Europe’s Older Adults Face a Care Divide as Geriatricians and Psychiatrists Unite

Across Europe, a quiet but consequential failure of modern healthcare is unfolding in the lives of millions of older people. Those who live with the double burden of serious mental illness and physical disease are being shuttled between two parallel systems that rarely speak to each other. Now, in a landmark perspectives paper published in the journal European Geriatric Medicine, the European Geriatric Medicine Society and the European Association of Geriatric Psychiatry have jointly declared that this fragmentation is no longer tolerable, and they have launched a coordinated effort to define, for the first time, what truly integrated physical and mental healthcare for older adults should look like across the continent.

The scale of the problem is staggering. By 2050, the number of adults aged 65 and over is projected to nearly double, while the population aged 80 and above is expected to triple. Within this expanding demographic, combined mental and physical multimorbidity is the rule rather than the exception. Roughly one in five adults over 65 lives with a mental or neurological disorder, and World Health Organisation survey data show that up to a quarter of people with one or more chronic physical conditions also experience depression, the single most significant factor driving poorer health scores in this group. The relationship runs in both directions: physical ill-health raises the risk of developing a mental health condition, and depression in turn accelerates physical disability, frailty, and mortality.

What makes this clinical overlap so dangerous is the way healthcare systems respond to it, or fail to. Physical and mental health services across Europe are typically funded, commissioned, managed, and physically located separately, a structural divide that makes genuine integration logistically difficult. Older adults with severe mental illness die earlier than the general population, a life-expectancy gap that extends into old age and that is partly preventable through better management of chronic physical conditions and lifestyle risks. Yet there is currently no mandate anywhere in Europe requiring physical health services to be delivered in specialised mental health settings, meaning that psychiatric inpatients are often transferred to emergency departments simply to receive an in-person physical health review, disrupting continuity of care and destabilising their mental state in the process.

The joint Task and Finish Group behind the new paper draws on the combined expertise of geriatricians and old age psychiatrists, along with people with lived experience, spanning Northern, Southern, and Eastern Europe, including the United Kingdom, the Netherlands, Belgium, France, Sweden, Ireland, Spain, Portugal, Italy, Türkiye, Croatia, and Romania. The group conducted an updated literature review across MEDLINE, Scopus, CINAHL, and PsychINFO, and refined its recommendations through five consensus meetings held between February and June 2026, attended by 17 members, with patient and public involvement representatives present at two of those meetings. Notably, the group deliberately excluded dementia from its scope, because integrated dementia care has already been studied extensively, whereas older adults with serious mental illness and other functional disorders remain comparatively underserved and face distinct barriers to physical healthcare.

The clinical picture these experts describe is one of compounding vulnerability. Older people with psychiatric disorders commonly experience early onset frailty at a younger age than their peers, falls and poor mobility linked to psychotropic medications such as antipsychotics, antidepressants, and sedatives, osteoporosis and fragility fractures, and cardiovascular disease driven by lifelong risk factors including smoking, sedentary lifestyles, long-term antipsychotic exposure, and high rates of metabolic syndrome. Chronic lithium therapy can produce renal and electrolyte problems, including nephrogenic diabetes insipidus, while antidepressants can cause hyponatraemia and poor oral intake related to dysphagia and cognitive impairment adds dehydration to the list. Layered on top of all this is polypharmacy, as combined physical and mental health medication regimes multiply the risk of dangerous drug interactions.

Beyond the biology, the group catalogued a series of systemic failures that patients and carers encounter daily. Patients with psychiatric disorders frequently report stigmatisation and a feeling of not being taken seriously when they present physical symptoms. Psychiatrists often lack knowledge of somatic disorders, while physicians in general hospitals may be poorly equipped to recognise psychiatric symptoms. Patients find themselves seeing multiple teams for individual problems, coordinating a maze of outpatient appointments, and repeating the same information to different clinicians who lack access to the whole picture. There is often no central care coordinator holding the complete clinical story, social prescribing is rarely offered to this group, and advanced care planning and end-of-life care are frequently absent altogether.

