Response

We welcome the call to action by Oude Voshaar et al ^{Reference Oude Voshaar, Fernandes, Benoit, Mukherjee, Vandel and Franco-Martin1} on behalf of the European Association of Geriatric Psychiatry (EAGP) to engage the next generation of trainees in geriatric psychiatry. The demographic shift in the UK and Europe, and indeed elsewhere in the world, makes this imperative if healthcare systems are to be able to meet demand. In the UK the number of people under 20 will decline over the coming decades while the fastest growing segment of the population, the over-80s, will more than double. ² Compared with old age psychiatrists, the UK currently has nearly 20% more child psychiatrists and more than five times as many general adult psychiatrists. ³ It will be vital for healthcare services to grow and adapt to meet this increased demand effectively not only for older people but also to ensure the effective functioning of general health services: for example, 25% of hospital beds are already occupied by people with dementia. ⁴

Oude Voshaar et al make a number of proposals to address the gap between current supply and future demand by engaging trainees in geriatric (old age) psychiatry. Their proposals include engaging medical students in the specialty, continuing medical education pathways, ensuring old age psychiatry is part of psychiatry training curricula, international training programmes, mentoring and formal recognition as a subspecialty. They cast a somewhat envious gaze towards the UK, and understandably so. The Royal College of Psychiatrists (RCPsych) Old Age Group (now the Faculty of Old Age Psychiatry) has been meeting since 1973 and has been an international leader in ensuring older people get the specialist service they need. The Faculty has had an active engagement programme with medical students, for example giving free places at the national Faculty conference each year, awarding annual essay prizes and engaging with medical school ‘psych socs’. Old age psychiatry is part of the national training curricula set by the RCPsych and this is supplemented by webinars to support trainees in topics they choose, as well as for the wider Faculty, on topics such as new drugs for dementia. Reach beyond the UK is being addressed through the new RCPsych International Diploma in Older Adults’ Mental Health. At least to some extent then the call to action from Oude Voshaar et al appears to have been responded to in the UK.

Does this mean the UK is an old age psychiatry utopia? Sadly not. As Oude Voshaar et al point out, there are still only around 500 consultant old age psychiatrists for a population of 10.5 million, roughly one for every 20 000 older people, of whom 3000 will have a treatable mental disorder and 1800 will have dementia. A consultant workforce which can be comfortably accommodated three times over in one lecture theatre at this year’s RCPsych International Congress is clearly inadequate for current need, let alone future demand as the population ages. This shortage will become more acute as investigations and treatments become more advanced. Examples of this include the emergence of blood biomarkers and disease-modifying treatments, where doctors will have a key role and the specialism required means this cannot be delivered by adult consultants in ‘ageless’ services. ^{Reference Barber, Ivenso, Jenkinson, Krishnan, Negi and Pattan5} Even more worryingly, the number of old age consultants per 100 000 population fell from 5.55 to 4.85 between 2018 and 2023 in England and (in spring 2023) 29% of posts in the UK were either vacant or filled by locum staff. ⁶ Although training programmes are high quality and have markedly improved fill rates, there are still vacancies, and the programmes are only adequate to replace, not significantly expand, the workforce. ⁷

We fully recognise, and share, the joy in the specialty described by Oude Voshaar et al. We support both the call to action and their specific proposals. However, these proposals, although worthy, will be inadequate in themselves to tackle the challenge ahead. We need to radically rethink all areas of medical training to address the needs of frail elderly patients and significantly increase the numbers and skills of old age psychiatrists. This will need to be addressed at a national level, including in the UK, supported by international coordination and cooperation. These actions are essential and cannot be delayed.