The Royal College of Psychiatrists’ Old Age Faculty withdrew College Report CR156, Psychiatric Services for Black and Minority Ethnic Older People (Shah et al., 2009) in 2014. This is in line with recent United Kingdom (UK) government National Health Service proposals and the range of diversity encompassed by the Equality Act (2010). The Act refers to “protected characteristics” including age, disability, religion or belief, race (based on colour, nationality, ethnic or national origins), and sexual orientation.

LGBT is an acronym used to describe people from diverse sexual orientation or gender identity, people that are gay, lesbian, bisexual, or transgender. LGBT people do not constitute a single group nor does each individual “group” constitute a homogeneous unity. However, as higher rates of depression and/or anxiety have been observed in older LGBT people, compared to their heterosexual counterparts (Guasp, 2011) there is a need to raise the profile of mental health issues amongst these groups. The additional letter I is also often included in the acronym LGBTI as intersex people are often included as another gender diverse group. However, there is very little research that includes intersex people and none on older intersex people's mental health so this editorial is restricted to consideration of older LGBT people.

In 2014, the International Psychogeriatric Association (IPA) celebrated the fact that IPA's flagship scientific journal International Psychogeriatrics (IPG) has matured, attaining 25 years of existence since its foundation in 1989. The IPG editorial team introduced several new features in the 2014 issues to celebrate this significant quarter century milestone. One of them was the new “paper of the month” category. Following an internal selection process amongst the editorial team, who ranked available accepted papers focusing on their scientific quality and clinical relevance each month, one paper was selected as paper of the month from the categories “original research articles” and “reviews”. This resulted in 12 papers of the month, of which eight were original research articles and four were reviews or meta-analyses. Each paper of the month was accompanied by a short commentary highlighting its importance, written either by an editorial team member, one of the reviewers of the paper, or an external international expert on the topic of the paper. The editorial team aimed to highlight various psychogeriatric topics, so there are papers covering the wide spectrum of cognitive impairment, from risk factors such a hippocampal atrophy (Ferrarini et al., 2014) and traumatic brain injury (Gilbert et al., 2014), via transition between diagnostic categories on the cognitive continuum (Ellis et al., 2014) to variations in symptom expression (Rockwood et al., 2014) and apathy (Theleritis et al., 2014) to exercise interventions for people with Alzheimer's disease (AD) (Farina et al., 2014) or antipsychotic use for patients with dementia living in residential care (Kleijer et al., 2014). Other papers reported on topics relevant to the aging process in general, such as neuroplasticity (Valkanova et al., 2014), loneliness (Yan et al., 2014) or attitudes to aging (Shenkin et al., 2014). Other psychogeriatric topics covered were delirium (Ritchie et al., 2014) and geriatric depression (Steffens et al., 2014). In the international spirit of IPA, authors of the 12 papers come from Australia, Canada China, Greece, Germany, Italy, Mexico, the Netherlands, Switzerland, the UK, and the USA. From those 12 papers an IPG paper of the year 2014 was selected with the help of three independent reviewers: Dr Doh Kwan Kim from South Korea, Dr Gill Livingston from the UK, and Dr Daniel Weintraub from the USA. Our three reviewers ranked all 12 papers of the month independently from each other and the highest ranked paper overall was “The association of traumatic brain injury with rate of progression of cognitive and functional impairment in a population-based cohort of Alzheimer's disease: the Cache County Dementia Progression Study” by Mac Gilbert, Christine Snyder, Chris Corcoran, Maria C. Norton, Constantine G. Lyketsos, and JoAnn T. Tschanz. The reviewers emphasized that traumatic brain injury (TBI) is recognized as an important risk factor for AD which needs more research, and that the study by Gilbert et al. contributes important new knowledge to the area with the specific strength of reporting long-term follow up. In this context, we refer to the excellent commentary on the paper of the year by Dr David Sharp (Sharp, 2014), which was published alongside the paper of the year when it was paper of the month in the October 2014 issue.

The focus in dementia research on discovery of cause and cure often leaves the care part of the triad hidden from the spotlight. While clinicians, caregivers, and policy makers eagerly await these scientific developments, daily they face challenges in striving best for quality of life for people with dementia and their family caregivers. This issue of the Journal addresses six topics: three relate to service delivery – at assessment, in the community and at end of life; and one each focus on ethics, driving and suicidality.

