The Geriatric Psychiatry Playbook in 10 Steps
by Shai Madjar, M.D., Ph.D.; Mary Blazek, M.D. | November 26, 2025
Article Citation: Richler LG, Shimizu M, Kester R. 10 Principles of Geriatric Psychiatry. Acad Psychiatry 2025; ePub ahead of print. doi: 10.1007/s40596-025-02126-6.
What is this article about?
Experience in geriatric psychiatry is a required and essential component of psychiatric training. This article highlights 10 key principles and skills useful for geriatric psychiatry across all care settings. The principles include honoring the uniqueness of every older adult, changing only one variable at a time, starting low and going slow with medications while avoiding sub-therapeutic doses, keeping polypharmacy on the differential, prioritizing safety in older adults, knowing how to assess functioning, understanding how to approach capacity questions in older adults, planning for the future with older adults, collaborating with colleagues for interdisciplinary care, and emphasizing that change is possible. The authors describe each principle and provide an explanation and rationale for its inclusion. A handy table delineates the 10 principles and related key points.
Why should you read the article?
Since people are living longer as a result of changes in population demographics, all physicians will encounter older adults among their patients or patient family members. Therefore, all physicians must have a basic understanding of geriatric healthcare. Additionally, the shortage of specialists in geriatric psychiatry and behavioral health means that behavioral care will fall to primary care providers and other non-specialists. Although this article explicitly targets residency training in psychiatry, these principles are not limited to behavioral or mental healthcare. They can actually be applied to all care of older adults in all fields, for all levels of training. This article parallels the 2017 article also in Academic Psychiatry, “Six things all medical students need to know about Geriatric Psychiatry and how to teach them,” by Wilkins et al.
How can you use this article?
You can use this article as a reference to create a curriculum to prepare medical students for the care of older adults in all fields and settings, and more specifically in behavioral health and psychiatry. You can disseminate this article to your training faculty, as an accessible and practical guide for what principles to explicitly cover with trainees at all levels, in all clinical settings, who are learning about the general care of older adults, as well as the more specific area of geriatric psychiatry.
Review Authors: Shai Madjar, M.D., Ph.D.; Assistant Clinical Professor of Psychiatry and Assistant Program Director in Ambulatory Psychiatry, University of Michigan Medical Center, Ann Arbor, MI (Co-authored with Mary Blazek, M.D., University of Michigan Medical Center). Organization: Association of Directors of Medical Student Education in Psychiatry