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Let’s talk about sex

 

A 45 year old man develops a neurological condition rendering him multiple physical health difficulties and depression. He has been married for five years. At an initial assessment from a health professional, he is asked about the impact these changes are having on his relationship with his wife, and whether he is interested in and still able to have a sexual relationship with her. When problems are detected, an open discussion takes place regarding what help he might benefit from, and whether it would be useful for him and his wife to receive help as a couple.

So why don’t we ask older people later in life about their sexual lives and sexual relationships? Why don’t we ask when we know that changes in physical and mental health often impact on sexual functioning? What are we afraid of?

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The many ages of psychiatry

 

The NHS needs to reverse its misguided practice of incorporating old age mental health services into generic “all age” services.

According to recent research in the British Journal of Psychiatry (http://bjp.rcpsych.org/content/207/5/440), older adults have better outcomes if cared for in mental health services specifically set up to meet their needs. The journal asked me to write the accompanying editorial (http://bjp.rcpsych.org/content/207/5/375), and in it I outlined the reasons why I believe the NHS has been wrong to move away from services catering specifically for the needs of older people.

Over the last few years, some NHS trusts have incorporated old age mental health services into generic “all age” services. In these services an 18 year old and 80 year old person would be treated by the same team. There are three main reasons for this trend to ageless services: cost saving, misunderstanding of the Equalities Act and ageism. There are also three main reasons why older people should have their own dedicated services:

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