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Old age psychiatry and geriatric medicine: Shared challenges, shared solutions?

  • James Fisher (a1) and Andrew Teodorczuk (a2)
Summary

The co-occurrence of physical and mental ill health means there is considerable overlap between the patients that geriatric medicine and old age psychiatry serve. In this editorial we detail similarities between the specialisms, highlight the common challenges facing them and argue that closer alignment holds the potential to improve patient care.

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Copyright
Corresponding author
James Fisher, Northumbria Healthcare NHS Foundation Trust North Tyneside General Hospital, Rake Lane, North Shields NE29 8NH, UK. Email: drjamesfisher@hotmail.com
Footnotes
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Declaration of interest

None.

James Fisher (pictured) is a consultant geriatrician working at Northumbria Healthcare NHS Foundation Trust and as an Associate Clinical Lecturer at Newcastle University. Andrew Teodorczuk previously worked as a consultant old age psychiatrist at Northumberland, Tyne and Wear NHS Foundation Trust and as an honorary senior lecturer at Newcastle University; he is currently associate professor in medical education and an old age psychiatrist at Griffith University, Australia.

Footnotes
References
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1 Centre for Workforce Intelligence. In-Depth Review of the Psychiatrist Workforce. Centre for Workforce Intelligence, 2014 (http://www.cfwi.org.uk/publications/in-depth-review-of-the-psychiatrist-workforce/).
2 Gordon, H. Census of Consultant Physicians and Higher Specialty Trainees in the UK, 2013–14: Data and Commentary. Federation of the Royal Colleges of Physicians of the UK, 2015 (https://www.rcplondon.ac.uk/file/1551/download?token=Da0VmvTz).
3 Royal College of Physicians. Consultant Physicians Working with Patients: The Duties, Responsibilities and Practice of Physicians in Medicine. Royal College of Physicians, 2011.
4 Campbell, JY, Durso, SC, Brandt, LE, Finucane, TE, Abadir, PM. The unknown profession: a geriatrician. J Am Geriatr Soc 2013; 61: 447–9.
5 Curtis-Barton, MT, Eagles, JM. Factors that discourage medical students from pursuing a career in psychiatry. Psychiatrist 2011; 35: 425–9.
6 Robbins, TD, Crocker-Buque, T, Forrester-Paton, C, Cantlay, A, Gladman, JRF, Gordon, AL. Geriatrics is rewarding but lacks earning potential and prestige: responses from the national medical student survey of attitudes to and perceptions of geriatric medicine. Age Ageing 2011; 40: 405–8.
7 Fisher, JM, Hunt, K, Garside, MJ. Geriatrics for juniors: tomorrow's geriatricians or another lost tribe? J R Coll Physicians Edinb 2014; 44: 106–10.
8 Cutler, J, Alspector, S, Harding, K, Wright, L, Graham, M. Medical students' perceptions of psychiatry as a career choice. Acad Psychiatry 2006; 30: 144–9.
9 Gordon, AL, Blundell, A, Dhesi, JK, Forrester-Paton, C, Forrester-Paton, J, Mitchell, HK, et al UK medical teaching about ageing is improving but there is still work to be done: the second national survey of undergraduate teaching in ageing and geriatric medicine. Age Ageing 2014; 43: 293–7.
10 Tullo, E, Khoo, TK, Teodorczuk, A. Preparing to meet the needs of an ageing population – a challenge to medical educators globally. Med Teach 2015; 37: 105–7.
11 Health Education England. Broadening the Foundation Programme. Health Education England, 2014 (https://www.hee.nhs.uk/sites/default/files/documents/Broadening%20the%20foundation%20report.pdf).
12 Kelley, TA, Brown, J, Carney, S. Foundation Programme psychiatry placement and doctors' decision to pursue a career in psychiatry. Psychiatrist 2013; 37: 30–2.
13 Briggs, S, Atkins, R, Playfer, J, Corrado, OJ. Why do doctors choose a career in geriatric medicine? Clin Med 2006; 6: 469–72.
14 Shape of Training. Securing the Future of Excellent Patient Care: Final Report of the Independent Review Led by Professor David Greenaway. Shape of Training, 2013 (http://www.shapeoftraining.co.uk/reviewsofar/1788.asp).
15 Warner, JP. Old age psychiatry in the modern age. Br J Psychiatry 2015; 207: 375–6.
16 Abdul-Hamid, WK, Lewis-Cole, K, Holloway, F, Silverman, AM. Comparison of how old age psychiatry and general adult psychiatry services meet the needs of elderly people with functional mental illness: cross-sectional survey. Br J Psychiatry 2015; 207: 440–3.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Old age psychiatry and geriatric medicine: Shared challenges, shared solutions?

