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The Royal College of Psychiatrists Improving the lives of people with mental illness

Old age psychiatry

Background to old age psychiatry

It is only over recent decades that the psychiatric care of older people has attracted particular interest. Mental illness in older people is increasingly recognised as a major public health issue in a wide range of contexts. The complexity of interaction between physical, psychiatric and social problems experienced in old age requires close collaboration between a range of agencies including psychiatrists, nurses, physicians, social services, occupational therapy and voluntary agencies to name a few. 

There is a wide spectrum of disorders which will fall under the remit of mental health services for older people and it is not just about dementia care although this is a significant, challenging and rewarding area of practice. Services for older people are in an exciting stage of their evolution with a strong focus on community care, developing memory services, intermediate care provision, liaison psychiatry services, along with improvements in acute inpatient services.

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Personal perspective

Those who express an interest in taking up psychiatry as a career will frequently experience negative and stereotypical views from fellow clinicians. This often reflects a misunderstanding of the roles and responsibilities of psychiatrists and a failure to recognise the fascination of working in a mental health profession. If you do have genuine interest in becoming a psychiatrist then do not be distracted by these notions; you will not regret it. I found this to be very much the case when I decided on a career in old age psychiatry.

Having worked in a number of medical and psychiatric specialties, I found old age psychiatry to be the most absorbing and varied medical specialty in which I have worked. Much of what we do is often misperceived as unattractive and unappealing. This, along with textbooks of old age psychiatry documenting the changing demographics of the population, the prevalence of mental disorder and particularly dementia increasing with age along with the rising demand for care in developed countries, does not distinguish it as a career that one might want to choose. That is a view that must be challenged. The needs and vulnerabilities of older people, the range of setting that we are required to work, as well as the broad scope of the medical, psychiatric and social predicaments that we are faced with, sets the specialty apart from others and requires particular psychiatric skills. The opportunity to work truly collaboratively and holistically with a broad range of professionals drawing on and developing one’s own skills in psychiatry, general medicine and neurology is constantly satisfying.

Many contemporary legal and philosophical issues around protection of an individual’s human rights, end-of-life decisions, matters of capacity, informed consent, the complex interface between mental capacity and mental health legislation are not just interesting theoretical considerations. They exemplify some of the clinical and ethical decisions that we are faced with on an almost daily basis working in old age psychiatry. Likewise, many of the exciting developments in modern molecular neuroscience represent tangible prospects for translating progress in the laboratory into effective treatments in the clinic.

The specialty itself has grown in strength and importance over recent decades, not least because of a greater collective understanding of particular needs of older people in society and a growing evidence base for interventions along with the developments in psychiatric services for older people. In my view, as a group of individuals, old age psychiatrists are generally pleasant and agreeable and I think all would unite in saying that this is a remarkably exciting time to come into the specialty.

Nick Brindle

Consultant psychiatrist

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