Sir, – Rising rates of anti-depressant prescription may be a marker of the increased prevalence of depression in the very elderly (“Nearly 25 per cent of anti-depressant prescriptions last year for people aged 75 and older”, News, June 3rd), but they also prompt the question as to whether these patients are able to access specialist psychiatry of old age teams that manage a range of mental illnesses and dementia in later life using a multidisciplinary and holistic approach to care.
This would mean that alongside appropriately prescribed evidence-based treatments, a patient is helped on their path to recovery by a range of professionals who specialise in optimising functioning (occupational therapy), maintaining financial and social independence (social work) and, where indicated, talking therapies (psychology).
The holistic approach means that medication is only one part of the treatment.
It starts with a comprehensive assessment accounting for all of the patient’s mental and physical needs and recovery goals are set with the patients and their carers.
This further requires maintenance of links with primary care (such as GPs, public health nurses, physiotherapists), voluntary agencies (such as Alone and day centres) and other specialists (such as geriatricians and neurologists).
The goal of recovery is to enable a patient to reach their full potential in their own social context.
Psychiatry of old age teams also provide liaison for acute hospitals where there are no liaison psychiatry of old age consultants.
Unfortunately, not all teams nationally have their required staff complement.
There is an increasing demand among the very elderly for specialist teams that can ensure that appropriate management of depression and other mental illnesses can be delivered where and when it is needed. – Yours, etc,
Dr ATIQA RAFIQ,
Chair of the Faculty
of Old Age Psychiatry,
College of Psychiatrists