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Most geriatric psychiatrists require a referral from a family physician with whom they will share the care of the patient. In order to find a geriatric psychiatrist, seniors or their families should contact their family physician to ask about local referrals. If an assessment is required for adult protection, power of attorney, capacity assessments or other medicolegal matters including testimony in court, this should be discussed with a lawyer. The CAGP cannot provide individual referrals
For the 2017 year there were 187 full members of the Academy, 14 Affiliate members, 30 Members-in-Training and 34 Affiliates-in-Training.
All general psychiatrists are expected to be able to treat geriatric patients and many may see mainly geriatric patients but perhaps not be members of the Academy so we expect there are many more in Canada who really practice primarily geriatric psychiatry.
The Academy with the Royal College of Physicians and Surgeons and the Canadian Psychiatric Association is working on sub-specialization now and in the future specified training may be used to identify specific geriatric psychiatry subspecialties.
Geriatric Psychiatry is a unique area of psychiatry that focuses on the prevention, diagnostic evaluation, management and treatment of mental disorders seen in older adults ( WHO, 1996). The population served represents a very unique focus relative to other patients typically seen in general psychiatric practice. For many of these patients, their first encounter with mental health care occurs at an advanced age. A specific set of knowledge and skills is required to orient them to the mental health care system, and to adequately assess and manage conditions in the context of an extensive life history. The medical co-morbidities of these patients are numerous and complex, mandating the geriatric psychiatrist to possess updated knowledge of the physiology of aging, a diverse variety of age-related physical conditions (both acute and chronic), and a large number of concurrent medications and potential drug interactions. Within this broad scope of practice, geriatric psychiatrists must be adept at performing detailed cognitive assessments in addition to the usual psychiatric diagnostic interview. Aging has its own set of unique psychosocial and developmental stages that must be recognized and taken into account. As a result of these developmental issues, the potential presence of cognitive impairment, and the high degree of co-morbid medical and physical limitations, there can be a notable heterogeneity of symptoms between individuals. Many presentations of psychiatric illness in older age would be considered atypical relative to usual presentations of the same condition in younger individuals.
As a result of these diagnosis and management complexities, older individuals require a holistic care approach encompassing bio-psychosocial, functional, familial, and spiritual elements ( WHO, 1997). Restrictions to mobility and other limitations often necessitate the delivery of care at the patient’s place of residence, requiring a unique flexibility in the geriatric psychiatrist to adapt to multiple environments, often traveling between them, and working with multiple teams of individuals over the course of any given day. Caregivers have a uniquely central involvement in the assessment and management of geriatric psychiatric illness, necessitating that the physician have a sensitive and thorough understanding of family dynamics and approaches, and an appreciation of the diverse cultural issues that may be present in families caring for an older adult. End of life issues, competency and capacity decisions are embedded within the psychiatric care to an extent not generally present when caring for younger individuals.
The unique nature of work often requires the development or utilization of systems approaches not routinely used in younger patients. Given this population’s vulnerability to abuse and neglect, as well as the double stigma imposed on them of being both old and mentally ill, advocacy issues are often central to the development of appropriate systems. Also, as the population ages ( Statistics Canada, 2007) and more individuals require Geriatric Psychiatry involvement, geriatric psychiatrists are particularly mindful of the need to maximize the accessibility of their specific knowledge and skills to the population. Emphases on collaboration with health care teams, other professionals, and a wide variety of community partners are essential. The development of strong consultation skills and excellence in education and knowledge exchange are further ways of enhancing availability to this expanding, high-need sector of the Canadian population and all of those providing their care.
Using the distinct combination of knowledge, skills and resources described above, our proposed subspecialty seeks to advance knowledge in this field through novel approaches for service delivery to this complex population, as well as through education, research and advocacy. As Dr Nathan Herrmann so eloquently articulated in his 2003 editorial, Geriatric Psychiatry is a subspecialty whose time has come ( Herrmann, 2005).
After intensive decades-long effort from the CAGP, the Royal College of Physicians and Surgeons of Canada approved geriatric psychiatry as one of the few sub-specialities in psychiatry in 2009. In Fall 2013, the Royal College began to provide a practical examination for sub-speciality designation in this area.
 WHO 1996. Psychiatry of the Elderly, a consensus statement. Geneva (Doc:WHO/MNH/MND/96.7).
 WHO 1997. Organization of Care in Psychiatry of the Elderly, a technical consensus statement. Geneva (doc: WHO/MNH/MND/97).
 Statistics Canada: Annual Demographic Statistics 2007 from 2006 Census (http://www.statscan.ca/daily/english/070717/d070717a.html).
 Herrmann Nathan, 2004. Geriatric Psychiatry: A subspecialty whose time has come. Can J Psych; 49(7): 415-416.