chapter  23
8 Pages

chapter 23

Old age psychiatrists have a pivotal role in the diagnosis and management of people with dementia. In the UK this reflects the relative strength and coherence of old age psychiatry as a discipline stimulated, at least in part, by the seminal studies of Roth (1955) and Post in the 1960s and 1970s (Post, 1972}, in addition to the pioneering work of practitioners such as David Jolley and Tom Arie Oolley and Arie, 1978)

The role of old age psychiatry services in the UK has been described previously Oolley and Arie, 1978}, brought up to date (Dening, 1992, Jolley and Arie, 1992) and recently summarized internationally (Draper et al, 2005). The principle for all old age psychiatry services, in particular in relation to people with dementia, is that care in the community is most important and, while services throughout the UK differ in their style of organization, the common theme is community outreach, carried out by multidisciplinary teams, usually with a consultant old age psychiatrist as 'the nucleus of the service' Oolley and Arie, 1992). The Royal College of Psychiatrists in the UK published norms some years ago for the approximate numbers of specialists and beds for a service, suggesting that one old age psychiatrist could serve a population of some 22 000 people over the age of 65 but more recently reflected an increase in the complexity of the service provided and in people's aspirations of care. A consultant might be expected to look after a population of between 10000 and up to a maximum of 15000 people over the age of 65. It is estimated that just over 20 acute beds with 45 continuing care beds and 45 day hospital places would be appropriate support for this (Royal College of Physicians and Royal College of Psychiatrists, 1989). However, the field changes on a regular basis and initiatives such as the NHS Plan and the National Service Framework for Older People have emphasized that services should be dynamic and should reflect the multidisciplinary nature

of the work involved. This attests to the rising strength of other professions in the care for older people with mental health problems, in particular dementia.