title: Psychiatry and the oldest old.
abstract: OBJECTIVE
  This article reviews the assessment and management of psychiatric problems among the oldest old.
  
  
  METHODS
  The author reviewed the English-language literature pertinent to the characteristics of people 85 years old or older and the assessment and management of psychiatric disorders in this age group with a special focus on depression in the oldest old.
  
  
  RESULTS
  Much of the current literature in geriatric psychiatry ignores the oldest old, focusing instead on the treatment of specific psychiatric disorders with unimodal or bimodal therapies. In contrast, geriatric medicine has focused on geriatric syndromes, functional status, comprehensive geriatric assessment, and multimodal intervention. The author describes an approach to treating the oldest old that incorporates depression as an example. This approach is based on the philosophy that has worked well in geriatric medicine but has been increasingly abandoned by psychiatry over recent years.
  
  
  CONCLUSIONS
  Comprehensive, interdisciplinary assessment and therapy were the cornerstones of geriatric psychiatry 30 years ago. As psychiatry has moved toward a medical model and emphasized pharmacological therapies, it has moved away from the mainstream of geriatric practice. The time has come for geriatric psychiatry to rejoin geriatric medicine so that psychiatry can recapture its roots and deliver optimal care to the oldest old.
authors.affiliation: Department of Pychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. blaze001@mc.duke.edu
authors.forename: D G
authors.initials: DG
authors.lastname: Blazer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care; D003866:Depressive Disorder / Q000175:diagnosis / Q000628:therapy; D005852:Geriatric Psychiatry; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis* / Q000628:therapy*