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Development and preliminary validation of an Observation List for detecting mental disorders and social Problems in the elderly in primary and home care (OLP)
- Authors:
- TAK Erwin C.P.M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 31(7), 2016, pp.755-764.
- Publisher:
- Wiley
Objective: Even though the prevalence of mental disorders and social problems is high among elderly patients, it is difficult to detect these in a primary (home) care setting. Goal was the development and preliminary validation of a short observation list to detect six problem areas: anxiety, depression, cognition, suspicion, loneliness, and somatisation. Methods: A draft list of indicators identified from a short review of the literature and the opinions of 22 experts was evaluated by general practitioners (GPs) and home care organisations for feasibility. It was then used by GPs and home care personnel to observe patients, who also completed validated tests for psychological disorders (General Health Questionnaire 12 item version (GHQ-12)), depression (Geriatric Depression Scale 15-item version (GDS-15)), anxiety and suspicion (Symptom Checklist-90 (SCL-90)), loneliness (University of California, Los Angeles (UCLA)), somatisation (Illness Attitude Scale (IAS)), and cognition (Mini-Mental State Examination (MMSE)). Results: GPs and home care personnel observed 180 patients (mean age 78.4 years; 66% female) and evaluated the draft list during a regular visit. Cronbach's α was 0.87 for the draft list and ≥0.80 for the draft problem areas (loneliness and suspicion excepted). Principal component analysis identified six components (cognition, depression + loneliness, somatisation, anxiety + suspicion, depression (other signs), and an ambiguous component). Convergent validity was shown for the indicators list as a whole (using the GHQ-12), and the subscales of depression, anxiety, loneliness, cognition, and somatisation. Using pre-set agreed criteria, the list was reduced to 14 final indicators divided over five problem areas. Conclusion: The Observation List for mental disorders and social Problems (OLP) proved to be preliminarily valid, reliable, and feasible for use in primary and home care settings. (Publisher abstract)
Psychotropic medication discussions in older adults' primary care office visits: so much to do, so little time
- Authors:
- AHN SangNam, et al
- Journal article citation:
- Aging and Mental Health, 15(5), July 2011, pp.618-629.
- Publisher:
- Taylor and Francis
This study investigated discussions of psychotropic medications during older patient's visits to primary care physicians. It also examined different scenarios physicians use to address mental health complaints of older adults. Fifty nine videotaped care visits involving mental health discussions were complemented by patient and physician surveys. Findings revealed that a third of visits contained no psychotropic medication discussions despite its important role in treating mental illnesses. When prescribing psychotropic medicines, physicians presented information about the medication's purpose and brand name more often than adverse effects or usage. More competing demands were associated with less psychotropic medication discussions. Given the seriousness of mental illness in late life, the authors concluded that system-level changes may be needed to correctly diagnose mental illness, take more proactive actions to improve mental health, and enhance information exchange concerning psychotropic medication.
Brief problem-solving treatment in primary care (pst-pc) was not more effective than placebo for elderly patients screened positive of psychological problems
- Authors:
- LAM Cindy L. K., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(10), October 2010, pp.968-980.
- Publisher:
- Wiley
This study investigated whether screening followed by brief problem-solving treatment by primary care doctors (PST-PC) could improve health-related quality of life (HRQOL) and reduce consultation rates in the elderly. Participants included 299 Chinese patients aged over 60, with positive screening scores for psychological problems by the Hospital Anxiety and Depression Scale (HADS). Of these, 149 received brief PST-PC from primary care doctors, and 150 control group video-viewing of health education videos. All subjects were followed up by telephone at 6, 12, 26 and 52 weeks. Findings indicated a significant improvement in the HRQOL role-emotional and mental component summary scores at week 6 in the PST-PC group but not in the control group. Several HRQOL scores improved significantly in the control group at weeks 6-52. Mixed effects analysis adjusting for baseline values and cofounders did not show any difference in any of the outcomes between the PST-PC and control groups. Screening followed by brief PST-PC was associated with a short-term improvement in HRQOL, but the HRQOL benefit was not greater than those found in the control group.
Improving treatment access and primary care referrals for depression in a national community-based outreach program for the elderly
- Authors:
- NYUNT Ma Shwe Zin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(11), November 2009, pp.1267-1276.
- Publisher:
- Wiley
This paper describes a nationwide community-based outreach service model, the Community-Based Early Psychiatric Intervention Strategy (CEPIS) programme, aimed at improving access and acceptance of treatment for depression among the elderly population in Singapore. In the CEPIS, community nurses routinely screened older people for depressive symptoms, and provided psychoeducation (giving information about depression and its causes and treatment and availability of care by a general practitioner, and addressing commonly held negative beliefs and attitudes) and referral for primary care treatment. The authors evaluated the impact of the programme and the extent to which determinants of treatment-seeking were altered by removing socioeconomic, physical and cognitive barriers to care. Their conclusions were that an outreach service model of routine and active screening for depressive symptoms in a community setting of providing social services for the elderly population greatly increased the use of primary care treatment for depression, and that by eliminating socioeconomic, physical, knowledge, belief and attitudinal barriers, equitable care to all in need is attainable through such a service.
