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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Page updated on 8
December 2010