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A tiered model of psychogeriatric service delivery: an evidence-based approach
- Authors:
- DRAPER Brian, BRODATY Henry, LOW Lee-Fay
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(7), July 2006, pp.645-653.
- Publisher:
- Wiley
Previous models of mental health care for older persons have not considered the full spectrum of mental disorders. The aim was to describe a tiered model for comprehensive evidence-based planning of service delivery for mental disorders in late life. The model depicts tiers of mental disorders in ascending order of severity and consequent interventions required. Interventions aim both to avert individuals from moving up tiers (prevention) and to move individuals down tiers (treatment). Individuals in the lower tiers have no mental disorders and prevention strategies are targeted at known risk factors. In the middle tiers, individuals with mild-moderate mental disorders will mainly be treated in primary care, often in collaboration with specialist mental health services for older people. Individuals in the top tiers with severe mental disorders usually require institutional care. The tiered model provides a basis for planning comprehensive service delivery.
Cognitive therapy for depression in the elderly
- Authors:
- KODER Deborah-Anne, BRODATY Henry, ANSTEY Kaarin J.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 11(2), February 1996, pp.97-107.
- Publisher:
- Wiley
Reviews the applicability for older patients of cognitive (CT) and cognitive-behavioural (CBT) therapies for depression, now well established for clinical populations aged less than 65 years. The review looks at eighteen English language articles published to the end of 1994. Outcome data from seven studies indicate that CT is clearly more effective than no therapy or placebo, though prediction of success is uncertain. The review, though limited, concludes that CT is an effective intervention for depression in older people and recommends strategies for further research to enable more accurate targeting of therapy.