King Lear and Geriatric Psychiatry: “Thou Shouldst Not Have Been Old Till Thou Hadst Been Wise”

2015 AAGP Annual Meeting psychiatry has been decreasing. Approximately 55-60 fellowship slots are being filled each year and this is woefully inadequate to meet the overall demands (3). The number of nurses entering psychiatric nurse practice (NP) training has increased. Kaiser Family Foundation estimated about 180,233 NPs in United States (4) and there is overall growth in the number of those training as psychiatric and mental health clinical nurse specialists and nurse practitioners (5). As the psychiatric NPs’ role expands to meet the mental health demands, geriatric psychiatrists should take on a collaborative, clinical educator role in their development so that they will work closely with us. At University of California, San Diego, we have developed clinical rotation for NP students at traditionally psychiatry resident focused outpatient clinic. The session will give overview of psychiatric NP program in California, comparisons with general residency clinical program, cultural and perceptual challenges in co-training, and potential ways to improve on and impact clinical training to encourage careers in geriatric mental health. 1) Administration on Aging, Department of Health and Human Services, http://www.aoa.gov/Aging_Statistics/ 2) Administration on Aging, Department of Health and Human Services, http://aoa.dhhs.gov/prof/Statistics/online_stat_ data/agePop2050.asp 3) Lyness, Jeffrey, “Geriatric Workforce Crisis in the United States,” International Psychogeriatric Association, Online article, http://www.ipa-online.org/ipaonlinev4/main/homepagearticles/oldagemh.html 4) The Henry J Kaiser Family Foundation, http://kff.org/other/state-indicator/total-nurse-practitioners/ 5) AACN (2008). 2007-2008 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing. Faculty Disclosures: Steve Koh Nothing to disclose Lawrence Malak Nothing to disclose Laura F. Marrone Nothing to disclose Alexandra C. Sietsma Nothing to disclose

KING LEAR AND GERIATRIC PSYCHIATRY: “THOU SHOULDST NOT HAVE BEEN OLD TILL THOU HADST BEEN WISE” Session 317 Mark J. Rapoport

Sunnybrook Hospital, University of Toronto, Toronto, ON, Canada Abstract: Shakespeare’s King Lear resonates strongly in contemporary clinical geriatric psychiatry practice. The stubbornness of the octogenarian Lear’s favorite daughter sets him into a rage, and he wills his inheritance to his elder daughters who ultimately betray him, setting off a descent into disorientation, confusion, tangentiality, hallucinations and delusions. There are many possible diagnoses in this play of an older man who prepares to “crawl toward death”. The presentation will include reflection on how contemporary clinical experience and research literature parallels the story of Lear, and how the multiple potential clinical interpretations parallel the choices available to artists interpreting the play. The importance of various perspectives in history taking, longitudinal followup, persisting delirium symptoms, lucidity amidst impairment, terminal cognitive decline, wisdom in “foolishness”, as well as the devastating impacts of abuse and losses will be highlighted. Faculty Disclosures: Mark J. Rapoport Nothing to disclose

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Am J Geriatr Psychiatry 23:3, Supplement 1