Organization of old age psychiatry services

In terms of service activity in psychiatry, older people are an important group. People over the age of 65 make up around a third of all mental health activity in the UK in terms of admissions, readmissions and community contacts. However, the profile of disorder and needs does differ from that in younger age groups. The challenges presented by dementia and co-morbid physical illness and disability require particular professional skills. Services need to be able to deal with the complex mix of social, psychological, physical and biological factors found in the elderly mentally ill. The development and delivery of such services is discussed in this contribution. Even given resource constraints and other challenges, there can be few more exciting parts of medicine with which to be involved, and where there is greater likelihood of clinically significant advances in treatment and care in the next 10-15 years, than old age psychiatry. The biological advances in understanding aetiology in dementia are being rapidly transformed into therapeutic approaches as diverse as disease-modifying medication, immunization, and stem cell therapy. The rate of transformational change in understanding and action in this area is stunning. In service terms we need to gear ourselves up to identify cases early, when there is the possibility of prevention of future harm; for example, in terms of crises, institutionalization, depression, carer burden, loss of function, and possibly further cognitive decline. The next generation of disease-modifying compounds will further challenge us to identify and intervene in presymptomatic states as well as in those already affected by dementia. Services must develop to meet local needs and will need to build on local strengths. In service development it is seldom the case that one size fits all, so there will be local variation in what works best. The goal must be to improve the quality of life for older people with mental disorder and their carers; we can only do this by improving the quality of care provided. If we are to succeed, this means working in a true partnership with social care, primary care, user and carer groups and patients and carers themselves.