Geriatric psychiatry: a subspecialty whose time has come.

W hat is geriatric psychiatry? Simply put, it is the subspecialty dealing with the assessment and management of mental disorders occurring in late life—a period occasionally and somewhat arbitrarily defined as aged 65 years and over (1). This definition falsely simplifies what we do as geriatric psychiatrists and does not acknowledge the scope of practice and the specific skills requisite to this subspecialty. The following are just some of the necessary skills and requirements: an awareness of the physiology of aging and how it affects the pharmacokinetics and pharmacodynamics of psychotropic medications; updated knowledge on the chronic and acute physical illnesses of late life and how they affect cognition and behaviour; a familiarity with medications used to treat chronic medical conditions, in order to evaluate their effects on behaviour and cognition and to avoid potential drug interactions with psychotropics; an expert ability to assess cognitive function and to determine the etiology of cognitive impairment; the ability to work with family systems, using extensive knowledge of community support networks and familiarity with the range of evidence-based psychiatric therapeutic modalities; the capacity to assess competence; and the capacity to deal with the multiple medical or legal issues that arise with elderly patients. Although many of these skills are not the exclusive domain of geriatric psychiatrists, this subspeciality is unique in that the assessment and management of each patient requires these skills. In Canada, geriatric psychiatry is flourishing. The Canadian Academy of Geriatric Psychiatry (CAGP) has over 190 members. The Academy hosts an annual academic meeting and provides residency training and fellowship awards. The CAGP was instrumental in developing the Canadian Coalition for Seniors’ Mental Health (CCSMH)—an organization that includes health professionals, researchers, government officials, caregivers, and seniors’ organizations. The goal of the CCSMH is to support collaborative initiatives to facilitate mental health for seniors through innovation and dissemination of best practices. Canadian geriatric psychiatrists play important roles in international organizations such as Alzheimer’s Disease International, the International Psychogeriatric Association, and the American Association of Geriatric Psychiatry. In 1999, the CAGP cohosted and organized the ninth Congress of the International Psychogeriatric Association—arguably the largest and most successful academic geriatric psychiatry meeting to date. As Canadian geriatric psychiatrists, we hold numerous peer-reviewed research grants, publish in peer-reviewed journals, and sit on international editorial boards. The articles in this issue, covering topics related to depression, dementia, and health services, are only a small sample of our academic activities. We have organized numerous undergraduate and postgraduate training programs in psychiatry across Canada, and we have published widely on educational issues related to geriatric psychiatry (2–6).