Palliative care, geriatric psychiatry, and you.

T opportunity to highlight palliative care in this special issue of the American Journal of Geriatric Psychiatry is a wonderful one, in part because there is much overlap between the fields and a growing interest among geriatric psychiatrists. This issue features a series of articles intended to give an idea of what palliative care is, how the field evolved, what data exist to support it, how it fits into the current healthcare climate, and to provide some examples of research that captures the interests of geriatric psychiatrists and palliative care clinicians alike. It is my hope that this issue generates more understanding and enthusiasm for collaboration by both camps. When I was a psychiatry resident, I wandered into an academic hospice and discovered a world in medicine I had not previously known. Aworldwhere I feel “medicine” is practiced the “right way,” where I continually feel that I get to make significant, visible, and positive impacts on patients and their families, and where I am able to practice psychiatry as I had imagined it as a medical student. In my view, the hospice desperately needed psychiatrists to augment the effective work they were doing. In fact, seven of the eight care domains they espouse as essential to adequately help patients and families fall within the psychosocial realm.1,2 When I asked why psychiatrists were not involved, they said, “We’ve tried, we can’t get the psychiatrists to help us. ” On the flip side, some at the hospice said, “We’ve not needed one for 30 years, why do we need one now? ” Now they cannot imagine a world without psychiatry input. As my career has progressed, I find myself advocating to both camps to engage each other. Psychiatry has so much to offer to palliative care, and vice versa,1,3 all in the name of improved patient and family care. To set the stage, palliative care is specialized medical care for people with serious illness, the goal of which is to improve quality of life for both the patient and their family.2,4 The focus of palliative care is on providing relief from pain, other physical symptoms, and psychosocial distress, whatever the underlying diagnoses. It is provided by a team of doctors, nurses, social workers, spiritual counselors, and other specialists, all of whom work with a patient’s other doctors to provide an extra layer of care. Palliative care is appropriate at any age and any stage of a serious illness, including dementia, and it may be provided concurrently with curative treatment.2,4 When curative treatment is no longer an option or no longer opted for, palliative caremay become the sole focus of care. Hospices provide this type of focused palliative care to patients and families when cure is no longer being pursued and prognoses are short. Hospice care also includes bereavement care for the families as part of the palliative care package they provide.2 This may sound familiar to a geriatric psychiatrist, as there is much overlap. In geriatric psychiatry, often the aim is to improve function andquality of life,manage symptoms, focus on psychosocial aspects of care, and coordinate among the myriad care providers that geriatric patients often have. The ages and diagnoses overlap as well. Using hospice care as an example, in