Education

Education is emphasized by the WHO-WPA document.(3) Three areas were targeted as priorities:

1. teaching psychiatry of the elderly to primary health-care workers;

2. training all existing mental health professionals in the special mental health problems of the elderly;

3. establishing multidisciplinary groups to act as resource centres.

At the time of writing there is increasing emphasis on consumer autonomy and choice in health care. In the elderly with existing psychiatric and cognitive impairment, unfortunately autonomy is already compromised. However, opportunities for prevention abound, particularly in primary health care. 'Consumers' (namely the public, patients, and their families), need to be educated in recognizing the warning signs of psychiatric illness and how to access appropriate care. Primary health care providers are in a position to screen elderly patients for mental and cognitive impairment, to work with patients and families to treat existing illness, and to reduce the risk of further morbidity and disability, and this should become part of their role in the provision of basic health care.

All psychiatrists should be trained in the psychiatry of old age. A rotation in geriatric psychiatry is now required by professional bodies in several countries, including the Royal College of Psychiatrists in the United Kingdom, the Accreditation Council for Graduate Medical Education ( ACGME) in the United States, the Royal College of Physicians and Surgeons of Canada, and the Royal Australian and New Zealand College of Psychiatrists. Since 1991, the American Board of Psychiatry and Neurology has offered an examination for added qualifications in geriatric psychiatry; this has been passed by 2360 psychiatrists as of 1999, and there are now 39 ACGME-accredited geriatric psychiatry fellowship programmes nationwide.

Specialist teams may use encounters with primary care providers and residential care staff as opportunities to help providers develop their skills and confidence in the care of the elderly, in addition to offering formal continuous education and training programmes. The education of patients and their families, as well as raising public awareness, is part of the responsibility of interdisciplinary professionals working in the field, who are urged to put pressure on governments to make resources available to meet the special needs of the elderly.(3)

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