It is well-documented that the population of much of the developed world is aging. On the one hand, this represents a success story in terms of reducing deaths from infectious and a number of systemic diseases, most notably cardiovascular disease. On the other hand, it also presents a challenge to provide adequate health services to a population with rapidly increasing longevity, as well as an opportunity to develop policies that can assist in promoting good physical and mental health. A number of authors have asked whether we are ready to meet the challenges of an aging population (Doyle et al., 2009; Connolly, 2012). Over the years, prominent psychologists have suggested that clinical psychology could play a greater role in the provision of services for older adults, and lamented the apparent lack of enthusiasm on the part of psychologists to work with this group (e.g. Karel et al., 2012). In this paper, we examine a range of questions pertinent to this theme: where are the psychologists in the provision of mental health services to older adults? What contribution can psychologists make to improve the mental health of this growing sector of the population? How can we encourage more psychologists to specialize in working with older adults?

One of the most difficult times for family carers is when the person they care for moves into a residential care home. Although they are relieved to some extent of the day-to-day tasks of caring, they lose the company of their loved one, which can be especially difficult for spouse carers. It is not always easy to obtain residential placement near to the carer's home, so carers may have to travel some distance to see the person they care for, which they often do on a daily basis. Furthermore, they lose control of the care provided, including the perceived quality of that care. They may also lose services, such as home care, or benefits, such as carer payments, that they were receiving on behalf of the person they were caring for or due to their caring responsibilities. These issues are often poorly recognized and managed in a service system that focuses more on the instrumental rather than emotional and social aspects of care for older people. It is often thought that residential care placement signifies the end of the caring role. However, qualitative research in this area highlights that family care is not relinquished when the cared for person goes into residential care and this is clearly demonstrated in the review of the qualitative literature by Afram and colleagues in this issue.

So what is known in the scholarship of religion and spirituality at this point of the 21st century? Definitions of spirituality show a growing understanding of the breadth and content of spirituality, and yet, there remains no firm definition. In one sense, it might be good that spirituality has not been tightly defined. Swinton and Pattison (2010, p231) note, “multiple definitions may be indicative of the necessity and the flexibility of the term to meet particular needs that would otherwise go unmet.” The publication of the paper written by Agli et al. in this edition of the journal, is timely and provides an excellent systematic review of the recent literature.

Anxiety is an adaptive human experience that may occur at all ages and serves to help draw attention to, avoid or cope with immanent threat and danger. Given its evolutionary importance, it has strong genetic and biological underpinnings, and when it serves that adaptive function for the organism, anxiety may be viewed as useful. However, complex adaptive systems, such as our adaptation to threat or stress, by definition provide many and often interrelated points of breakdown or dysregulation, which, if sustained, may lead to psychopathology. Anxiety has been described as a common currency for psychopathology, indicating that it is a first line and universal way for us to respond to stress and threat. It is more or less prominent in patients diagnosed with practically all psychiatric or neurodegenerative disorders. This has lead to the inclusion of anxiety as a cross-cutting symptom measure in the development of DSM-5 (APA, 2013). Given that they are rooted in a complex adaptive system that has many potential points of impact to develop pathology, it is not surprising that anxiety disorders are extremely heterogeneous. This heterogeneity of anxiety disorders pertains to symptomatology, etiology and outcomes, and poses great challenges to both research and clinical practice.

Early in 2015, I was asked to chair the judging panel for the 2015 International Psychogeriatric Association (IPA) Junior Research Awards in Psychogeriatrics, and was pleased to help in this way for the second Congress in succession. The other five judges who kindly gave up their time to assist with the selection of the three prize winners were Nicola Lautenschlager, an old age psychiatrist from Australia, co-opted to the panel in her role as the current Editor-in Chief of International Psychogeriatrics (the three winning papers are published in this issue as has been traditional for over 25 years), Glenna Dowling, a nurse from the USA who is also an associate editor of International Psychogeriatrics, Karen Ritchie, a psychologist working in France, Martina Roes, a nurse turned sociologist from Germany, the host country for the 2015 IPA Congress, and Huali Wang, a psychiatrist from Beijing, China. Depending on how you look at it, our panel consisted of three psychiatrists, one psychologist, two nurses and a bonus sociologist, five judges from developed countries and one from a developing nation, or five women and one man, which I think is the first time that such an IPA prize judging panel has had a female majority.

Stroke usually occurs in the latter years of life, is sudden and all too often unexpected and unforgiving. When non-fatal, stroke, the second leading cause of disability after dementia, is nearly always disabling (World Health Organization (WHO), 2011). Due to common ensuing physical and cognitive impairments, many stroke survivors are unable to care for themselves in the following weeks, months, and possibly years (Lutz et al., 2011). Thus, the caregiver role is instant and often long-term with no or very little time to adapt to the many, varied and immediate challenges.

