Principles and Practice of Geriatric Psychiatry
Interest in the health and well-being of the elderly has existed since antiquity; over the centuries some remarkable observations were made regarding the health, the mental changes, and the care of the elderly. Some explanations were offered for age changes that were reasonable and some were fanciful, limited by existing scientific knowledge.
During the twentieth century, many biological and behavioral theories of aging have been advanced and tested, emphasizing that aging is a multidimensional phenomenon.
To understand the rapid emergence of the psychiatry of old age during the twentieth century, one must appreciate that around the year 1900, the age composition of the population began to change.
Life expectancies for both males and females were being extended, particularly for females. This was paralleled by a rapid expansion in science and technology.
For the past several decades, psychiatry and geriatrics have been experiencing what is called by many an “identity crisis”. This crisis in identity centers on the sphere of professional activity that is the proper task of psychiatrists and geriatricians and whether their activity produces a source of self-esteem to the physicians.
The geriatric psychiatrist is making a significant contribution to solving this so-called identity crisis. The geriatric psychiatrist must often function as a primary care physician and his/her skills include proficiency in psychiatry, geriatric medicine, neurology and the social sciences. Geriatric psychiatrists arc very aware that many of the disorders they treat can be cured or prevented but the resulting suffering can be relieved and the disability reduced.
The situation does encourage the clinician to make observations that contribute to a better understanding of the course of chronic illness and to look for hidden clues that can lead to investigations which may, in the future, bring improved convalescence or even eradication of chronic disease and disability.
For many years, it was believed that many physicians arc reluctant to become involved in geriatrics. Numerous explanations have been offered, including relatively low monetary compensation, the lack of satisfactory treatment outcomes and lack of personal satisfaction and scientific challenge. This view has rapidly changed and considerable interest and satisfaction is evident among medical students as well as physicians in training and practice.
A recent study of those who completed geriatric fellowships in geriatric medicine or psychiatry and have now been in practice for at least 3 years found that 93% were satisfied with their career choice, 80% felt that they had maintained professional status and prestige, 71% were satisfied with their incomes and 96% found personal gratification in taking care of elderly patients.
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