Mohammed T. Abou-Saleh

Principles and Practice of Geriatric Psychiatry.Editors: Professor John R. M. Copeland, Dr Mohammed T. Abou-Saleh and Professor Dan G. BlazerCopyright & 2002 John Wiley & Sons LtdPrint ISBN 0-471-98197-4 Online ISBN 0-470-84641-0119Psychiatry of the Elderly—the WPA/WHOConsensus StatementsCornelius KatonaRoyal Free and UCL Medical School, London, UKBetween 1997 and 1999, under the Chairmanship of the lateProfessor Jean Wertheimer, the World Psychiatric Association,Section of Geriatric Psychiatry, published a series of consensusstatements in collaboration with the World Health OrganizationDivision of Mental Health. A wide range of non-governmentalorganizations (NGOs) participated.The first Consensus Statement 1 defined the scope of thespecialty, emphasizing that this has become necessary because ofincreasing longevity (most markedly in the developing world); therelatively high prevalence of both functional mental disordersand the dementias in old age; and the need to adopt amultidisciplinary approach, while defining professional roleswithin the team. The scope of psychiatry of the elderly is ‘‘thepsychiatry of ‘retired’ people’’, and includes the full range ofmental illnesses, including affective disorders, psychoses, substanceabuse, the dementias and the mental health problemsof ‘‘graduates’’ whose mental health problems continue intoold age. The specialty also needs to address psychological,physical and social aspects of mental health problems in olderpeople and the biosociocultural changes associated withageing.The characteristics of a successful psychiatry service for theelderly are summarized as community orientation, a multidisciplinaryapproach, an emphasis on abilities as well asdeficits, and a core aim to improve quality of life rather thansimply to alleviate symptoms. The main objectives of treatmentare the restoration of health, improvement of quality of life, theminimization of disability, the preservation of autonomy, andaddressing the needs of family and other carers as well as those ofthe individual patient. The high relapse rate of functionalpsychiatric problems in old age necessitates close follow-up aftersuccessful initial treatment.Priorities within any new specialist service include teachingpsychiatry of the elderly to primary healthcare workers; trainingexisting mental health professionals in special mental healthproblems of the elderly, and establishing at least one multidisciplinaryresource/expertise centre.The second Consensus Statement 2 identified general principlesthat should underpin any quality specialist psychiatry of theelderly service:. Good health and optimal quality of life are fundamentalhuman rights irrespective of age or mental disorder. All people have right of access to appropriate services. Recognized needs should, within resource constraints, be metappropriately and ethically. This can only be achieved through health and social measuresadapted to local needs. Older people with mental health problems and carers shouldbe involved, individually and collectively, in care planning. Governments should recognize the crucial role of nongovernmentalorganisations and work with them.The specific qualities of a good service are that it should beComprehensive, Accessible, Responsive, Individualized, Transdisciplinary,Accountable and Systemic (CARITAS), and shouldattempt to both prevent mental health problems from arising andidentify them early when they do arise. As well as offeringcomprehensive assessment and acute management, the serviceshould provide continuing care and support to patients and carersand address spiritual and leisure needs as well as medical needs.The third Consensus Statement 3 focused on education. Targetsfor educational initiatives include: health and social care professionalsat undergraduate, postgraduate and continuing educationlevels; health and social service managers; other care workers;family and other informal carers; voluntary workers; public policymakers; and the general public. Although such a wide range oftarget groups inevitably start with different needs and differentstarting levels of knowledge, a generic core curriculum can bederived from the learning needs of health professionals. Essentialcurriculum elements include:. Processes of ageing in individuals.. The demography, economics and politics of ageing societies.. The epidemiology, pathology, clinical features, assessment,diagnosis, treatment and management of the mental disordersof old age.. Physical disorders and impairments of function thatcommonly occur in old age.. The special significance in old age of the interdependence ofmental, physical and social factors.. Principles of health promotion and the preventive psychiatryof old age.. Ethical and legal issues relevant to older people.. Principles of planning, provision and evaluation of services indifferent settings.. Needs of carers and approaches to their support.. End-of-life issues.. Principles and practice of multidisciplinary teamwork.. Interviewing and communication skills.. Fostering of positive attitudes and insight into the reasons fornegative attitudes.Principles and Practice of Geriatric Psychiatry, 2nd edn. Edited by J. R. M. Copeland, M. T. Abou-Saleh and D. G. Blazer&2002 John Wiley & Sons, Ltd