With the increase in aging all over the world, and the elderly population nearly tripling from 524 million (8% of the world's population) in 2010 to 1.5 billion (16% of the world's population) in 2050, we will face new challenges and opportunities in providing healthcare. In 2050, it is estimated that Europe will see an increase of 70% in elderly population aged over 65 years, and 170% in those aged over 80 years (World Health Organization (WHO), 2011). It is vital to respond to the needs of this emerging population and the consequent rise in chronic diseases, especially dementia and mental health disorders, which will overload the healthcare system, as well as raise health and social costs, and demand new policies from national governments (World Health Organization, 2012). We urgently need to know how to organize healthcare for elderly people in the years to come.

Mental health service delivery to rural and remote communities can be significantly impeded by the tyranny of distance. In Australia, rural and remote mental health services are characterized by limited resources stretched across geographically large and socio-economically disadvantaged regions (Inder et al., 2012; Thomas et al., 2012). Internationally, rural and remote area mental health workforce shortages are common, especially in relation to specialist mental health services for older people (McCarthy et al., 2012; Bascu et al., 2012).

It is well established that depression is common in late life and associated with a range of consequences for the individual and those close to them. These consequences include higher use of health services and declines in functional ability (Luppa et al., 2007), not to mention negative subjective experiences, such as reduced engagement with, and enjoyment of day-to-day activities. Depression in late life is a heterogeneous condition made more complex by the links between depression, cognitive decline and dementia. The “Vascular Depression Hypothesis” suggests that a subset of late life depressive disorders are caused by cerebrovascular disease (Taylor, 2014), but questions about the relationships between depression and cognitive decline remain unanswered. The paper chosen as the paper of the month in this issue of International Psychogeriatrics addresses one of these questions, namely, whether we can identify clinical signs and symptoms that predict cognitive decline in individuals diagnosed with depression. This question is of great clinical relevance, as not all patients and clinicians will have access to the neuroimaging or detailed neuropsychological assessment that could cast light on risk for cognitive deterioration.

Invited commentary for International Psychogeriatrics on Tieges Z, Stíobhairt A, Scott K, Suchorab K, Weir A, Parks S, Shenkin S and MacLullich A. Development of a smartphone application for the objective detection of attentional deficits in delirium. International Psychogeriatrics. 2015 Mar 6:1–12.

The following paper, entitled “A Comparison of Delirium Diagnosis in Elderly Medical Inpatients using the CAM, DRS-R98, DSM-IV and DSM-5 Criteria” by Adamis and colleagues, reports the results of a single delirium assessment of 200 medical inpatients, aged 70 years and older. The aim was to compare the prevalence of delirium using two different diagnostic classification systems (DSM-5 and DSM-IV) and two commonly used research tools (Confusion Assessment Method and the Delirium Rating Scale-Revised ‘98). This editorial focuses on the comparison of the two versions of the DSM. The authors conclude that, while both diagnostic systems identify a core concept of delirium, the DSM-IV criteria are the most inclusive of the four approaches and the DSM-5, the most restrictive, identifying a prevalence of 19.5% and 13%, respectively in this sample. Furthermore, they conclude that these two systems do not appear to detect the same patients: only 14 of 26 (54%) individuals identified as delirious by the more exclusive DSM-5 criteria were also identified as such by DSM-IV.

Frontotemporal dementia is clearly a very important condition, not only because alongside Alzheimer's disease, vascular dementia, and Lewy body dementia it is one of the four most common causes of dementia, but because its broad symptom profile and younger age of onset makes it a particularly challenging condition to diagnose and manage. In recent years, great progress has been made in understanding genetic and pathological underpinnings of frontotemporal dementias, and in characterizing specific pathological causes. In particular, three major subtypes can be delineated: those associated pathologically with tau; transactive responsive DNA binding protein (TDP-43); or fused in sarcoma (FUS). Of these, tau and TDP-43 are by far the two most common subtypes of frontotemporal dementia. In addition, there have been important genetic advances and several autosomal dominant mutations have been described, for example associated with MAPT, progranulin, and C9ORF72. However, despite these important advances regarding pathophysiological heterogeneity, relatively little is known about the frequency, nature, and correlates of psychotic symptoms in the disorder. It is therefore very timely that in this month's Paper of the Month, Waldo and colleagues (Waldo et al., 2015) describe a very detailed description of a cohort of 97 consecutive subjects seen in Lund who received a neuropathological diagnosis of frontotemporal lobar degeneration.