Questions in the psychiatry of old age

The last ten to fifteen years have been a time of rapid development in the psychiatry of old age. Biological research on the dementias has moved forward impressively, but significant too has been the development in many countries of local services specially designed to meet the needs of old people with mental disorders, and of those who look after them. Such services are built on the experience both of psychiatry and of geriatrics, but have also broken new ground: the UK experience is described. The facts have belied earlier misgivings about the potential of this field of work to attract and satisfy able staff in the health professions; indeed, this work has developed with style and enthusiasm, and with widespread educational programmes and growing research activity. This paper reviews briefly these developments and considers some broader issues of policy as they bear on the care of mentally ill old people. Considered also is tentative evidence that the dementias of old age may be becoming less prevalent. Finally, current studies in Nottingham which look at the social associations of old age mental disorders are briefly described and the implications are considered of the broadening of the base of 'psychogeriatrics' which such studies represent.