Old age psychiatry
Old age psychiatry
Old age psychiatrists (OAP) are doctors who 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 including dementia and other disorders including depression and schizophrenia
Nature of the work
Mental health problems in older people are increasingly being recognised as a major health issue. Increased life expectancy has resulted in a growing demand for dedicated old age psychiatry services. 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 50% 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.
Assessing patients is an essential of the work. There's a growing demand for cognitive assessments for patients with cognitive impairment. Both assessments and follow-up may be carried out in the patient’s home or in designated memory clinics.
Patients may present with organic disorders (such as memory loss) as well as functional disorders (such as depression or psychosis). They may also suffer from multiple complex physical and social issues.
Treatment can involve medication, talking therapy or a combination of the two. Prescribing and monitoring appropriate medication is an important part of the role. Old age psychiatrists need a detailed knowledge of the way in which older people metabolise medication, since this can change as part of the aging process. The interaction of physical health medications, as well as the high rate of polypharmacy in this population, means that old age psychiatrists need a high level of pharmacological expertise.
Talking therapies such as cognitive behaviour therapy may be provided by the old age psychiatrists themselves, or they may refer patients to a therapist or clinical psychologist who specialises in this treatment.
Old age psychiatrists may also be required to treat patients who are subject to the legal framework provided by the Mental Health and the Mental Capacity Acts. They may be detained against their will under a “section” or may not be able to make some or all of their own decisions.