In Ireland, the Medical Council gave full specialty recognition to what it terms ‘Psychiatry of Old Age’ in 1998 and specialist psychiatric services for individuals over 65 years have significantly expanded in recent years (Reference SwanwickSwanwick, 2002).

The aim of the study was to provide a name for the psychiatric service for older people in Southwest County Dublin. This is a new service that initially provided a liaison consultation service within a large general hospital. The scope of the service increased in 2004 with the recruitment of a multidisciplinary team, and has been extended to provide day hospital assessment and treatment.

Choosing a name for this service presented a difficulty. Terms used to describe both ‘psychiatry’ and ‘elderly’ may be considered stigmatising and in some instances act as barriers to care.

The Oxford dictionary describes stigma as a ‘mark or sign of disgrace or discredit’. Names can be stigmatising for two reasons. First, terms used over the years to describe those with mental illness have been inherently stigmatising, such as ‘mental defective’. Second, technical terms used to describe mental illness may become derogatory with time, because they describe a stigmatised group of people. The terms ‘lunatic’ and ‘ idiot’, for example, were initially used as medical terms to differentiate between patients with psychiatric problems and patients with intellectual disability, but both have acquired a negative connotation over time.

Ideally, the negative conceptualisations that people have of those with psychiatric illness could be changed over time. The Royal College of Psychiatrists’ Changing Minds Campaign aimed to reduce the stigma attached to psychiatric disorders, in order to change attitudes and behaviour towards people with mental health problems (Reference CrispCrisp, 2001). At present it is important to be aware that particular titles already have negative associations. Our aim was to explore current views on this matter as we wished to avoid the most stigmatising labels.

A literature search was performed to see if any previous exploration of this topic in the area of psychiatry of old age had been carried out. No relevant articles were found in the field of psychiatry.

With regard to terms used to describe older people, a study was found which had been carried out by the local geriatric medical service (Reference O'Neill, Rice and WalshO’Neill et al, 1993). In choosing a title for their service, they sought the opinions of patients, marketing managers and journalists. Patients expressed a preference for the term ‘elderly’. Marketing managers preferred the term ‘age-related’. Both groups rejected the term ‘ geriatric’. Age-Related Healthcare was the title given to this service, as it was felt to provide the most positive image. It is also worth noting that the National Council for the Elderly, a body set up in 1990 to advise the Irish government on all aspects of ageing, changed its name in 1997 to the National Council on Ageing and Older People.

Method

We conducted a survey of general practitioners (GPs) and hospital doctors referring to the service. Addresses of GPs in the greater Dublin area were obtained from hospital records and narrowed down to those practising in or just outside the catchment area. A list of doctors at all levels within the hospital was obtained and those disciplines making referrals to the service were selected.

These doctors were given 13 possible options as titles and were asked to choose the 3 titles they considered the most suitable for the service. Terms that could be chosen instead of ‘psychiatry’ were ‘mental health’ and ‘psychological medicine’. The terms ‘old age’, ‘elderly’, ‘agerelated’, ‘older people’, ‘geriatric’ or ‘later life’ could be chosen in combination with these. Doctors were also invited to make any suggestions of their own. The options given are shown in Table 1.

Table 1.

Results of the survey for choosing a name for psychiatric services for older people¹

	GPs (n=115)	Hospital doctors (n=52)	Workshop attendees (n=129)
Names selected as one of top three choices		n(%)
Psychiatry of old age	16 (14)	9 (17)	5 (4)
Psychiatry of later life	22 (19)	26 (50)	34 (27)
Psychiatry for the elderly	21 (18)	25 (48)	8 (6)
Psychiatry for older people	18 (16)	6 (12)	14 (11)
Psychological medicine for older people	20 (17)	0 (0)	26 (21)
Psychological medicine of later life	26 (23)	5 (10)	50 (40)
Psychological medicine for the elderly	12 (10)	4 (8)	21 (17)
Mental health for older people	28 (24)	5 (10)	40 (32)
Mental health of later life	26 (23)	6 (12)	73 (58)
Mental health for the elderly	29 (25)	5 (10)	27 (21)
Psychogeriatrics	17 (15)	10 (19)	20 (16)
Geriatric psychiatry	12 (10)	10 (19)	9 (7)
Age-related psychiatry	50 (43)	29 (56)	55 (44)
Other suggestions: please specify	3 (3)	4 (8)	5 (4)

A pilot survey was carried out on the GP trainees working in the general adult psychiatric services at that time. Following this, the survey was sent to 179 local GPs in March 2003. We attempted to minimise our response bias by sending out the survey on two separate occasions to the entire group. Accompanying this was a covering letter explaining the purpose of the survey. Hospital doctors who refer to the service were also asked to fill out their preferences using the same form.

