The challenges of Old Age Psychiatry

Dr Alan Spratt is a foundation year two doctor 

Four months

Old age Psychiatry is akin to an Addenbrooke’s cognitive assessment.

1. The general populace of medics tend to avoid it (we’ll ignore the surgeons altogether).
2. It seems it will take a while to get through it.
3. Although it can seem simple to highlight a problem, the management and repercussions are far from simple.

Few FY2 rotations are available in psychiatry. Although I sought the rotation out, many do not. For a specialty that is essential in many other specialties including Emergency Medicine, GP and General Medicine, people do not have an opportunity at foundation level to experience it. 

Four months isn’t a long time unfortunately to fully submerse into a specialty or indeed a sub-specialty. 

Cross your path

However, in a four month rotation I have seen the division of care between community and hospital and the importance of the community psychiatric team and the communication skills to keep it linked together (meeting upon meeting followed by phone calls and then referral letters). 

Caffeine-laced on call duties where no two referrals were ever the same provided exposure to acute admissions across all sub-specialties. These were by far the most challenging aspect of the rotation. In these situations although help was never far away, when you’re on your own the most prominent and lasting lessons are learnt. These situations are meant to be stressful in medicine, it just so happens in psychiatry you carry an alarm and the door opens both ways in the assessment room.

Now a humbling realisation is that care of the elderly was the highlight of the rotation. Organic illness will be an increasing problem in the future of the NHS. Regardless of what specialty people end up in, dementia and Alzheimer’s will cross your path and I guarantee you will have no idea how to manage it as successfully as is done in psychiatry. It will affect you, your patients or your family. 

It is therefore worth spending four months finding out about it and the challenges it brings.