Gerontopsychiatrie

Gerontopsychiatrie, or geriatric psychiatry, is a medical subspecialty of psychiatry dedicated to the mental health of older adults. It addresses psychiatric disorders in the context of aging, multimorbidity, cognitive impairment, functional decline, and the involvement of family and caregivers. The field integrates diagnosis, treatment, and care coordination across diverse care settings, with emphasis on preserving autonomy, safety, and quality of life.

Common conditions in gerontopsychiatry include major depressive disorder, anxiety disorders, delirium, late-onset psychosis, and neurocognitive disorders such as Alzheimer's disease and other dementias. Behavioral and psychological symptoms of dementia (BPSD) form a central aspect of care planning. Delirium, often secondary to medical illness, is a frequent and urgent focus in hospital and long-term care.

Assessment in gerontopsychiatry combines psychiatric evaluation with comprehensive geriatric assessment. Clinicians use cognitive tests (for example, MoCA or MMSE), functional status measures, evaluation of comorbidities, cognitive reserve, medication review to assess polypharmacy, and social support networks. Diagnostic challenges include atypical symptom presentation, communication barriers, sensory deficits, and symptom overlap with physical illnesses.

Treatment principles emphasize safety, functional improvement, and overall well-being. Pharmacotherapy requires careful dosing and monitoring due to increased sensitivity and drug interactions; anticholinergic burden should be minimized. Psychosocial interventions, adapted psychotherapy, reminiscence therapy, cognitive rehabilitation, caregiver support, and structured activities are important components. Nonpharmacological approaches often complement medical treatment and help reduce behavioral symptoms.

Care settings include outpatient clinics, inpatient geriatric psychiatry units, nursing homes, and home-based programs. Integrated care models that coordinate primary care, geriatrics, neurology, and social services are common, aiming to address medical and psychosocial needs in a holistic manner. Ethical considerations include informed consent and advance care planning when cognitive impairment is present.