In psychogeriatrics, clinicians are often confronted with the problem of whether a patient's clinical disorder is associated with an organic brain syndrome. Such pathological cerebral changes and the associated impairments are often very difficult to distinguish from “normal,” nonpathological changes. Everyone has to cope with some limitations in old age. Having to cope with changes in social position and social environment and with the loss of certain abilities is part of the aging process, but in psychogeriatrics, attention must go beyond the assessment of how a person deals with loss. A so-called normal aging person can overcome such losses, compensating for deficits in a particular area by drawing on skills acquired through a lifetime of experience.

Research and practice amidst interesting dichotomies — such is the state of psychogeriatrics in the 1990s — a field that reflects interesting dichotomies, though often in a complementary manner. Alzheimer's disease (AD) is a case in point. Discoveries at the molecular level and in understanding neurobiological phenomena in AD have generated enormous scientific excitement and public hope about potential breakthroughs; findings involving chromosome 14, the amyloid precursor protein, synaptic changes, the tau protein, and the like are increasing chances of cracking the mystery that surrounds the etiology of AD. Meanwhile, neither cause nor cure is known. However, it would be incorrect to say there is no treatment for AD. While there are no treatments that can reverse or stop the progression of the disorder, there are a number of interventions that can alleviate many of the behavioral symptoms that compound the course of the disorder. These behavioral problems contribute significantly to excess disability in AD; treating these behavioral symptoms can alleviate patient suffering, improve patient coping at that point in time, and reduce family burden. Hence, while research on the molecular biology of AD offers hope for tomorrow, attention to the manifest behavioral problems of the disorder contributes to improved management today (Group for the Advancement of Psychiatry, 1988).

Although scientific research is generally and appropriately initiated by individuals, there are limitations and inefficiencies inherent in studies done by individuals alone. Collaboration is the concept of our time. As an example, both the medical community and lay public recognize the urgent need for an effective antidementia drug. Sound clinical trials will require subjects sufficiently numerous for investigation, and a multicentered collaborative study approach, extending even to international collaborative clinical trials.

Suicide rates for older people are increasing worldwide, thereby creating a major public health concern. There has been an absence of public policy and research interest in this area, although the needs are pressing and promise to be even more so.

Increasing numbers of people in absolute terms, and even more so in relative terms, are reaching an age in which psychogeriatric illness, as well as geriatric illness, frequently is manifested. This unprecedented increase in average individual lifespan is due largely to advancement in life standards of the population as a whole, the enormous improvement in hygiene, and the progress made by preventive and curative medicine in controlling acute and fatal disease, in addition to advancements in available treatments of chronic disease in old people.

The rapid growth of the field of psychogeriatrics, spurred on by aging populations, substantially increased funding, and growing interest by professionals, government, and society, has led, in turn, to a rapid growth of medical information. The management of this information poses a significant challenge to health care professionals and scientists. This rapid growth of knowledge has spawned a whole new field, “Medical Informatics.” This field concerns itself with the “cognitive, information processing, and communication tasks of medical practice, education and research, including the information science and the technology to support these tasks” (Greenes & Shortliffe, 1990).

Where ill or frail older adults might reside is still too narrowly viewed, as if there are but two choices—home versus nursing home. But the choices are expanding, and, in the process, new treatment challenges and opportunities are emerging. This is especially the case from a psychogeriatric perspective.

This issue of International Psychogeriatrics is the first in the last decade of this century. If progress in the field of psychogeriatrics during the 1980s is any indication, the 1990s should be all the more impressive. The 1980s witnessed a remarkable upsurge of psychogeriatric research and clinical interest in working with older patients. There was a geometric growth of scientific publications and a new infrastructure fostered by the growth and development of national and international professional societies emphasizing psychogeriatrics.

Driving the growing interest in psychogeriatrics is its growing knowledge base. This knowledge base has been both product and impetus of an ever-expanding number of research studies. Moreover, psychogeriatric knowledge is catalyzing the proliferation of scientific journal articles and professional textbooks, as well as influencing significant changes in curricula and training programs. International Psychogeriatrics is itself a response to rapidly accruing knowledge in this area.

In allen Fällen einer bestehenden PsychKG-Unterbringung ist einer möglichen Änderung dieser Rechtsgrundlage jederzeit besondere Aufmerksamkeit zuzuwenden.

Wie bereits oben erwähnt, bezieht sich die Unterbringung nach den Vorschriften des PsychKG allein auf den Gefährdungstatbestand. Dabei wird in der Tradition der geschichtlichen Entwicklung aus einer sicherheitspolizeilichen Betrachtung heraus auf die Gefahrenabwehr für die Allgemeinheit und/oder den Einzelnen abgestellt (vgl. § 1 Ziff. 3 PsychKG NW). Demgegenüber liegt das Schwergewicht der Unterbringung durch Vormund oder Pfleger in der Fürsorge für den Kranken. Maßgebend für Erteilung, Versagung und Dauer der Unterbringungsgenehmigung gemäß § 1631 b, 1800 BGB ist allein das Wohl des Betroffenen.

Eine von Heiliger und Holzschneider (in Vorbereitung) an der Rheinischen Landesklinik Köln durchgeführte Analyse der rund 1200 Unterbringungsverfahren nach dem PsychKG NW im Jahre 1983 erbrachte empirische Belege über die Umstände der Unterbringungen, die Verfahrenspraxis und den betroffenen Personenkreis.

Im Hinblick auf die Konsequenzen, die sich aus einer PsychKG-Unterbringung für den Betroffenen nach seiner Entlassung ergeben können, ist grundsätzlich die Zusammenarbeit zwischen Ordnungsamt und Gesundheitsamt als problematisch anzusehen. Auch nach dem 1980 erfolgten Verbot der bis dahin üblichen Meldung an das Bundeszentralregister sind insbesondere durch die regional bestehenden Unterschiede in der Handhabung Unsicherheiten bei den Betroffenen nicht ausgeräumt worden. So hat beispielsweise erst ein Erlaß des zuständigen Ministers für Arbeit und Soziales in Nordrhein-Westfalen geregelt, daß die Straßenverkehrsbehörden nicht automatisch von den Ordnungsämtern über Zwangsunterbringungen informiert werden dürfen. Unklar geblieben ist bis heute auch, ob und wann Sozialversicherungsträger und Krankenkassen von einer Unterbringung Kenntnis erlangen. Ob alle Auflagen der Datenschutzgesetze hinlänglich beachtet werden, steht dahin. Alle in diesem Zusammenhang erhobenen Bedenken sind keineswegs zufriedenstellend ausgeräumt worden.