Liaison with geriatric and general medicine

In keeping with the team concept of care of the elderly, collaboration with geriatric and general medicine is important for effective care. Mutual consultation should be available. Geriatric medicine input to the psychogeriatric team—with, for instance, regular clinical and/or teaching rounds—should be encouraged. Patients with delirium are usually best managed in a medical setting, because the cause is usually physical, but staff on medical units are not always comfortable managing patients with behaviour problems. The support of the psychogeriatric team in the management of psychiatric syndromes among patients admitted to hospital with medical illness, and also those whose personality or behaviour may present challenges to non-mental health staff, can be of great assistance to the geriatric team. A sense of common purpose in the care of a shared patient population can result in greater flexibility and improved patient care. However, such an approach can represent a departure from the traditional hospital approach and can take considerable administrative, collegial, and interdisciplinary effort to establish and maintain. In addition to liaison with general and geriatric medicine, opportunities exist for liaison with other specialties. In the United States, efforts are being made to integrate geriatrics into the medical and surgical specialties by incorporating it into residency training programmes. It is hoped that this will improve each specialty's expertise in the management of the frail elderly, as it is recognized that orthopaedists, cardiologists, urologists, nephrologists, and others, are all seeing increasing numbers of older people. Geriatric medicine has recently become realigned with general medicine in hospitals in the United Kingdom, in an attempt to make new investigations and treatments available to all age groups.(41) Although some concerns have been expressed that this may take geriatricians away from the community, it is important to recognize the need to share resources in the care of this population, and one area in which this is particularly so is restoration of function. Despite psychiatry having become increasingly adept at psychosocial rehabilitation, the elderly frequently require physical rehabilitation that in the past has not been readily accessible in psychiatric programmes. The need to maintain function and independence often persists after discharge to the community, but this can be addressed by sharing resources and collaborating with other providers. The psychosocial rehabilitation of the elderly includes attention to the needs of the caregivers as well as the patient, and is discussed above under day-care programmes and community support.

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