be sent to

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