OBJECTIVE The authors examine changes in psychiatric referral patterns for geriatric inpatients since last reported in the United States, more than 20 years ago, and compare geriatric psychiatric referrals to those of a non-geriatric cohort. METHOD Retrospective study comparing psychiatric diagnosis, treatment and aftercare of younger (ages 18-60 years, n = 474) and older (>60 years, n = 487) patients seen in psychiatric consultation in a large, urban, university-based tertiary care hospital setting. RESULTS Compared to previous reports in the literature, this cohort contains a notably higher percentage of the 'old-old' (>80 years), reflecting the general aging of those who are hospitalized. Compared to younger patients, geriatric inpatients were more commonly referred for psychiatric consultation, but overall rates of referral remain low (<4%). Geriatric patients were diagnosed with dementia and delirium more frequently; with substance dependence less frequently; and were just as likely to be diagnosed with depression. Geriatric patients were also more likely to receive atypical antipsychotic medications and less likely to receive benzodiazepines than younger patients. In patients diagnosed with depression, psychiatric follow-up is more likely relegated to outpatient geriatricians and nursing homes. CONCLUSIONS Consulting psychiatrists frequently encounter geriatric patients and, given patterns of diagnosis and aftercare, should play a major role in medical staff education and in development of enhanced in-hospital and aftercare services, including psychiatric liaison.