It is difficult to define the place of Psychiatry in the field of Geriatrics. While senescence is a process involving loss of the ability to live, diseases that may lead to death are part of another problem. They of ten have their origins in mechanisms quite apart from senescence. Too of ten we take it for granted, that everybody who is over 65 years old is somewhat 'demented' and somewhat „diseased'.
It is not enough to rehabilitate a patient physically. He is in want of mental rehabilitation too.
In old age there is of ten a multiplicity of pathological conditions in a given patient, who now seems to be a physically diseased person while the next day he seems to be more mentally disturbed. The doctor for interval medicine should therefore work together with a social psychiatrist, who understands better the social situation in which he finds the patient as well as his family background.
It is essential to maintain the elderly patient in an as active and independent condition as possible. The doctor must have knowledge of the possibilities which are still there. Some practical examples are given. There is little known about the range of variation in intellectual decline. Many old neglected people are only pseudo-demented and neurotic. Differential diagnosis between the different forms of mental disease in old age is therefore of the utmost importante.
Some facilities for mentally disturbed elderly sick people in Haarlem are discussed.
It is stated that the organic psychoses are at resent beyond our control. But we need to know more about the life histories and personality profiles of people aging badly and of those retaining vitality and drive.