Geriatric psychiatry in primary care. A focus on ambulatory settings

Considering how tightly interwoven are the strands of mental and physical health in the fabric of late life, it would be unwise for psychiatrists and primary care physicians to continue to insist on separately tracing and mending frayed old threads, each in mostly one direction, occasionally irritated by the shortcomings in the others work, and only occasionally seeking or offering assistance. As reflected in their help-seeking behavior and their characterization of suffering, the elderly often do not see, or do not choose to recognize, the theoretical and professional distinctions we hold so dear. Acknowledging the impact of the unmet needs of elderly patients, and respecting the wisdom of their choices, primary care physicians and psychiatrists have an obligation to work together more effectively. Improved mental health in our geriatric patients will require major efforts in the areas of research, public education, health care funding, and community resource development, as well as in individual patient care. Medical disciplines working in isolation or in opposition will not attenuate these obstacles effectively.