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I was a clinical assistant on a psychogeriatric unit for the most severe end of the spectrum for 15 years doing a session a week. My partners did another couple of sessions and we did all the screening medicals and day to day medical management on the 20 place day hospital and 3 wards of 28 inpatients each initially. The whole unit was slowly run down over the last 5 years and closed last October. The replacement is an extra CPN and a day hospital on the other side of the city. The inpatients have all gone into grossly expensive private nursing homes. An absolute scandal Trefor -----Original Message----- From: GP-UK [mailto:[log in to unmask]] On Behalf Of Julian Bradley Sent: 18 September 2008 12:10 To: [log in to unmask] Subject: A solution to care of the elderly It seems our local hospital, while it does provide eg. rehabillitation, and eg. stroke care does not actually have a specialist geriatrician any more. Geriatrics at Oxford seems from the Internet to have some fancy new name and to be led by someone whose entire focus seems stroke care. The solution to the care of complex elderly patients with multiple needs seems to be to a) ignore them, and b) de-medicalise them - even when they have conditions recognizable as diseases in any other group. Their needs may demand the highest standards of holistic, person centred care (if not the same knowledge base as IVs, ventilators and ITU / NICU pts) but instead the standard view is that they should be looked after by people who are not trained nurses, either RGN or psychiatric nurses (for dementia, depression etc.) With the current financial crisis things are only likely to get worse - is there an answer? Googling on geriatrics and psychogeriatrics seems to suggest that these specialities had their heyday in the 1980s and 1990s and are now on the way out...., are GPs with (3 months) geriatric experience all that's left now? Julian