AAGP Position Statement: The Clinical Roles and Functions of the Geriatric Psychiatrist

Published Saturday, March 1, 1997 7:00 am

Adopted by the AAGP Board of Directors, March 1997

Position 1: Appropriate care of older adults with mental health problems requires a comprehensive approach that relies on specialized knowledge and clinical skills to integrate the biomedical, psychological and social aspects of mental disorders as they occur in late life. Clinicians who care for older adults with mental health problems must therefore be capable of understanding and addressing the complex interactions of psychiatric disorders, the aging process, medical illness, and disability, as well as the psychological, social, cultural, economic and environmental factors that are relevant to the proper assessment and treatment of elderly patients.

Rationale: It is widely recognized that persons in the late stages of life have biological, psychological, and social characteristics that are distinct from those of persons in earlier developmental stages. Accordingly, the presentation, clinical course, treatment tolerance and response, and clinical outcomes of mental health problems of elderly patients can differ substantially from those of younger patients. The assessment and treatment of late life mental disorders is often complex, due to the high prevalence of medical comorbidity and disability in the geriatric population. Therefore, specialized knowledge and clinical skills are required to address the unique problems of older persons with mental disorders, using an approach that integrates an understanding of the biological characteristics of older adults in health and disease with knowledge of the specific emotional, cognitive and behavioral changes, and the substantial alterations in social, economic and environmental conditions that commonly occur in late life.

Position 2: Geriatric psychiatrists are physicians with the specialized knowledge and skills required for the assessment and treatment of mental disorders in older adults. While many of these conditions characteristically have their onset in late life, some begin earlier and continue into late life. These conditions include but are not limited to:
  • Alzheimerís disease and other dementing disorders
  • Cognitive, affective, and behavioral complications of neurological disorders such as stroke and Parkinsonís disease
  • Delirium
  • Depression and other affective disorders
  • Substance abuse and addictions
  • Anxiety disorders
  • Sleep disorders
  • Schizophrenia and other psychotic disorders
  • Adjustment disorders
  • Complications of bereavement

The clinical expertise of the geriatric psychiatrist should be used to perform specific functions that are medically necessary for the appropriate care of the mental disorders of late life and the end stages of life. Functions that require the special medical competencies of the geriatric psychiatrist include but are not limited to:

  • Performing comprehensive, biopsychosocial clinical assessment. This entails
    • complete, accurate diagnosis of psychiatric disorders of late life
    • evaluation of the interactions among psychiatric disorders, the aging process, acute and chronic medical illnesses, and associated disabilities in the elderly patient
    • specialized, integrated understanding of the psychological, social, cultural, economic and environmental factors that affect the patientís and familyís perception of the problem and the patientís adaptation to the aging process and the illness
    • assessment of the patientís decision-making capacity, when indicated.
  • Providing or facilitating comprehensive treatment and management. This entails
    • developing and implementing a comprehensive treatment plan that addresses all aspects of the illness and identifies the most effective ways of managing these for the elderly patient
    • psychotherapeutic and behavioral interventions with attention to issues of late life
    • expert utilization of pharmacologic treatment with attention to the potential effects of aging, medical comorbidity, and other medications
      d. serving in leadership roles within interdisciplinary health care teams; ensuring the coordination and integration of psychiatric care with the patientís primary care provider, with clinicians from other relevant health care disciplines, and with staff who provide support services as part of the interdisciplinary care of older adults.
  • Providing consultative administrative and educational services that are essential for mental health care of older adults. This may entail consultation and teaching for
    • patients and families
    • primary care physicians, general psychiatrists, and other medical specialists
    • professionals from other health care disciplines
    • staff who provide support services for older adults
    • health care administrators and third party payors (including utilization review)
    • health care policy makers and legislators

The geriatric psychiatrist is the physician specialist best equipped with the knowledge and clinical skills to perform these functions in an integrated, comprehensive manner. These functions of the geriatric psychiatrist are appropriately performed in the wide range of clinical settings in which mental health services are essential for the proper care of older adults, including acute care hospitals, partial hospital programs, sub acute care units, long term care facilities, special care units, ambulatory care facilities and in-home care. Geriatric psychiatrists have an essential role on the medical staff of all health care systems that provide medical, mental health, or rehabilitative services for older adults, including health maintenance organizations (HMOs) and managed care organizations.

Rationale: The subspecialty field of geriatric psychiatry has developed in response to the uniqueness of mental disorders of late life that, coupled with the distinct characteristics of the late stages of life, result in specialized needs of older adults with mental health problems. The field of geriatric psychiatry is based on a discrete, definable, and rapidly growing body of scientific knowledge that has evolved over the past several decades, through the efforts of an international community of clinicians and researchers. The National Institute of Mental Health has formally recognized geriatrics as a distinct area for investigation, by forming a separate Mental Disorders of the Aging Branch. Special requirements for clinical training in this subspecialty have been established by the Accreditation Council on Graduate Medical Education; and a standard board examination for determining clinical competency to practice this subspecialty has been established by the American Board of Psychiatry and Neurology (ABPN).

Geriatric psychiatrists have the full range of knowledge and clinical skills required to address the biological, psychological, and social aspects of mental disorders of late life and are uniquely qualified to integrate these complex factors in the assessment and management of geriatric mental health problems. Geriatric psychiatrists perform essential roles as consultants, administrators, and educators, as well as providers of direct patient care.