As the study was carried out prior to commissioning the community-based service it was not possible to survey patients directly. In order to try to address this limitation we used the opportunity of a workshop on ageing and dementia to survey a group of nuns, all of whom were over 50 years of age and were either carers or had an interest in dementia. The workshop was conducted by one of us (G.S.) in conjunction with the Sisters of Mercy, Ireland, and the same options of possible titles were given to this group immediately prior to the workshop.

Results

Discussion

In choosing a name for a psychiatric service for older people there are two main considerations. First, the term chosen should be acceptable to service users, carers and professionals. Second, there are pragmatic issues. It must be an accurate term to describe the service provided and fit within the existing spectrum of services for older people. It must also be easy to recall and not too long. Names should not be changed for change's sake without a sound rationale.

Other disciplines within psychiatry have struggled with similar issues. For example, ‘mental retardation’ has been replaced by the term ‘ learning disability’ to describe the sub-specialty within the Royal College of Psychiatrists. However, in the USA the term ‘learning disability’ is not synonymous with ‘mental retardation’ but rather with specific learning disabilities such as dyslexia. Many practitioners actually prefer the term ‘intellectual disability’.

In this study, we investigated preferred terms for both ‘older people’ and ‘psychiatry’. The term ‘age-related’ was the most popular with the doctors to describe ‘older people’ but not with the workshop attendees. This may be because the name for the local geriatric medicine service is ‘age-related healthcare’ and they may have chosen it because it was a term with which they were familiar. Similarly, within the hospital our service had been using the title ‘ psychiatry of later life’, and this may explain why half of the hospital doctors had this term as one of their top three preferences. However, the group who attended the workshop were not familiar with the term ‘ later life’, yet surprisingly rated it twice as highly as any other term to describe older people.

In contrast, doctors and workshop attendees shared a negative opinion of the term ‘geriatric’. This has broader implications, as many services and organisations use this term for those over 65. This includes well-recognised journals such as the International Journal of Geriatric Psychiatry, the American Journal of Geriatric Psychiatry and International Psychogeriatrics. Also of note is the fact that all groups had poor regard for the term ‘psychiatry of old age’, which is used by the Irish Medical Council.

With regard to the terms for mental health, doctors preferred the term ‘ psychiatry’, whereas workshop attendees preferred the term ‘ mental health’, choosing ‘mental health for later life’ and ‘psychological medicine for later life’ frequently. It is interesting to note that in Ireland the term ‘ community psychiatric nurse’ has recently been changed to ‘ community mental health nurse’. One-third of the responses from the workshop attendees included the term ‘psychiatry’. Again, it was not the most popular term but was by no means unacceptable.

‘Age-related psychiatry’and ‘psychiatry of later life’ were universally acceptable terms. The term ‘age-related psychiatry’ was ruled out for pragmatic reasons. An important consideration for us was not to be confused with the geriatric medical service in the same hospital, which is called ‘age-related healthcare’. The term‘age-related’ is also not specific to people over 65 years.

The next most commonly chosen term to describe this age-group was ‘ later life’. This suggests that at the very least it was not unpopular. The term ‘psychiatry of later life’ was the only term that was not found to be unacceptable by anyone. Taking all these views into account, the title ‘psychiatry of later life’ was chosen for this service.

No consistent ‘other suggestions’ emerged. This suggests that no important alternative terms have been omitted. Many of the other suggestions (from ‘department for the promotion of age-related mental health’ to the more interesting ‘twilight care’) were discarded as they were felt to be either too wordy or misleading.

In the UK the term ‘old age psychiatry’ is the formal designation for the specialty. In Ireland, however, the Department of Health and the Irish Medical Council use ‘psychiatry of old age’. The authors believed that the terms were too similar to include them both as options.

Declaration of interest

None.