Geriatric Psychiatry and Fellowship Programs in the United States

Article excerpt

Psychiatric disorders are extremely common in the elderly and are a major cause of morbidity and mortality. For example, 8% to 15% of the geriatric population has clinically significant symptoms of depression (NIH Consensus Conference, 1992). Elderly Americans commit suicide at a rate twice the national average (National Strategy for Suicide Prevention, 2007). Ten to 15% of elderly community residents have Alzheimer's disease (AD) or other dementias (Evans et al., 1989). AD is the seventh-leading cause of death in the United States (Centers for Disease Control, 2006).

Keywords: geriatric psychiatry; fellowship programs; academic discipline; recruitment; interdisciplinary approach

Geriatric psychiatry is the branch of psychiatry concerned with the prevention, diagnosis, and treatment of psychiatric disorders in the elderly. In addition to depression and other mood disorders and AD and other late life dementias, such conditions include schizophrenia and other psychotic disorders, substance abuse disorders, sleep disorders, delirium, personality disorders, neuropsychiatric disorders, and adjustment disorders. In order to assess and manage such conditions properly, geriatric psychiatrists must possess a specialized knowledge base to address the complex situations of older persons with mental disorders. This includes an understanding of the biologic and psychological factors in the aging process; medical and neurological illness in the elderly; the social, cultural, and economic factors that are relevant in the aged; and knowledge of geriatric medicine and neurology.

Geriatric psychiatrists see patients in a wide range of settings, including psychiatric inpatient units, acute medical/surgical hospitals, long-term-care units, assisted living facilities, ambulatory care settings, in-home care, and community settings, such as senior centers. In addition to providing direct patient care, geriatric psychiatrists often provide consultative and educational services to other physicians, nurses, social workers, families, and caregivers. In these settings, the geriatric psychiatrist plays a critical role on the interdisciplinary care team.

A BRIEF HISTORY OF GERIATRIC PSYCHIATRY IN THE UNITED STATES

Benjamin Rush published in 1805 the first known work in the United States on geriatric psychiatry, "An Account of the State of the Body and Mind in Old Age; With Observation on its Diseases and Remedies" (Butterfield & Rush, 1976). During the first half of the 20th century, American psychiatry was heavily influenced by Sigmund Freud and psychoanalysis. Freud did not believe that psychotherapy was an effective treatment for the elderly: "The age of patients has this much importance in determining their fitness for psychoanalytic treatment, that on the one hand, near or above the age of fifty, the elasticity of the mental processes, on which the treatment depends, is, as a rule, lacking-old people are no longer educable-and, on the other hand, the mass of material to be dealt with would probably prolong the duration of the treatment indefi- nitely" (Freud, 1905/1978, p. 264).

Following the end of World War II, there was a rapid expansion of the scientific knowledge base in geriatric psychiatry. In the 1950s, researchers at Duke University began a series of longitudinal studies on aging and psychiatric illness. In 1978, the American Association for Geriatric Psychiatry (AAGP) was established, the first national professional organization dedicated to geriatric psychiatry. Since its inception, the AAGP has enjoyed steady growth, with membership now exceeding 1,700.

The 1980s and 1990s saw the growing emergence of geriatric psychiatry as an academic discipline. In 1989, geriatric psychiatry was declared an official subspecialty by the American Board of Psychiatry and Neurology (ABPN, 2007). The first certifying exam was given in 1991; to date, more than 2,800 certificates in geriatric psychiatry have been issued. …