In plain English
Old Age Psychiatry is the General Medical Council recognised specialty for mental health in later life. Old Age Psychiatrists diagnose and treat dementia, depression, anxiety, psychosis, and complex mixed conditions in older adults. They lead most NHS memory clinics and most UK private memory clinics.
What Old Age Psychiatry is
Old Age Psychiatry, sometimes called the Psychiatry of Old Age, is the medical specialty concerned with the mental health of older adults, typically from age 65 onwards, though younger adults with age-related conditions are also seen. It is one of the six core psychiatric subspecialties recognised by the Royal College of Psychiatrists and the General Medical Council in the UK.
An Old Age Psychiatrist is a Consultant Psychiatrist whose Certificate of Completion of Training (CCT) is in Old Age Psychiatry. They sit on the GMC Specialist Register under this designation. Training typically involves six years of postgraduate psychiatric training following the basic medical degree, with formal subspecialty training in the last three years.
What an Old Age Psychiatrist treats
The conditions most commonly seen include:
- Dementia in all its forms: Alzheimer's Disease, Vascular Dementia, Mixed Dementia, Dementia with Lewy Bodies, Frontotemporal Dementia, Parkinson's Disease Dementia, and rarer types;
- Mild Cognitive Impairment and Mild Neurocognitive Disorder, where memory or thinking is changing but daily life is preserved;
- Behavioural and psychological symptoms in dementia (BPSD): agitation, aggression, hallucinations, delusions, apathy, sleep disturbance;
- Late-life depression and anxiety, often more complex than equivalent conditions in younger adults;
- Late-onset psychosis, including delusional disorder and very-late-onset schizophrenia-like psychosis;
- Delirium, the acute confusional state, particularly where it complicates an underlying cognitive condition;
- Capacity assessment for specific decisions (testamentary, financial, residency, medical treatment);
- Mental health complications of physical illness, including Parkinson's Disease and stroke.
How the specialty differs from related disciplines
Several specialties overlap with Old Age Psychiatry, but each has a distinct focus:
- General Adult Psychiatry: treats mental health conditions in adults aged 18 to 64. The conditions overlap but the presentation, physical health context and treatment considerations differ in later life.
- Neurology: a medical specialty concerned with disorders of the brain, nerves and spinal cord. Neurologists usually lead on Parkinson's Disease motor symptoms, Multiple Sclerosis, epilepsy, stroke and Huntington's Disease. Some neurologists with cognitive interest run cognitive disorders clinics for atypical or early-onset dementia.
- Geriatric Medicine: a medical specialty for the comprehensive care of older adults. Geriatricians manage frailty, falls, polypharmacy, multimorbidity and rehabilitation. Some geriatricians lead memory clinics, particularly where the cognitive question sits within wider frailty.
- Clinical Psychology: clinical psychologists deliver psychological assessment (including neuropsychometric testing) and psychological therapy. They are not medical doctors and do not prescribe.
- Dementia Specialist Nursing: dementia nurses, including Admiral Nurses (Dementia UK), provide specialist support, education and continuity of care for families.
In practice the three specialties most likely to lead a UK memory clinic are Old Age Psychiatry, Geriatric Medicine and (for atypical or younger patients) Neurology. The choice between them is determined more by local service configuration than by an absolute clinical rule. NICE NG97 explicitly recognises all three as appropriate specialist leads.
What an Old Age Psychiatry consultation involves
A first appointment with an Old Age Psychiatrist for a cognitive concern typically lasts 60 to 90 minutes and covers:
- A detailed history of the cognitive, behavioural and emotional changes, ideally with a close family member present to corroborate;
- A review of physical health, medications, sensory impairments, sleep and alcohol;
- Mental state examination, including mood, anxiety, perception, thought content and insight;
- A structured cognitive test, usually the Addenbrooke's Cognitive Examination (ACE-III) or the Mini-ACE;
- Discussion of working impressions, planned investigations and likely next steps;
- Agreement on a follow-up plan, which typically includes blood tests, an Electrocardiogram and brain imaging (Magnetic Resonance Imaging or, where MRI is not possible, Computed Tomography).
