Psychiatry: disorder groups
Old age psychiatry
Old age psychiatry cares for older adults with mental illness, including dementia, late-life depression, anxiety, psychosis and delirium, alongside physical illness and frailty. Psychiatrists adapt diagnosis, medication and services to ageing bodies and family circumstances.
Depth by stage, Pre-U → Consultant (details)
What is it?
Older people face different mental health challenges: memory decline, depression linked to illness, loss and loneliness, anxiety, late-onset psychosis and delirium during hospital stays. Physical illnesses and many medicines complicate diagnosis and treatment.
Old age psychiatry is a recognised subspecialty. Specialists work in memory clinics, hospital wards, nursing homes and community settings, often with geriatricians, nurses, occupational therapists and social workers.
Malaysia's population is ageing rapidly, so demand for old age mental health services and carer support is expected to rise.
Why does a psychiatrist need it?
Every psychiatrist treats older adults. They need to know how ageing affects drug handling and side effects (falls, low sodium, confusion), how to recognise depression presenting with physical complaints, how to assess capacity and elder abuse, and how to support families caring for relatives at home.
What level is expected at each stage?
Scale: 1. Aware → 2. Understands → 3. Applies → 4. Masters / Teaches. What the levels mean.
- Pre-UNot expected
- Pre-clinicalNot expected
- ClinicalAwareAware of how mental illness presents differently in older people during geriatric or psychiatry postings.
- HousemanshipUnderstandsManages confusion and mood changes in elderly medical patients and avoids risky prescribing.
- Medical officerUnderstandsAssesses older patients in psychiatry clinics and wards with attention to physical health.
- Psych traineeAppliesCompletes an old age rotation and manages the main late-life conditions.
- Specialist / consultantMasters / TeachesOld age subspecialists lead services, memory clinics and teaching.
What are the key topics?
Clinical conditions
- Dementia and mild cognitive impairment
- Late-life depression and suicide risk in older men
- Late-onset psychosis and very late-onset schizophrenia-like psychosis
- Anxiety disorders in older adults
- Delirium and its overlap with dementia
- Alcohol and prescription drug misuse in later life
Ageing and treatment
- Pharmacokinetic and pharmacodynamic changes with age
- Anticholinergic burden and falls
- Hyponatraemia with SSRIs
- Antipsychotic risks in dementia
- ECT in older adults
- Psychological therapies adapted for older people
Social, legal and ethical issues
- Capacity assessment and decision-making
- Elder abuse and neglect
- Carer burden and support
- End-of-life care and advance planning
- Services: memory clinics, day care, care homes, community teams
How is it learned and assessed?
- Geriatric and psychiatry postings in medical school
- Old age psychiatry rotation during specialist training
- MMed Part II; MRCPsych Paper B (old age topics) and CASC stations
- Subspecialty fellowship for those who specialise
Typical textbooks and resources
- Oxford Textbook of Old Age Psychiatry — Oxford University Press
- Shorter Oxford Textbook of Psychiatry — Oxford University Press
- The Maudsley Prescribing Guidelines in Psychiatry — Wiley (older adults section)
Titles are widely used examples; editions change. Use university libraries or legitimate purchases.
Common questions
Is depression a normal part of ageing?
No. Many older people are content. Depression in later life is common but treatable, and it is often missed because it presents with physical complaints or memory problems.
What is an old age psychiatrist?
A psychiatrist with additional training in the mental health of older adults, often focusing on dementia, late-life mood disorders and the interaction of physical and mental illness.