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Demographic trends, and older people over 65 years disproportionately occupying beds in psychiatric hospitals, pointed to their increasing clinical needs. Clinical work with older people often required different skills from work with younger people. 'General psychiatrists', nominally working with adults of all ages, usually had little interest in working with older people. By 1977, it was clear to clinical leaders in the field of psychogeriatrics that official recognition of their specialty by the government was essential to ensure service development. Official recognition would provide the means to collect data to identify gaps in services, to obtain information on the implementation of government guidance and to advocate for resources, including ensuring high quality training posts for doctors wanting to specialise in the field. Doctors have traditionally taken the lead in creating new medical specialties, and psychogeriatrics was no exception. However, support fluctuated towards the specialty from the leadership of the Royal College of Psychiatrists. Health service leaders who did not undertake work with older people, were incredulous that others wished to do so. Negotiations between the Royal College of Psychiatrists and the Department of Health and Social Security about recognising psychogeriatrics were convoluted and prolonged. Recognition was achieved in 1989, following intervention by the Royal College of Physicians of London.

In the 1950s, the population aged over 65 years continued to increase, and older people occupied mental hospital beds disproportionately. A few psychiatrists and geriatricians demonstrated what could be done to improve the wellbeing of mentally unwell older people, who were usually labelled as having irreversible 'senile dementia'. Martin Roth demonstrated that 'senile dementia' comprised five different disorders, some of which were reversible. These findings challenged established teaching and were doubted by colleagues. Despite diagnostic improvements and therapeutic successes, clinical practice changed little. Official reports highlighted the needs, but government commitment to increase and improve services did not materialize., (© The Author(s) 2016.)

Objective: To create a record of the development of old age psychiatry in Britain, as seen through the eyes of some of the people who participated in building it, from the earliest days until it was officially recognised as a specialty by the Department of Health in 1989., Method: Group reminiscences and discussions in the format of a witness seminar which was audio-recorded and transcribed. Witnesses also provided written biographical information., Results: The annotated full record created at the seminar is available on line. This paper reflecting themes, lessons and highlights has been derived from it., Conclusions: Early old age psychiatrists often encountered opposition and incredulity from other health care professionals and managers. However, their experiences were demonstrating just how much could be achieved in improving the lives of older mentally ill people. They conveyed their enthusiasm for their work in both clinical and university settings. Clinical creativity, support when working in relative professional isolation, and dealing with opposition benefited from both the development of the Group for the Psychiatry of Old Age at the Royal College of Psychiatrists and from close links with geriatric medicine.

The twentieth century saw an increasing number of people living into old age, and consequently a higher prevalence of age-related chronic degenerative brain disorders. By 1971 the mental hospitals were almost half full with people over 65 years of age. Thus plans to close the mental hospitals meant that the development of community mental health services for older people was a necessity. Although there was a multi-disciplinary focus on the care of older people, the lead in service development was largely taken by psychiatrists, both individually and through the Group for the Psychiatry of Old Age at the Royal College of Psychiatrists.

Felix Post was a refugee from Nazi Europe. Appointed psychiatrist at the Maudsley Hospital, London in 1947, he pioneered treatment of mental illness in older people clinically and through meticulous research. He had a reputation as a brilliant clinical teacher. His work helped set the scientific foundations for the development of the specialty of old age psychiatry in Britain and he inspired junior doctors who worked with him to specialize in the newly emerging discipline.

Background: The psychiatry of old age in Britain can be traced back to the 1940s. Provision of services for mentally ill older people, however, did not become widespread until the 1970s., Method: Survey of archive sources, published work, and oral history interviews relating to the development of services for mentally ill older people in Britain between 1950 and 1970., Results and Conclusions: Despite considerable progress in research leading to a firm academic foundation for the specialty of old age psychiatry, there was relatively little progress made in the coordinated development of services from 1950 to 1970. A new generation of old age psychiatrists began to take service delivery issues forward at the very end of the 1960s and into the 1970s., (Copyright 2005 John Wiley & Sons, Ltd.)

