Older Mind Matters

Has old age psychiatry lost its way?

At the Faculty of Old Age Psychiatry residential conference earlier this year I heard a lot about what old age psychiatrists don't or shouldn't do. A talk about memory clinics and shared care protocols emphasised the need to discharge people once they have been given a diagnosis of dementia. And it's the GPs who should be treating them with cholinesterase inhibitors (CEIs) and following them up. Did someone say CEIs are cheap as chips or did I imagine that? Does it all come down to money now? People certainly asked - why would people living with dementia need old age psychiatry follow up? What has old age psychiatry got to offer them?

We also heard about clustering, and about how people with functional illness who are not complex enough don't need old age psychiatrists either. Several times I heard how expensive doctors are compared with nurse practitioners and other mental health professionals. We heard how history doesn't change: our psychiatrist colleagues think the important area of work is with working aged adults - always was, still is. Rest assured, ageism is alive and well and afflicts us all, psychiatrists and doctors, as much as everyone else including our patients.

The big debate raised lots of questions - in proposing that "old age psychiatry has become excessively focused on dementia at the expense of functional disorders." Alistair Burns spoke about the need for us to start from what's best for patients and carers. That's when something clicked for me: we're too busy thinking about ourselves, our services and the money. We're being brainwashed by politicians, commissioners and managers. We need to be confident in our skills, stay close to our patients and their families, and be open to evolution. We need to stop saying it can't be done and just do it. Yes we need to provide proper services for families living with dementia, but how does that prevent us from providing proper assessment, diagnosis and treatment for older people with functional illnesses who, we all know, get a really bad deal in the hands of general psychiatrists? We need to stop saying we can't and look at how we can.

NOTE: This is a shortened version of a piece published online in the Old Age Psychiatrist Issue 59: May 2014. The full version is available here.

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