The paper also grapples with the definitional question at the heart of the field: what does integrated care actually mean? The authors define it as a person-centred, coordinated, interdisciplinary approach that addresses physical, mental, social, and functional health needs through collaboration across providers, settings, and levels of care. From the older patient’s perspective, integration is closely associated with continuity, relational trust, clear communication, timely access, involvement in decision-making, and support responsive to individual needs and preferences. The International Foundation of Integrated Care’s meta-framework of nine pillars, covering shared purpose, health in context, people as partners, teamwork, coordination, governance, information and technology, finance, and learning, provides one structural template, but the authors argue that current approaches are often too limited in scope and variability to meet the needs of older adults with combined illness, and that a broader conceptualisation of integration may be required.

The examples of integrated services that do exist across Europe are strikingly uneven. The Task and Finish Group identified localised models spanning liaison-type services in the Netherlands and the United Kingdom, integrated care units and joint outpatient services in Belgium and the Netherlands, and broader models in Italy and Portugal that weave together social, psychiatric, and geriatric care, sometimes in private hospital settings. One particularly novel example was an emergency physician response unit in London providing emergency department-level care within a psychiatric setting, the only service of its type identified by the group. Four of the surveyed services sat in general hospitals, three in psychiatric hospitals, two in outpatient clinics, and two in private hospitals, with only two operating across more than one setting. No examples were identified from Eastern Europe, and the group notes that services tend to be concentrated in areas of significant socioeconomic deprivation, such as Tower Hamlets in London and Leeds, where severe material strain is common, raising questions about equity of access for rural and less deprived regions alike.

From this evidence base, the group issued prioritised recommendations across four domains. Clinically, services should be proactive, person-centred, and delivered by interdisciplinary teams grounded in comprehensive geriatric assessment, with adequate outcome measures defined. In research, the central priority is identifying which integrated care models work best for which patient groups and healthcare contexts, since the evidence underpinning existing services remains thin. In training and education, the authors call for undergraduate curricula to be restructured to reflect the urgent need for skills in both the physical and mental healthcare of older people, who are the largest users of health services. At the policy level, reimbursement systems, workforce planning, and organisational structures must be aligned to support integration. Feasible near-term projects include Europe-wide surveys of how physical and mental health services are currently delivered, and of whether geriatric-psychiatric training is incorporated into postgraduate programmes.

The authors are unequivocal in their conclusion: integrated physical and mental healthcare for older adults is no longer a desirable aspiration but an urgent clinical, educational, research, and policy imperative. The continued separation of the two systems perpetuates inequity, delays diagnosis and treatment, increases avoidable hospitalisation and long-term care, and leaves some of the most vulnerable older adults without coordinated, person-centred support. Innovation exists, but it remains isolated and inconsistently implemented. The message to patients, clinicians, educators, researchers, professional societies, and policymakers is a call to action: geriatric medicine and old age psychiatry must work together to build integrated systems of care that are equitable, scalable, and responsive to the needs of an ageing population, before the demographic tide makes the current fragmentation impossible to sustain.

Subject of Research: Integrated physical and mental healthcare services for older adults in Europe

Article Title: Integrated physical and mental healthcare for older adults in Europe: from concept to implementation—a joint EuGMS and EAGP perspectives paper

Article References: Beishon, L., Nobels, A., Alves, M., Bogdanovic, N., Cowan, R., Crowther, G., Flôr-Rodrigues, B., Frisardi, V., Geoghegan, C., Miot, S., Soysal, P., Van Den Noortgate, N., Walesby, K. E., Welsh, T. J., Yilmaz, O., Voshaar, R. C. O., Benraad, C., & on behalf of the EuGMS and EAGP Task & Finish Group on Integrated Psychiatric & Geriatric Care (2026). Integrated physical and mental healthcare for older adults in Europe: from concept to implementation—a joint EuGMS and EAGP perspectives paper. European Geriatric Medicine. https://doi.org/10.1007/s41999-026-01620-w

Image Credits: AI Generated

DOI: 10.1007/s41999-026-01620-w

Keywords: integrated care, geriatric medicine, old age psychiatry, serious mental illness, multimorbidity, frailty, polypharmacy, health services research, Europe, ageing population, health policy, EuGMS