What Factors Contribute to Senior Psychiatry Residents' Interest in Geriatric Psychiatry? A Delphi Study
Susan J Lieff, MD, FRCPC1, Diana Clarke, BSc2

Objective: To generate hypotheses regarding factors that influence senior psychiatric residents, to consider treating geriatric patients in their future practices.
Method: Using the Delphi technique, designed to generate ideas and consensus, we asked  psychiatry residents at the University of Toronto who had completed, or were completing, their geriatric rotation about the factors they thought might influence residents in devoting some of their practice to geriatric patients. Residents then rated the degree of influence of these factors which had been synthesized into a questionnaire.
Results: Twenty-six items were rated according to their degree of influence. The most influential item was positive clinical experiences with seniors. This was followed closely by supervisor characteristics such as enthusiasm, role modeling, competence, and mentoring. Interest in and comfort with the medical psychiatric and neuropsychiatric nature of the field were also felt to be influential.
Conclusions: The factors that influence  senior psychiatry resident interest in the practice of geriatric psychiatry are primarily educational and result from exposure to the field under optimal educational circumstances (positive clinical experiences and excellent supervisors). The medical and neuropsychiatric nature of the field also likely exerts a unique influence and should be considered in stimulating interest in this population.

(Can J Psychiatry 2000;45:912-916)

Key Words: geriatric psychiatry, postgraduate education, residency training, practice interest

Individuals over 65 years of age currently constitute about 12% of the Canadian population (1). Statistics Canada has predicted that from 1976 to 2001, the number of 75- to 84-year-old individuals will double and that the population 85 years and older will increase by 127%. When the baby boomers reach their senior years, they will comprise 25% of the general population. In 1987, the Canadian Medical Association stated that approximately 30% of the elderly required mental health services (2). The Ontario Health Supplement, a community survey of mental health needs conducted between November 1989 and March 1990, reported that people 65 years of age  and older have the highest rates of fair or poor self-rated mental health status (7.6% to 7.8%, versus 3.6% to 5.6% in younger groups) (3). Data from 1992 suggest that the 1-year prevalence rate of depression in community-based elderly is 11.2% (4). The Canadian Study of Health and Aging in 1992 reported a prevalence of dementia of 8% for those over 65 years, which includes 34.5% for those over 85 years (5). Studies investigating various  psychiatric conditions report that 10% to 50% of individuals with dementia will suffer from comorbid psychiatric illnesses such as depression and psychosis. Since at least 30% of the elderly will still require mental health services, clearly there will be an increasing demand for psychiatric services as this segment of the population grows.

Manuscript received July 1999, revised, and accepted August 2000.
1Assistant Professor, Department of Psychiatry, University of Toronto Postgraduate Education; Coordinator, Division of Geriatric Psychiatry, Baycrest Centre for Geriatric Care, Toronto, Ontario.
2Research Assistant, Department of Psychiatry, Baycrest Centre for Geriatric Care, Toronto, Ontario.
Address for correspondence: Dr SJ Lieff, Baycrest Centre for Geriatric Care, 3560 Bathurst Street, Toronto, ON  M6A 2E1

Currently, physicians in general, and psychiatrists in particular, are not meeting the demand for geriatric services. The second edition of the Institute for Clinical Evaluative Sciences practice atlas, which reported on patterns of health care in Ontario from 1992 to 1995, noted marked differences in billings to the province for mental health services by age of patients (6). Fewer dollars were spent on billings for provincially-funded mental health services for those over 65 years of age than for those 20 to 64 years old (16.2% to 36.8%). The authors conclude that there is a noticeable gap between distribution of per capita provincial dollars spent on mental health services and need for these services in the geriatric age group. Alternatively, elderly individuals may not seek help from or are not diagnosed by physicians. Hildebrand and LeClair, in their 1993 survey of Canadian psychiatrists, found that individuals over 65 years of age constituted more than 25% of the patients for only 7% of the psychiatrists (unpublished data). The gap between the mental health needs of Canadian seniors and the psychiatric services that they are currently receiving is significant and will likely widen as this population expands.

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