Gerontopsychiatry--the present situation in the Federal Republic of Germany

Although gerontopsychiatry today is no longer the darkest area of psychiatry as characterized by Kraepelin 50 years ago, clearly defined and commonly accepted nosology and classification are lacking even today. The concept of a multidimensional diagnostic, therapy and rehabilitation is not yet developed beyond the early stages. Main research effort is concentrating at clinical, biochemical, immunological, morphological and genetic aspects of etiology and pathogenesis of organic brain syndromes especially of the senile and presenile dementias and vascular brain processes. Several clinical research groups moreover concentrate at present on the development of psycho- and sociotherapeutic treatment concepts in functional psychoses as well as in establishing a criminal-gerontology in connection with forensic psychiatry of higher age. Another area of emphasis in gerontopsychiatric research is concerned with gerontopharmacology and gerontopharmacotherapy. One of the most urgent problems of gerontopsychiatry is still the problem of improper primary and secondary admission of older people in psychiatric hospitals and homes. Up to this day the "principle of permanence" in the care and treatment of older people still rules in almost all institutions. Guidelines for a gerontopsychiatric supply system which were set down in the recommendations of an "Enquete-Commission" concerning the state of psychiatry remain to this day in their essential prerequisites unfulfilled and largely ignored. Measures for primary, secondary and tertiary prevention must be urgently intensified. Rehabilitation may no longer remain an empty formula, it must finally become a teaching formula.