TRAINING ENVIRONMENTFictional educational health system · No real patient data
Specialty Practice Area
Specialty Practice GuideGuidance for a population, acuity, or practice context.
Geriatric Psychiatry and Neurocognitive Disorders
Psychiatric care for older adults requires attention to cognition, function, medical illness, medication burden, sensory changes, caregiver systems, and goals of care. New behavioral or cognitive symptoms must be evaluated in context rather than attributed to aging alone.
Clinical application
Using this resource
Apply these prompts within the simulated clinical context. They support—but do not replace—clinical judgment, supervision, consultation, current guidance, local policy, law, or emergency procedures.
01Use this when
A change in mood, behavior, cognition, perception, or function in an older adult requires assessment in relation to baseline, health, medications, and daily context.
02Clarify first
Establish the onset and tempo of change, baseline cognition and function, current medical status, sensory factors, medication burden, substance exposure, and available collateral.
Assess mood, psychosis, delirium or neurologic contributors, capacity for the decision at hand, caregiver context, vulnerability, and practical supports without attributing symptoms to age alone.
03Act now
Prioritize reversible or time-sensitive contributors and integrate function, goals, capacity, supports, feasibility, and interdisciplinary input into the next decision.
Clarify responsibility for medication review, medical evaluation, collateral, support planning, and reassessment.
04Document and communicate
Record the baseline and change, information sources, cognitive and functional findings, medical and medication contributors, capacity assessment, supports, uncertainty, actions, and follow-up ownership.
05Escalate or consult when
There is an acute change or delirium concern, possible neurologic or medical instability, inability to meet basic needs, exploitation or serious vulnerability, acute safety concern, or inability to manage safely in the current setting.
Practice overview
Person-centered, function-informed care
Assessment often depends on longitudinal history, collateral information, medication reconciliation, cognitive and functional evaluation, and close coordination across medical and community settings.
Care model
Interdisciplinary, person-centered, and caregiver-inclusive
Typical pace
Deliberate longitudinal assessment with rapid response to acute change
Population
Older adults across home, outpatient, hospital, and residential settings
Common presentations
Late-life depression, anxiety, grief, psychosis, and sleep disturbance
Mild or major neurocognitive disorder with behavioral or psychological symptoms
Acute confusion, fluctuating attention, agitation, falls, or functional decline
PMHNP priorities
Distinguish delirium, neurocognitive disorder, depression, and medication or medical effects
Assess cognition, function, safety, capacity, supports, and caregiver burden
Use cautious prescribing, nonpharmacologic strategies, and shared goals of care
Care team
PMHNPs, geriatric psychiatrists, primary care and geriatric clinicians, neurologists, nurses, pharmacists, therapists, social workers, rehabilitation clinicians, caregivers, and community aging services.
Beyond the Presenting Symptom
Establish the patient’s baseline
Establish baseline cognition and function, compare current findings with the patient's usual state, review medications and recent changes, seek collateral when appropriate, and consider sensory, environmental, infectious, metabolic, neurologic, and substance-related contributors.