The importance of psychiatry of old age.

475 AustrAlAsiAn Psychiatry P sychiatry of old age (POA) is a psychiatric subspe-cialty focusing on the mental health of older people. This subspecialty has been developing in the UK since the 1940s; and in Australia and New Zealand, since the 1970s and 1980s. 1 The Royal Australian and New Zealand College of Psychiatrists (RANZCP) section in POA was established in 1987. 1 POA gained faculty status in 1999 and there are now more than 270 faculty members. Training in POA is mandatory in the RANZCP fellowship programme. For example, in their first three years of training, all psychiatry trainees are expected to have in-depth knowledge of specific POA disorders, including: dementia, very-late-onset schizophrenia-like psychoses, and the effects of ageing in people with early-onset and late-onset psychotic disorders. In addition, trainees can specialise in POA by completing a certificate of advanced training. Like in other developed countries, the population of older people, in particular the oldest old group (85 years and over), is increasing rapidly in Australia and New Zealand. Mental health disorders in older people are associated with age-related biological, psychological, social and developmental factors. These factors include physical illnesses, cognitive decline, grief and loss, resilience , vulnerability, role changes, aged residential care and end-of-life care. Old age psychiatrists, who usually work in the setting of a multidisciplinary team that provides home-based treatment, skillfully take these factors into consideration in their assessment, formulation and management of mental health disorders in older people. Draper reviewed the effectiveness of POA services and concluded that there is a level II evidence for community POA services, in terms of acute treatment outcomes, particularly with depression. 2 One of the challenges facing the subspecialty of POA is consolidating where our specialist skills can best be deployed. This need has come about as a result of increasing awareness and recognition of late-life mental health disorders, the ageing population of people with adult-onset mental health disorders (which is often complicated by physical comorbidity), a change in the provision of aged residential care, increasing barriers to care for people with mental health disorders and resource constraints. Some of these factors have driven a change in service structure and provision in the UK. Despite the clear evidence that older people derive better outcomes from specialised services, 'ageless' mental health services have recently been created by some UK health providers. 3 The threat of the development of ageless mental health …