Caring for Older People: What an old age psychiatrist does

Mental illness is common in old age and is also often associated with physical illness and social problems, whether these be general deprivation or traumatic life events. Its detection demands vigilance and its diagnosis and management demand teamwork. This article considers three major disorders, but other problems such as drug and alcohol dependence and schizophrenia do occur, though they are mercifully rare compared with depression, delirium, and dementia.

Old age psychiatry as a specialty arose from the unique needs of old people with psychiatric disorder and the special knowledge and skills needed to deal with these needs. It differs from general psychiatry not only because of the greatly increased prevalence of dementia in older people but also because the presentation and management of other disorders is different. The pattern of work is also different. Work in interdisciplinary community mental health teams and in partnership with general practitioners, social services, and hospital doctors is a necessary response to the complicated mixture of social, psychological, and medical needs in old people with psychiatric disorder. About three quarters of the referrals to old age psychiatrists come from general practitioners and about a quarter are liaison referrals from hospital departments.

Although old age psychiatry began as a hospital specialty, many old age psychiatrists today are based in the community and give equal emphasis to their community and hospital work. They aim to provide services that are sensitive to the needs of caregivers and patients and also support general practitioners, social services, and other hospital departments. Their work includes the direct assessment and management of disease and the provision of education and information to others working with older adults, aiming to influence the practice of others, as the prevalence of mental illness is far too high for them to deal with it all directly. Three …