The government acknowledged scandalously poor care of long‐stay patients in National Health Service (NHS) hospitals in 1969. This followed the Ely Hospital inquiry, which emerged in the aftermath of revelations of abuse at seven hospitals described in Barbara Robb's book Sans Everything: A Case to Answer (1967). Allegations in Sans Everything and at Ely were similar. However, the inquiry committees which investigated, 'disproved' those in Sans Everything and upheld those at Ely. The Ely inquiry became pivotal to NHS policy reform for long‐stay mental illness and mental handicap hospitals, and for giving patients and their families a greater voice if they had concerns about inadequacies. This paper explains the relationship between Sans Everything and 'Ely' and analyses the impact of Robb's work—her high‐profile press campaign, networking, and determination to achieve improvement—which triggered revelations at Ely and elsewhere, and helped shape the course and constructive outcome of the Ely inquiry. [ABSTRACT FROM AUTHOR]

Clinical knowledge and experience, and demographic changes, indicated the need to ensure provision of adequate ‘psychogeriatric’ services to provide treatment for mentally ill older people (generally over 65 years). Various factors influenced the provision of these services, including politics, economics and stereotypical negative attitudes towards older people. Clinicians successfully led service developments, often unsupported by central government and local health authorities, despite benefits being noted in the localities where services were established. In 1989, services were available to most of the population of England and the Department of Health officially recognised psychogeriatrics as a medical specialty. [ABSTRACT FROM AUTHOR]

Attitudes towards autonomy and personal freedom changed in the 1960s in England, but hardly touched the needs of dependent older people. In particular, deeply embedded public and professional attitudes and priorities linked to little change in ‘psychogeriatric’ treatment for those who were mentally unwell. Total beds in psychiatric hospitals decreased, but those remaining were increasingly and disproportionately occupied by older people receiving custodial care, often long term, despite evidence that appropriate treatment could prevent admission and facilitate discharge. Widely publicised scandals of inhumane care of older people in psychiatric hospitals prompted a more responsive government approach to improving services. [ABSTRACT FROM PUBLISHER]

Objective This study aims to investigate the history of joint geriatric-psychiatric units. For policy making and planning of high-quality clinical service models, clinical and social contexts need to be considered. Longitudinal, contextual information can be provided by historical analyses, including the successes and failures of earlier, similar services. Historical analyses complement clinical, randomised controlled studies and may contribute to ensuring optimum outcomes for future schemes. Methods Standard historical methodology was used, including searching published sources and institutional and personal archives and conducting a 'witness seminar' and individual oral history interviews. Results Proposals to create joint units have existed since 1947. Most clinically successful units were led by enthusiastic, dedicated clinicians. Joint units had the potential to provide appropriate assessment and treatment for patients with multiple disorders and education for staff and students. Joint units never became widespread. Conclusions Reasons for the limited success of joint geriatric-psychiatric units might have included personalities of individuals, administrative boundaries separating geriatrics and medicine, unequal numbers of geriatricians and old-age psychiatrists, varying professional ideologies about the meaning of 'integrated' services, lack of reciprocity for each other's inpatients and lack of government support. Identified stumbling blocks need to be considered when planning joint clinical schemes. If current research indicates benefits of integrated wards for patients and their families, there needs to be ways to ensure that personal factors and fashions of management or government re-prioritisation will not lead to their premature termination. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

While the incidence of general paralysis of the insane (GPI) has declined, AIDS (acquired immune deficiency syndrome) has emerged as a new illness. Today, in England and Wales, as many elderly people die from AIDS as from neurosyphilis, although both diagnoses are rare in this age group. Both are serious medical conditions with psychiatric manifestations. For both, serological tests may identify the disease, and treatment may be of benefit, but there is considerable social stigma attached to the diagnoses. Ethical guidelines for serological testing for HIV (human immunodeficiency virus) have been available for over a decade. In view of the similarities between the diseases, it may be unethical to test patients for syphilis routinely. Epidemiology, risk factors, neurological and neuropsychiatric features and ethics must be considered before testing for both syphilis and HIV. Copyright © 1998 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Post-traumatic stress disorder (PTSD) may present many years after the original trauma. Case studies of two elderly patients are described. Both had experienced life-threatening combat situations and witnessed intense suffering during the Second World War. Marked distress was triggered by the media commemorating the fiftieth anniversary of the end of the war. PTSD patients often avoid talking of their traumatic experiences because of associated distress. Without taking a military and trauma history from elderly patients the diagnosis is likely to be missed. © 1997 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]