Old Age Psychiatry is a growing speciality due to the ageing population which is leading to an increase in the numbers of people over the age of 65 years. We provide specialised and holistic assessment, treatment and continuing care for older adults (or those with similar needs) who suffer from a range of mental health problems.
Dementia care and memory problems are a significant aspect of the work. Depression and other mental health problems common across the spectrum of psychiatric illness including delirium, schizophrenia and personality disorder are also treated. About half of the work is non-dementia. There are significant differences in mental health problems in older adults compared to the younger population, meaning there is a great need for specialised skills to manage these problems effectively.
In the past old age psychiatrists worked with people over the age of 65. However, most old age psychiatry services now work in a ‘needs-led’ way rather than strictly on age. Generally speaking, old age psychiatrists work with people with cognitive problems, plus those with mental health and significant physical health co-morbidities or ‘frailty’. They will also work with people who have psychological problems as a result of the ageing process. Working with patients’ families and carers is an important and interesting aspect of the work. Person-centred, individualised care, promoting independence and prioritising choice are at the very heart of old age psychiatry.
Mental health and social problems in old age are closely related. Old age psychiatrists collaborate closely with many different agencies including GPs, social services, occupational therapy and voluntary agencies. Nowadays, there is a strong emphasis on community care and delivering interventions and care packages that enable older people to stay in their own homes. Other priorities include developing memory services and improving acute in-patient services.
Physical problems also affect mental health and in this respect a holistic, integrated approach is important. Old age psychiatrists therefore need good working knowledge of general medicine and it is therefore amongst the most ‘medical’ of all the psychiatric specialties.
An understanding of the legal and philosophical issues regarding protection of individuals’ human rights, end of life decisions, capacity, informed consent and mental health legislation is essential in providing safe, holistic care of a high quality. Clinical decisions are always balanced with ethics.
Old age psychiatry services may be provided in acute general hospitals (as a liaison service given the recognition of the high prevalence of mental health problems suffered by patients in these hospitals) as well as in community settings including residential and nursing facilities or in mental health in-patient units for those requiring a hospital admission.