Towards living long and being healthy—the challenge for liaison psychiatric services for older adults

The ultimate goal of our generation is to live long and be healthy. Despite prolonged life expectancy (the second half of the last century added 20 years to the average life span, and this will increase by another 10 years by 2050) [1], the health problems we face remain similar to those of the last century. Furthermore, the number of 'unhealthy' days (in terms of physical or mental ill health as well as activity limitation days) over the last 8 years seems to be on the increase, especially in the older population [2], and worsening health appears to affect equally both institutionalised and community based elderly adults [3]. During the last four to five decades, we have witnessed a dramatic epidemiological transition in the leading causes of death from infectious and acute diseases to chronic and degenerative illnesses including cardiovascular diseases and cancer, respiratory diseases and injuries, diabetes and Alzhe-imer's disease [4]. These conditions also cause severe disability , which when measured via limitations in activities of daily living is a common factor leading to the need for long-term care [5]. These physical problems are usually accompanied by a worsening of mental function in the elderly: (i) depression following cerebrovascular accidents, heart problems and hip injury; (ii) delirium due to various physical problems; and, above all, (iii) cognitive impairment underlying many sustained injuries and predisposing the elderly to delirium. In many frail elderly adults, many highly prevalent symptoms due to multiple diseases and risk factors (e.g. immobil-ity, instability, impaired cognition and incontinence) are frequently reported. The concept of these geriatric syndromes can be a useful theoretical framework to guide diagnostic analysis and education in medical practice and teaching and also needs to include the diagnosis, treatment, teaching and awareness of mental health problems associated with these syndromes. Not surprisingly, the Education Committee Writing Group of the American Geriatric Society recommended that undergraduate medical training should include at least five psychiatric or psychiatrically related symptoms and problems out of the 13 most common geriatric syndromes, including depression, delirium, dementia, failure to thrive and sleep disorders [6]. This stresses the importance of both psychological skills and the role of liaison psychiatry services in the treatment of physical illness. Indeed, pharmacological and behavioural treatments of depression improve activities of daily living function post-stroke, protect against myocardial infarction, improve glycaemic control and give relief from physical symptoms in somatoform disorders. Furthermore, psych-oeducational interventions and …