  • James Fisher (a1) and Andrew Teodorczuk (a2)
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eLetters

"Thinking Together" - a grass-roots project addressing an analogous experience of training issues in CAMHS and Paediatrics

Rory J P Conn, ST6 Child and Adolescent Psychiatry Trainee, Tavistock and Portman NHS Foundation Trust
Chloe E Bulwer, ST5 Paediatrics Trainee, Whittington Health
13 February 2017

Fisher and Teodorczuk highlight significant concerns in the care of the elderly population: that geriatricians are not suitably trained in mental health treatment and old age psychiatrists are similarly underprepared to recognise and manage physical health problems. They identify the unhelpful splits between services which should work hand in hand, as well as being trained side-by-side.
/>The problem is a familiar one for those of us working at the other end of the age spectrum. With the precipitous rise in mental health problems in those under 18, paediatricians are increasingly presented with problems in which they feel they lack expertise, particularly risk management in crisis admissions with self-harm or overdose. Equally, CAMHS trainees tend to deskill rapidly and lose confidence with regards physical health issues (even those as basic as physical examinations, reading ECGs and interpreting blood tests).

Both sets of trainees have a number of mandatory curricular competencies which can be difficult to come by in day-to-day practice, especially as services come under increasing strain. Just as in the elderly population, specific local services may be delivered by one specialty or another, but there is little consistency on whom leads (for example ADHD or ASD services).

To solve this worsening problem, a small group of trainees from London devised a 6 month pilot scheme to link trainees from each specialty - we called this the "Thinking Together" project. The simple and cost-neutral concept was to forge links between the specialties at a trainee level, by allowing attendance and participation in each other's outpatient clinics. We hoped to foster a novel, joint way of learning and working together.

Trainees were thus allowed to share clinical encounters at the Mental-Physical Interface for Children and Young People, attending at least two clinical encounters in each setting.

Curriculum competencies for both specialties were outlined in a resource pack. Trainees were encouraged to explore a variety of learning possibilities, including clinics, referral meetings and signposting their partner to other relevant clinical opportunities.



Results:

30 trainees took part; 20 were paediatric, therefore some CAMHS trainees were paired with 2 paediatric trainees. 80% of participants completed both pre and post course evaluation. Prior to the pilot, 70% stated they had no experience of working in a jointly delivered paediatric/ mental health clinic. Only 33.3% of trainees felt that their current training programme enabled them to achieve their curriculum competencies in paediatrics or mental health respectively, which increased to 90% following involvement in the project. 91% of participants felt that their patients benefitted from access to the jointly delivered paediatric and mental health clinics.

Conclusion:

Our results highlighted that trainees felt they had achieved curriculum competencies in their linked specialty, whilst improving their capabilities in collaborative, patient-centred practice. Trainees felt the scheme benefitted both their patients and themselves, thinking together through cases and developing a greater appreciation of different professionals' roles and responsibilities.

As a working group we have since approached Health Education England and the respective Royal Colleges, RCPCH and RCPsych, in a hope that this initiative can be rolled out on a national scale. As movement between medical specialties becomes more flexible, we hope to encourage more applications to Child and Adolescent Psychiatric Training, simultaneously addressing the major problem of under-recruitment.

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Conflict of interest: None Declared

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