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RELATIONSHIPS BETWEEN OLD AGE PSYCHIATRY AND GERIATRIC MEDICINE

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RELATIONSHIPS BETWEEN OLD AGE PSYCHIATRY AND GERIATRIC MEDICINE

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									RELATIONSHIPS BETWEEN OLD AGE PSYCHIATRY
AND GERIATRIC MEDICINE
A joint statement of the Faculty of Psychiatry of Old Age of the Royal Australian and New Zealand College of
Psychiatrists, the Australian Society for Geriatric Medicine and the New Zealand Geriatric Society.


                                 PREAMBLE                                     services in all parts of Australia and
                                 The Faculty of Psychiatry of Old Age,        New Zealand. Rather, it established a
                                 the Australian Society of Geriatric          set of principles to help the two sub-spe-
                                 Medicine and the New Zealand Geriatric       cialties work better together, adapting
                                 Society recognise the need for old age       to local circumstances. These princi-
                                 psychiatry and geriatric medical serv-       ples still apply. This revised statement
                                 ices to work closely together to ensure      reflects the current move, which is
                                 the best treatment and care of older         endorsed by all three professional bod-
                                 patients, many of whom suffer from           ies, to promote easy access by elderly
                                 complex combinations of mental and           patients and their carers to high quality,
                                 physical ill-health. The following is a      well-integrated community, residential
                                 statement of agreement between the           and hospital aged services of which old
                                 three bodies regarding best policy and       age psychiatry and geriatric medicine
                                 practice in this regard.                     are key components.
                                   The statement is a revision of one         RELATIONSHIP BETWEEN
                                 prepared in October 1990. Old age psy-       SERVICES
                                 chiatry services were being established
                                                                              1. Both old age psychiatry and geriatric
                                 at that time in many parts of Australia
                                                                                 medical services should be available
                                 and New Zealand and referral arrange-
                                                                                 in health care areas with more than
                                 ments and service responsibilities var-
                                                                                 50,000 inhabitants. Where old age
                                 ied from place to place. In general,
                                                                                 psychiatrists are not readily avail-
                                 geriatric medicine accepted responsibil-
                                                                                 able, arrangements should be made
                                 ity for the treatment and care according
                                                                                 for visits by specialists and/or tel-
                                 to the type and complexity of medical
                                                                                 ephone or video conferences. Where
                                 problems. In contrast, most old age
                                                                                 no such arrangements are possible,
                                 psychiatry services use aged-based cri-
                                                                                 it is expected that geriatric medical
                                 teria, thereby creating barriers to cross-
                                                                                 services, adult mental health servic-
                                 referral of some patients. There was
                                                                                 es, private psychiatrists and general
                                 also uncertainty about whether old age
                                                                                 practitioners will liaise to provide a
                                 psychiatry or geriatric medicine should
                                                                                 substitute service.
                                 take prime responsibility for the assess-
                                 ment and management of the cognitive         2. Where old age psychiatry and geri-
                                 and behavioural problems associated             atric medical services have defined
                                 with dementia.                                  catchments, their boundaries should
                                                                                 correspond.
                                   The aim of the 1990 position state-
                                 ment was not to prescribe identical          3. Wherever possible, old age psy-




                                                                                                                     1
   chiatry and geriatric medical serv-         services, when resourced adequate-
   ices should be co-located to promote        ly, are usually best placed to provide
   ease of access and continuity of care       assessment and treatment to patients
   for patients, carers and referring          whose dementia is complicated
   agencies. It is imperative, however,        by behavioural and psychological
   that old age psychiatrists maintain         symptoms.
   close professional and educational
                                            10. It is important that services be ade-
   links with their colleagues in general
                                               quately funded. Resources (staff,
   psychiatry.
                                               physical facilities etc.) should
4. Where co-location is not practicable        be allocated on the basis of local
   or desirable, it is important that old      need in line with the RANZCP's
   age psychiatry and geriatric medi-          Statement on Psychiatric Services
   cal services be integrated function-        for the Elderly (Position Statement
   ally to ensure the clinical outcomes        #22).
   described below.
                                            11. Reciprocal arrangements for rota-
5. Where the two services are co-locat-        tions by advanced trainees in each
   ed, referring persons or agencies           other's disciplines are highly desir-
   should have the option of referring         able and training committees should
   explicitly to either old age psychia-       provide clear guidance about stand-
   try or geriatric medicine.                  ards of training and supervision.

6. Irrespective of service structure,       12. Wherever possible, representatives
   cross-referral   between     services       of both disciplines should contribute
   should be freely available to opti-         to medical appointment committees
   mise care and prevent indiscriminate        and to planning processes where the
   transfer of patients from one service       outcome impacts on the other sub-
   to another.                                 specialty.

7. Criteria for the division of respon-
   sibility between the two services
   must be known and accepted both
   internally and externally.

8. Responsibility for patient care must
   be based on assessed needs. When a
   patient is referred from one service
   to another, clinical accountability
   rests with the original service until
   the other accepts primary responsi-
   bility.

9. In general, delirium is best managed
   by physicians. Old age psychiatry




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