Spotlight

Psychogeriatrics: Definition and Description of Psychogeriatrics

Finding a definition and description of psychogeriatrics that is agreeable to all has long been a source of discussion among health professionals working in the field of mental health of the elderly. One useful description can be found in the Preface by Manfred Bergener and Sanford I. Finkel, Editors, of Clinical and Scientific Psychogeriatrics, Volume 1, The Holistic Approaches (1990), Springer Publishing Company, New York:

"Since the concept of psychogeriatrics is relatively new, it seems useful to explain its several underlying principles:

• Psychogeriatrics represents an integrative approach to adaptation in later life. Thus, the problems and developments of later life must be viewed from a bio-psycho-social perspective, with consideration of socioeconomic, spiritual, environmental, psychological, and biological factors. Alterations in one of these areas is likely to impact and affect other areas. Further, aging is a process that can alter the balance of any of the above.
• Psychogeriatrics is an integrative paradigm within which health and disease are part of continuum Ñ both part of a total life experience to be viewed as a unified process.
• Psychogeriatrics abandons the deficit model of aging. Symptoms of psychogeriatric disease must be understood with due consideration of specific symptoms, the personality of the individual, the social and cultural environment, and the psychological reaction of the individual to specific life events.
• Psychogeriatrics is a model of a broadly conceived somatopsychic and psychosomatic pathology. For example, a stroke may precipitate depression. Social isolation can impact nutrition or contribute to alcoholism, thereby impacting mental state. Dementia can lead to poor dental care and significant dental problems.
• Psychogeriatrics includes prevention, diagnosis, treatment, and rehabilitation. The coordination of treatment and rehabilitation is all too often neglected. Yet, rehabilitative measures are an integral part of psychogeriatrics.
• Psychogeriatrics emphasizes multidisciplinary and especially interdisciplinary Ñ not only in services, but also in education and research. Interdisciplinary intedigitates the skills and efforts of professionals in diverse fields to construct a synergistic effort in which the total is more than the sum of the parts.
• Psychogeriatrics transcends traditional thinking which has been characteristic of separate disciplines. Instead it provides multiple perspectives in order to represent the discovery of the greater whole.

...The future of psychogeriatrics looks positive indeed. With older populations in developed and developing countries growing, clinicians, scientists, and planners are taking increasing interest in the understanding of the problems and opportunities of later life. The importance of sharing our expertise - both between disciplines and between countries - is becoming an increasingly expected and welcomed goal."

Another statement about psychogeriatrics is that formulated by representatives of the World Health Organization and World Psychiatric Association at a Consensus Conference meeting held at Lausanne, Switzerland in February 1996. A definition in their consensus statement contributes to the understanding of psychogeriatrics and represents the perspective of psychiatry, one of the many disciplines involved in the field Psychiatry of the Elderly: A Consensus Statement 1996, World Health Organization, Geneva:

"Psychiatry of the elderly is a branch of psychiatry and forms part of the multidisciplinary delivery of mental health care to older people. The specialty is sometimes referred to as geriatric psychiatry, old age psychiatry or psychogeriatrics.

Its area of concern is the psychiatry of people of `retirement’ age and beyond. Many services have an age cut-off at 65 but countries and local practices may vary; several specialist services include provision for younger people with dementia. The specialty is characterized by its community orientation and multidisciplinary approach to assessment, diagnosis, and treatment.

An elderly patient suffering from mental health problems often has a combination of psychological, physical and social needs. This implies that individual assessment management and follow-up requires collaboration between health, social and voluntary organizations and family carers. Mental health problems in old age are common, and an understanding of the principles involved in their identification and management should be an integral part of the general training of all health and social care workers. Progress in the field must be evidence-based and founded on rigorous empirical research with which practitioners should aim to keep up to date.

Past experience and behavior may influence whether a person develops mental illness and how such illness presents itself. Multiple losses (death of relatives/friends, declining health, loss of status, etc.) in old age may be particularly important though many older people remain resilient despite multiple adversity.

The specialty deals with the full range of mental illnesses and their consequences, particularly mood and anxiety disorders, the dementias, the psychoses of old age and substance abuse. In addition, the specialty has to deal with older people who developed chronic mental illness at a younger age. At any rate, psychiatric morbidity in old age frequently coexists with the physical illness and is likely to be more complicated by social problems. Older people may also have more than one psychiatric diagnosis.

The above factors, together with the biological, social and cultural changes associated with the ageing may significantly alter the clinical presentation of mental illness in old age. Current diagnostic systems (ICD-10, DSM-IV, etc.) do not fully allow for these factors.

The diagnostic approach is essentially similar to that used in other age groups. There are nevertheless differences. Older people are often frightened by unfamiliar diagnostic investigations. They should have their initial assessment in their home or other familiar setting wherever possible. It is particularly important to obtain a collateral history. Invasive or stressful tests should only be undertaken where their results might alter management or to fulfill family needs for diagnostic answers.

Many mental illnesses in old age can be treated successfully. Some (particularly the dementias) are chronic and/or progressive. Appropriate intervention can nonetheless contribute to improving quality of life."