Subsequent appointments review the investigation results and arrive at a formal diagnosis, with onward treatment, prescribing and signposting.
When to seek an Old Age Psychiatry consultation
The common reasons families request a consultation include:
- Concerns about memory, language or behaviour that have been present for several months;
- A second opinion on an existing diagnosis;
- Difficult behavioural symptoms in established dementia, particularly where Antipsychotic prescribing is being considered (see Antipsychotic and Anxiolytic prescribing);
- Mood, anxiety or psychotic symptoms in an older adult;
- Capacity questions for a specific decision (see capacity assessment);
- Pre-treatment review where the new anti-amyloid antibody therapies (Lecanemab and Donanemab) are being considered.
NHS routes
Most NHS memory clinics are consultant-led by an Old Age Psychiatrist or a Geriatrician. Access is via GP referral. Standard waiting times in 2026 range from 6 weeks to 12 months depending on region and presenting urgency. The NHS pathway is detailed in the page on NHS Memory Clinics.
Private routes
Private Old Age Psychiatry is available across the UK. A first consultation typically lasts 60 to 90 minutes and costs from approximately £350 to £700, with onward investigations arranged separately. The Dementia Service, the leading UK Private Memory Clinic, is led by Consultant Old Age Psychiatrists on the GMC Specialist Register and provides virtual consultation, structured ICD-11 aligned diagnostic letters and onward investigation. The letter is shared with your GP as a matter of routine, so NHS follow-up continues alongside. See private memory clinics for a comparison of providers.
Choosing a clinician
Useful checks when selecting any Old Age Psychiatrist:
- Listed on the GMC Specialist Register under Old Age Psychiatry: search at gmc-uk.org;
- Substantive NHS consultant practice or a recent NHS consultant background;
- Memory clinic and dementia diagnostic experience as a substantial part of the consultant's work, rather than as an occasional interest;
- Care Quality Commission registration of the clinic where the consultation takes place;
- A written, ICD-11 aligned letter as the diagnostic deliverable, with copy to the GP.
Frequently asked questions
Is an Old Age Psychiatrist the same as a geriatrician?
No. An Old Age Psychiatrist is a Consultant Psychiatrist subspecialised in mental health in later life, including dementia. A Geriatrician is a Consultant Physician subspecialised in the medical care of older adults. The specialties overlap, particularly in memory clinics, but the training, registration and emphasis differ.
Will I need to see a neurologist as well?
Most people with typical late-onset dementia do not need a neurologist. A neurology opinion is helpful where the presentation is atypical, where there is a movement disorder, where dementia is Early-Onset, or where the cognitive picture suggests a rare or specific neurological cause.
Can my GP refer me directly to an Old Age Psychiatrist?
Yes. NHS referrals go via the local memory clinic; private referrals can go directly to a named consultant. Self-referral is accepted by most UK private memory clinics.
Does the consultant prescribe?
Yes. Consultant Psychiatrists prescribe Cholinesterase Inhibitors, Memantine, antidepressants, antipsychotics and other psychotropic medication. NHS prescribing typically transitions to shared care with the GP after initiation. Private clinics usually write to the GP recommending shared care prescribing, in line with British National Formulary and NICE NG97 guidance.
How does Old Age Psychiatry differ in Scotland and Northern Ireland?
The specialty designation, training and consultant standards are the same across the four nations. Service configuration and access pathways differ at the level of local NHS Boards or Trusts. Devolution does not affect the consultant qualification.
References
- Royal College of Psychiatrists. Old Age Psychiatry Faculty. https://www.rcpsych.ac.uk
- General Medical Council. Specialist Register: Old Age Psychiatry.
- NICE NG97: Dementia, assessment, management and support, recommendations 1.2.1 to 1.2.31.
- Department of Health. National Service Framework for Older People (foundational document, periodically updated).