Chapter 1 14 factors to be considered besides spending on resources, efficiency, and so on. Screening takes its toll in many areas, but the benefits of screening should always outweigh its disadvantages. These negative factors also depend on where, that is, in which setting or for which population, the screening takes place. Haphazardly screening the general population costs more than it will yield. Therefore, it should not only be considered when (or for what) to screen but also where to screen. 1.3 Where Particularly in geriatric psychiatry, the symptoms of several aetiological entities resemble or even overlap each other. Not only is it difficult to distinguish the aetiologies one from the other, but sometimes they coexist and contribute to the same complaint (to some extent). One particular entity is always present in an old age psychiatric practice: old age. Where living its life has left its mark on many patients. However, where do these traces of old age turn into ‘no longer appropriate for age, education, and social context’? Alternatively, they have a (negative) impact on the quality of life, even if they are (still partly) appropriate for their age or social context. When is an intervention justified if they negatively affect ‘wellbeing’? How much of it must deteriorate before it can be called a disease? Who is to judge if someone’s ‘wellbeing’ needs to be improved? If so, which domains should be prioritised? Is that for the doctor to decide, the next of kin representing society, or is the decision of themain character, that is, the patient? This accounts for different domains, such as social, psychological, and physical, but this is especially true for cognitive impairment. These questions or dilemmas can only be solved if one also has insight into the complaints and how much they play a role: the quantitative part. In old age psychiatry, these factors play a significant role as they tend to add up known as ‘frailty’, more than in other disciplines where they may seem to be in the background or have no influence at all. These factors not only include age-appropriate problems, but also the field of geriatric psychiatry. Geronto-psychiatry and psychogeriatrics have always been the core of old age psychiatry. Where the psychiatrist for (younger) adults can focus on the complaints of her patient without worrying about age-related complications or comorbidities, in old age psychiatry this will always have to be considered. However, the extent to which age alone plays a role in the clinical picture of elderly patients, and to what extent (complications of) age cause a different form of the disease or even another disease? Is it more of the same problem (compared to a younger patient) or is
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