SUMMARYOlder people with mental health problems are entitled to the same level and quality of care as younger people. Several factors continue to influence policy and delivery of older adults' mental health services in the UK. Following the introduction of the Equality Act 2010, there has been a drive to create an ‘ageless’ National Health Service. This has opened up the debate about whether such a service is best equipped to meet the specific needs of older adults. In this contribution we consider the concepts of ‘old age’ and ‘frailty’ and their clinical and service provision implications in psychiatry. The management of late-life depression and early-onset dementia, advance care planning and palliation in dementia are also considered.LEARNING OBJECTIVES•Appreciate how old age psychiatric services and the concept of ‘old age’ have evolved over time•Gain an understanding of issues at the interface between old age and general adult psychiatry and those specific to old age psychiatry•Gain an overview of procedures involved in transferring care between general adult and old age psychiatric services and the need for a separate old age psychiatry subspecialtyDECLARATION OF INTERESTNone.