Working with geriatricians is crucial in view of the multiple and interlinked disorders of old people, yet at times this has been erratic. Although active treatment, both physical and mental, was being advocated by the 1940s, geriatrics developed much earlier than psychogeriatrics. This was in part because many early geriatricians saw themselves as holistic practitioners for older people, therefore requesting little psychiatric assistance. The advocacy of Lord Amulree, a civil servant and geriatrician, and the other founders of geriatrics drew the successes of rehabilitation, including emptying hospital beds, to the attention of the government¹⁰. Such a phenomenon did not occur in old age psychiatry until around 1970 when new local services, such as that established at Goodmayes Hospital in 1969¹¹, were drawn to the attention of the Department of Health and Social Security¹²: only then it was recognized that a modern approach could reduce bed occupancy, improve outcomes and save money. Until the 1970s old age psychiatry in the UK was characterized by research in clinical treatment, nosology, pathology and epidemiology, with only small pockets of local service innovation.

In 1970 there were 200 geriatric medicine consultants¹³ but only a handful of psychogeriatricians^14,15. By 2006 there were 700 psychogeriatricians¹⁶. Where enthusiastic geriatricians and psychiatrists existed in a particular locality they collaborated. In addition, collaboration between the Royal College of Psychiatrists and the British Geriatrics Society¹⁷ since the 1970s has led to the development of guidelines for good practice and working collaboratively¹⁸. Moving services away from isolated mental and ‘chronic sick’ hospitals and their coming together in district general hospitals has given better access to each other’s services. Sometimes this facilitated joint working, but formal joint services were rare. In 1977, a department of Health Care of the Elderly, comprising both medicine and psychiatry working together, along with other relevant disciplines and professions was set up in Nottingham. There was an orthopaedic-geriatric unit, a stroke unit and a continence service, and joint research, along with extensive teaching of medical students and postgraduate trainees of relevant disciplines, and of overseas workers^19-21.

‘Memory clinics’ are another development, now widespread, with their roots in both psychogeriatric and geriatric practice in the mid-1980s²². More recent developments include psychiatric liaison services for patients with acute physical illness in district general hospitals²³. Jointly run ‘intermediate care’ or ‘convalescent’ rehabilitation units for confused older people, especially those recovering from both delirium and physical illness, are also new. Geriatricians and psychiatrists still have much to learn from each other, and ‘seamless’ services remain the ideal. ‘Guidelines for collaboration’ have recently been updated²⁴.

Before the establishment of the specialty, mentally ill old people requiring secondary care were the responsibility of general psychiatrists, but they rarely showed interest in actually working with them, especially those with dementia. However, some of the pioneering psychogeriatric services, such as Sam Robinson’s in Dumfries (195 8)²⁵, or Brice Pitt’s at Claybury, Essex (1966)²⁶, emerged in part due to the far sightedness and encouragement of general psychiatrists who were medical superintendents of mental hospitals. Despite such early developments, it took until 1989 for the Royal College of Psychiatrists and the government to agree officially to the creation of the new specialty of old age psychiatry. Until then, lack of recognition meant that it had often been impossible to extract from official statistics adequate data on older people’s use of services, and hence to establish the scale of need for services and for training.

Competition for resources is inevitable, so long as resources are limited. The low status of the aged, the perceived needs of people of working age, and the common misperception that young severely mentally ill people are frequently dangerous have generally resulted in funding for services for younger people disproportionately exceeding that for older people.

Research on older people’s mental health has flourished and has helped the development of evidence-based practice. Sir Martin Roth in the 1950s defined the major diagnostic categories in older people²⁸, rather as Emil Kraepelin had done 50 years earlier for younger people. Felix Post undertook follow-up studies of treatment of depression and psychotic disorders. Nick Corsellis²⁹ followed by Bernard Tom- linson, Martin Roth³⁰ and Elaine and Robert Perry unpicked the neu- rochemical and neuropathological features of Alzheimer’s disease³¹. Early research by Raymond Levy into lecithin and later tacrine was a forerunner of today’s evidence-based antidementia drugs³².

Difficulty in obtaining funding for research has been characteristic¹⁵. But the growth of the neurosciences, along with the influence of bodies such as the Alzheimer’s Society, has enhanced the scale of funding for research into the dementias, and has attracted able workers.