Geriatric Psychiatry or Psychogeriatrics? Partnership at the CAGP/CCSMH 2012 Scientific Meeting

CANADIAN GERIATRICS JOURNAL, VOLUME 16, ISSUE 1, MARCH 2013 The 2012 joint Canadian Coalition for Seniors’ Mental Health (CCSMH) and Canadian Academy of Geriatric Psychiatry (CAGP) conference was held at the Banff Centre in Banff Alberta on September 21st and 22nd, drawing record attendance of 268 physicians, health-care providers, and stakeholders in the care of the elderly. Co-sponsored by the CAGP and CCSMH, the meeting was followed by the inaugural Geriatric Psychiatry annual review course, which was also sponsored by the CAGP. The meetings provided an opportunity for us to reflect on the areas of overlap in the fields of geriatric medicine and geriatric psychiatry over the years, and to speculate on where we are heading in the future. The keynote addresses were given by two visionaries in the field of Geriatric Psychiatry and Geriatric Medicine, Dr. Ken Shulman (Richard Lewar Chair in Geriatric Psychiatry, University of Toronto) and Dr. David Hogan (Brenda Strafford Foundation Chair in Geriatric Medicine, University of Calgary). Dr. Shulman provided an overview of the evolution of Geriatric Psychiatry over time, both in Canada and abroad, highlighting important historical figures and events. He alluded to the literature of the 1950s and 1960s, in which an age of 55 years was listed as the cut-off for being considered geriatric, as opposed to our current standard of 65 years. Furthermore, he informed us that there were no Old Age Psychiatry Programs prior to 1950 and noted that a geriatrician, Dr. Ignatz Nascher, published the first textbook on diseases of old age in 1915.(1) He paid homage to Dr. Marjorie Warren who, in 1935 in the United Kingdom (UK), formed the first geriatric medicine service, emphasizing the principles of adequate treatment, assessment, aftercare, multidisciplinary treatment, and holistic approaches—principles very much at the core of geriatric medicine today. In the early days, he suggested, geriatricians attended to both the medical and psychiatric needs of their patients and thus were the first “psychogeriatricians”. Services were then reclaimed by psychiatry in the 1950s, becoming “Old Age Psychiatry” in the UK and “Geriatric Psychiatry” in North America. In the 1970s, governments began to mandate the creation of psychogeriatric units within general hospitals, ushering in a new era. Dr. Shulman praised his mentor, Prof. Tom Arie, with whom he trained in East London, England. He explained how Prof. Arie’s service exemplified the core principles of comprehensiveness, defined target population, accountability, availability, community focus, and caregiver support, principles that still guide outreach programs today. The experiment in Nottingham of combining the Departments of Geriatric Psychiatry and Geriatric Medicine unfortunately ended with his retirement. In terms of academic milestones, Dr. Shulman referenced Sir Martin Roth, who published a landmark paper in 1955 entitled the “Natural History of Mental Disorders in Old Age”. (2) Sir Martin followed 318 patients, admitted to a geriatric psychiatry services with a variety of diagnoses, for two years and discovered that most patients with affective disorders were discharged, most patients with dementia and senile psychosis were deceased, most patients with paraphrenia were hospitalized, and half of delirious patients were discharged while the other half were deceased. Dr. Shulman alluded to many seminal figures in the development of geriatric psychiatry, including Drs. Felix Post, Bruce Pitt, and Robert Butler. Dr. Butler was credited with founding the National Institute of Aging (NIA) in 1975. Also seminal to the development of geriatric psychiatry were the development of rating scales, such as the Folstein Mini-Mental Status Exam (MMSE) by Marshall Folstein in 1975,(3) the Neuropsychiatric Inventory (NPI) by Cummings et al.,(4) and the Geriatric Depression Scale (GDS) by Yesavage et al.(5) He also alluded to the contribution of professional organizations, including the American Association of Geriatric Psychiatry (AAGP) founded in 1978, the International Psychogeriatric Association (IPA) founded in 1982, and the CAGP founded in 1991. In terms of Canadian milestones, the first academic Division of Geriatric Psychiatry was established at the University of Toronto in 1978, and training in geriatric Geriatric Psychiatry or Psychogeriatrics? Partnership at the CAGP/CCSMH 2012 Scientific Meeting