A geriatric psychiatrist is a physician who specializes in the field of medical sub-specialty called geriatric psychiatry[5]. A geriatric psychiatrist holds a board certification after specialized training after attaining a medical degree, residency, and an additional geriatric psychiatry fellowship training program[5]. The requirements may vary by countries[6][7]. Some geriatric psychiatrists also conduct research to determine the cause and better treatments for neurodegenerative disorders and late-life mental health disorders.[8]
Diseases and disorders diagnosed or managed by geriatric psychiatrists include, but are not limited to:[10]
Late-life Presentations of Psychiatric Disorders[11]
Late onset of depression is associated with higher rates of cardiovascular disease, higher risk of suicide, and higher possibility of treatment resistant depression.[12]
Anxiety Disorders can be characterized by restlessness, irritability, and muscle tension, but in older adults can be misinterpreted as manifestation of aging.[13]
Bipolar Disorder in older adults is associated with increased risk of premature death, increased risk of dementia and cognitive deficits.[14]
Schizophrenia after the age of 65 is considered very-late onset and is associated with higher rates of psychosis, which are often secondary to other medical comorbidities.[15]
Many risk factors for Substance use disorder are seen commonly in the elderly population such as: polypharmacy, multiple co-morbid health conditions, and social isolation [17].
Alois Alzheimer (1915), a German psychiatrist who identified the pathology involved in Alzheimer's disease
The origins of geriatric psychiatry began with Alois Alzheimer, a Germanpsychiatrist and neuropathologist who first identified amyloid plaques and neurofibrillary tangles in a fifty-year-old woman he called Auguste D[19]. These plaques and tangles were later identified as being responsible for her behavioural symptoms, short-term memory loss, and psychiatric symptoms.[19] These brain anomalies would become identifiers of what later became known as Alzheimer's disease[20].
Subspecialty
The subspecialty of geriatric psychiatry originated in the United Kingdom in the 1950s[21]. In 1958, the first mental health service was designed specifically for the elderly under the guidance of Dr. Ronald Robinson in Scotland[22]. At this time, much of the knowledge related to this field was based of notable psychiatrists in the United Kingdom including: Sir Martin Roth (psychiatrist), Dr. Felix Post, Dr. Aubrey Lewis, and Dr. David Henderson[23].
There are many different screening tools used in the elderly[26].
The Patient Health Questionnare-9 (PHQ-9) is used to screen for depression[27].
The Generalized Anxiety Disorder 7 (GAD-7) is typically used to screen for anxiety, however it is typically used in younger adults (19-64)[28]. In those 65+, the Geriatric Anxiety Inventory is used in its place[28].
The Clock Drawing Test (CDT) can be used to quickly assess cognitive function through visuospatial skills and executive function[32].
The CDT can be interpreted as normal, Mild Cognitive Impairment (MCI), possible Alzheimer's Disease (AD), or other diagnoses[32].
Treatments
When determining appropriate next steps in treatment for psychiatric conditions in the elderly, the discussion first focuses around pharmacologic intervention vs. non-pharmacologic intervention.[33]
Pharmacologic Interventions
In the geriatric population, careful pharmacologic consideration is required due to possibility of drug-drug interactions, co-morbid conditions, and risk of adverse effects[34]. In 2023, The American Geriatric Society updated the Beers Criteria to outline potentially inappropriate medications in the elderly[35]. The Beers Criteria is meant to identify medications that may cause harm to geriatric patients, but it requires case by case interpretation for each patient [36].
Common psychiatric medications used in the elderly include[35]:
Antidepressants and anxiolytics such as SSRI's, SNRI's, TCA's, MAOi's.
Adverse effects, particularly concerning in this age group include drowsiness, increased risk of falls, postural hypotension, and sleep disturbances[34].
When pharmacologic intervention has failed, electroconvulsive therapy is an option for treatment resistant depression, agitation secondary to delirium, catatonia, psychosis, and other psychiatric conditions in the elderly[38].
Training
International
The International Psychogeriatric Association is an international community of scientists and healthcare geriatric professionals working for mental health in aging[39]. International Psychogeriatrics is the official journal of the International Psychogeriatric Association[40].
Canada
The Royal College of Physicians and Surgeons of Canada is responsible for training and certifying geriatric psychiatrists in Canada[41]. Geriatric psychiatry requires an additional year of subspecialty fellowship training in addition to general psychiatry training[6].
United Kingdom
The Royal College of Psychiatrists is responsible for training and certifying psychiatrists in the United Kingdom[42]. Within the Royal College of Psychiatrists, the Faculty of Old Age Psychiatry is responsible for training in Old Age Psychiatry[42]. Doctors who have membership of the Royal College of Psychiatrists can undertake a three or four-year training program to become a specialist in Old Age Psychiatry[43]. There is currently a shortage of old age psychiatrists in the United Kingdom.[7]
↑Jiang, Wei (2020-05-01). "Depression and Cardiovascular Disorders in the Elderly". Clinics in Geriatric Medicine. 36 (2): 211–219. doi:10.1016/j.cger.2019.11.003. PMID32222297.
↑Juul, Dorthea; Colenda, Christopher C.; Lyness, Jeffrey M.; Dunn, Laura B.; Hargrave, Rita; Faulkner, Larry R. (May 2017). "Subspecialty Training and Certification in Geriatric Psychiatry: A 25-Year Overview". The American Journal of Geriatric Psychiatry. 25 (5): 445–453. doi:10.1016/j.jagp.2016.12.018. PMID28214074.
↑Bush, K.; Kivlahan, D. R.; McDonell, M. B.; Fihn, S. D.; Bradley, K. A. (September 14, 1998). "The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test". JAMA Internal Medicine. 158 (16): 1789–1795. doi:10.1001/archinte.158.16.1789. PMID9738608.
12Kok, Rob M.; Reynolds, Charles F. (2017). "Management of Depression in Older Adults A Review". JAMA. 317 (20): 2114–2122. doi:10.1001/jama.2017.5706. PMID28535241.
12"2023 AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults". Journal of the American Geriatrics Society. 71 (7): C1, 2033-2357. March 2023. doi:10.1111/jgs.18372) (inactive 21 January 2026).{{cite journal}}: CS1 maint: DOI inactive as of January 2026 (link)
↑Laliberté, V.; Rapoport, M. J.; Rabheru, K.; Rej, S. (July 14, 2016). "Practice eligible route for certification in geriatric psychiatry: why some Canadian psychiatrists are disinterested in writing the RCPSC subspeciality examination?". International Psychogeriatrics. 28 (10): 1749–1750. doi:10.1017/S1041610216000909. PMID27411496.
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