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Psychiatry and the oldest old.

¹Department of Pychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. blaze001@mc.duke.edu

The American Journal of Psychiatry

|December 1, 2000

Summary

Geriatric psychiatry must reintegrate with geriatric medicine to optimally manage psychiatric issues in the oldest old. A comprehensive, interdisciplinary approach is crucial for this vulnerable population.

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Area of Science:

Geriatric Psychiatry
Psychogeriatrics
Mental Health in Aging

Background:

The oldest old (85+ years) often have complex psychiatric needs.
Current geriatric psychiatry literature frequently overlooks this demographic.
Existing treatments may not adequately address the unique challenges of this age group.

Purpose of the Study:

To review the assessment and management of psychiatric problems in individuals aged 85 and older.
To highlight the specific challenges and needs of the oldest old regarding mental health.
To advocate for a more integrated approach in geriatric psychiatry.

Main Methods:

A review of English-language literature was conducted.
Focus was placed on characteristics of individuals 85+ and their psychiatric disorders.
Depression in the oldest old was a specific area of focus.

Main Results:

Geriatric psychiatry has shifted focus from comprehensive care to specific disorders and pharmacotherapy.
Geriatric medicine emphasizes geriatric syndromes, functional status, and multimodal interventions.
An integrated approach, drawing from geriatric medicine principles, is proposed for the oldest old, using depression as an example.

Conclusions:

Geriatric psychiatry has moved away from its interdisciplinary roots.
A return to comprehensive, interdisciplinary assessment and therapy is advocated.
Reintegration with geriatric medicine is essential for optimal care of the oldest old.

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