Recognition and response: approaches to late-life depression and mental health problems in primary care
- Author:
- ILIFFE Steve
- Journal article citation:
- Quality in Ageing, 10(1), March 2009, pp.9-15.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
The boundaries between what is a healthy response to stress and anxiety and what is abnormal are often difficult to determine, especially in primary care. This paper considers depression in later life as an example of this tension. Depressive symptoms may be viewed as an understandable response to bereavement of physical illness, or it can be a disabling and life-threatening condition if left untreated. The article discusses the key role primary care has to play in supporting depressed older people, though improved pattern recognition and diagnosis, by tailoring effective treatments to fit the individual, and providing or signposting the older person to information and advice.
The Hopkins Symptom Checklist-25 is a sensitive case-finder of clinically important depressive states in elderly people in primary care
- Authors:
- FROJDH Karin, HAKASSON Anders, KARLSSON Ingvar
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(4), April 2004, pp.386-390.
- Publisher:
- Wiley
No depression rating scale has yet been designed to identify all clinically important depressive states in elderly. Therefore, this study investigated the Hopkins Symptom Checklist-25 (HSCL-25), a self-rating scale for depression, to see if it was a sensitive indicator of major, minor and subsyndromal depression. Structured interviews of 37 people with a high depressive score and an age and sex matched control group comprised of 37 persons with a low depressive score in HSCL-25, in order to compare the HSCL-25 ratings with the Montgomery- Åsberg-Depression Rating Scale (MADRS) as well as with the criteria for major, minor and subsyndromal depression. The sensitivity for identifying any depression was 94% and the specificity was 94% for HSCL-25 compared to the diagnostic criteria for depressive disorders. HSCL-25 is a sensitive case-finder of any depressive disorder and may be useful in general practice and for screening studies of depression in elderly people
Interdisciplinary working in mental health
- Author:
- BAILEY Di
- Publisher:
- Palgrave Macmillan
- Publication year:
- 2012
- Pagination:
- 256p.
- Place of publication:
- Basingstoke
This book presents a model for interdisciplinary working, and offers an overview of practice and policy across a range of mental health settings. It explores how to combine skills, theories and expertise from a range of disciplines in response to the diverse needs of service users, from children to older people, and those with complex needs. Chapters include: the evolution of interdisciplinary working: definitions and policy context; models and values for interdisciplinary working in mental health; interdisciplinary working and the mental health legislation; interdisciplinary care planning in mental health; interdisciplinary risk assessment planning and management; involving people who use services in interdisciplinary working in mental health; interdisciplinary working with people with mental health problems in primary care; interdisciplinary working with children and young people with mental health problems; interdisciplinary working with older adults with mental health needs; interdisciplinary working with individuals with complex needs; interdisciplinary education and training; and managing interdisciplinary working and practice in mental health.
Adult community statistics: 1st April 2008-31st March 2009
- Author:
- NORTHERN IRELAND. Department of Health, Social Services and Public Safety
- Publisher:
- Northern Ireland. Department of Health, Social Services and Public Safety
- Publication year:
- 2009
- Pagination:
- 80p., tables
- Place of publication:
- Belfast
This statistical report presents information on activity for all Programmes of Care for adults, gathered from HSC Trusts via the annual and quarterly statistical returns. Statistical tables are presented in 6 sections. All Programmes of Care, Elderly Care, Mental Health, Learning Disability, Physical and Sensory Disability, and Primary Health and Adult Community.
Adult community statistics: 1st April 2009-31st March 2010
- Author:
- NORTHERN IRELAND. Department of Health, Social Services and Public Safety
- Publisher:
- Northern Ireland. Department of Health, Social Services and Public Safety
- Publication year:
- 2010
- Pagination:
- 77p., tables
- Place of publication:
- Belfast
This statistical report presents information on activity for all Programmes of Care for adults, gathered from HSC Trusts via the annual and quarterly statistical returns. Statistical tables are presented in 6 sections. All Programmes of Care, Elderly Care, Mental Health, Learning Disability, Physical and Sensory Disability, and Primary Health and Adult Community.
Adult community statistics: 1st April 2007-31st March 2008
- Author:
- NORTHERN IRELAND. Department of Health, Social Services and Public Safety
- Publisher:
- Northern Ireland. Department of Health, Social Services and Public Safety
- Publication year:
- 2008
- Pagination:
- 78p., tables
- Place of publication:
- Belfast
This statistical report presents information on activity for all Programmes of Care for adults, gathered from HSC Trusts via the annual and quarterly statistical returns. Statistical tables are presented in 6 sections. All Programmes of Care, Elderly Care, Mental Health, Learning Disability, Physical and Sensory Disability, and Primary Health and Adult Community.