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Deliberate self-harm (DSH) among older people: a retrospective study in Barnet, North London
- Authors:
- RUTHS Florian, TOBIANSKY Robert Ian, BLANCHARD Martin
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(2), February 2005, pp.106-112.
- Publisher:
- Wiley
Rates of suicide remain high among older people and those who deliberately self harm are believed to be at an increased risk of killing themselves in the future. If older people who deliberately harm themselves are to be helped by developments in services we need to understand what currently happens to them in terms of service provision and outcome. A retrospective paper and electronic case note survey was carried out on all older people living in the London Borough of Barnet who presented to Accident & Emergency Departments with DSH over a two-year period. Ensuing actions and events were then tracked. Forty-three older people with DSH were identified. 18/43 (42%) had previous contact with local psychiatric services. The main method of DSH was overdose of medication (36/43 or 84%). Compared to the general population there were more women and widows. There were similar levels of physical ill-health. Thirty-seven of 43 (86%) received documented psychiatric input outside of hospital following the DSH. The mean follow-up period was 789.0 days (SD 419.8) and during this time 8/43 (19%) had a further documented episode of DSH, and 18/43 (40%) died from natural causes. This study confirms the need for improved documentation of DSH and its coding; this needs to be reviewed at local and national level. The vast majority of older people who attempt suicide do have subsequent contact with psychiatric services. There is a strong likelihood of repeat DSH and a higher risk of death by natural causes, emphasising the need to conceptualise DSH as a risk factor relevant to all medical specialities.
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
A pilot study to assess attitudes, behaviors, and inter-office communication by psychiatrists and primary care providers in the care of older adults with schizophrenia
- Author:
- JONES Sarah M.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(3), March 2009, pp.254-260.
- Publisher:
- Wiley
There is a lack of assessment tools and empirical data concerning clinician attitudes and behaviours with respect to the health care of older adults with schizophrenia. A survey instrument of physician attitudes, behaviour, and inter-office communication was developed to used to provide preliminary data on physician-related issues in the provision of health care to this population. A semi-structured 20-item survey instrument was administered to a stratified convenience sample of 24 primary care physicians (PCPs) and 27 psychiatrists working in the New York metropolitan area. Using open ended and multiple choice items, scales, summed scores, and case vignettes, we assessed attitudes, experiences, and procedures in treating medical illnesses in older persons with schizophrenia. There were no differences between PCPs and psychiatrists in reported and anticipated behaviour towards older adults with symptoms of schizophrenia, and both groups displayed favourable views. However, both groups had slightly negative stereotypes and attitudes concerning these patients. PCPs reported receiving information from psychiatrists slightly more than 0 to 10 percent of the time. The preliminary findings indicated more favourable attitudes and behaviours by PCPs than had been anticipated based on earlier research with younger patients. The data suggest that the failure of older schizophrenia patients to receive adequate treatment may not be due primarily to clinicians' negative attitudes and behaviours, and that problems with communication may play a more important role.
Poor mental and physical health differentially contributes to disability in hospitalized geriatric patients of different ages
- Authors:
- MARENGONI Alessandra, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(1), January 2004, pp.27-34.
- Publisher:
- Wiley
This article seeks to evaluate the relationship between depressive symptoms, cognition and somatic diseases on functional status of geriatric patients at hospital discharge. Patients 65+ years consecutively admitted to the acute care geriatric ward of the Internal Medicine Department I, Civil Hospital of Brescia, Italy, from February 1998 to December 2000 (n = 830) were examined. Functional disability was defined as need of physical assistance in at least one of the basic Activities of Daily Living (ADL). The Greenfield Index of Disease Severity (IDS) and the Geriatric Index of Comorbidity (GIC) were used to measure number and severity of diseases. The Mini-Mental State Examination (MMSE) assessed cognitive status and the Geriatric Depression Scale (GDS) measured depressive symptoms. Prevalence of functional disability at discharge was 29.3% in the younger age group (65-74 years) and 55.2% in the older age group (75+ years). Using logistic regression models, older age, poorer cognitive status, and depressive symptoms were independently associated with functional disability in the younger and older age group, respectively. Additionally cognitive impairment and depressive symptoms showed an additive association with disability, especially in younger patients, while comorbidity was correlated with functional status only in the oldest old, in particular among those who were cognitively impaired. Functional disability after acute hospitalization is highly prevalent in geriatric patients. Depressive symptoms, comorbidity, and cognitive impairment often coexist, interact and are differentially associated with function depending on age. Considering that depressive symptoms are a modifiable problem, their detection in hospital settings may help clinicians in targeting subjects at high risk of functional disability.
Identification of psychological morbidity in older people in primary care by practice nurses
- Authors:
- CAPE J., et al
- Journal article citation:
- Aging and Mental Health, 7(6), November 2003, pp.446-451.
- Publisher:
- Taylor and Francis
Older people with psychological morbidity generally first present to health services in primary care, where they are increasingly seen by primary care nurses. In order to evaluate primary care nurses' identification of psychological morbidity, 190 older patients attending eight practice nurses completed the General Health Questionnaire (GHQ) and the practice nurses made an assessment as to the presence or absence of psychological problems. The practice nurses identified only 26% of probable cases of psychological morbidity identified by the GHQ. Their threshold for identification was high, rating only 12% of patients as experiencing psychological problems compared to 29% probable cases identified by the GHQ, and their accuracy was low (kappa for agreement between GHQ and nurse ratings = 0.23). Likelihood of identification depended on length and type of visit. The findings suggest that it may be unrealistic to expect practice nurses, without additional training and reorganisation of their work, to identify more than a minority of older patients with psychological morbidity in the course of their routine work.
Geriatric depression in Nigerian primary care attendees
- Authors:
- SOKOYA Olukunle, BAIYEWU Olusegun
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(6), June 2003, pp.506-510.
- Publisher:
- Wiley
202 older people were screened using the Geriatric Depression Scale (GDS). The Geriatric Mental State schedule (GMS) was administered to participants who scored above the cut-off on the GDS in order to assess psychopathology. Diagnosis of depression was based on ICD-10 criteria as well as the GMS-AGECAT programme. The rate of geriatric depression in primary care was found to be 7.4%. Severe depression was only 1.5%. Very low income and subjective report of poor health were significantly associated with depression in the cohort. AGECAT recognition of depression was comparable to that by the ICD-10 (k = 0.7). The study is the first known study of geriatric depression in primary care in Nigeria. The rates are comparable with rates obtained in other countries. Specific correlates of depression in the older Nigerians identified included poor self-assessed health and low income.
Would older people use psychological services?
- Authors:
- AREAN Patricia A., et al
- Journal article citation:
- Gerontologist, 42(3), June 2002, pp.392-398.
- Publisher:
- Oxford University Press
This article examines older patient preferences for psychological services, including the types of services they would be interested in and who should provide them. Seventy-nine percent of the sample surveyed said they would use any of the psychological services which were presented to them. Seventy-two percent preferred to talk to their primary care provider, and 46% of the sample indicated that they would also speak with a mental health worker or nurse about their problems. Few older people said they would attend group psychotherapy, but 69% said they would attend psychoeducational classes. Implications: Our findings suggest that older adults would be amenable to psychosocial services, particularly individual services and psychoeducational programming.
Forget me not: mental health services for older people
- Authors:
- BENBOW Susan M., LENNON Sean P.
- Journal article citation:
- Psychiatric Bulletin, 24(11), November 2000, pp.403-404.
- Publisher:
- Royal College of Psychiatrists
The exclusion of services for older people from the Mental Health National Service Framework and the delays in publication of the National Service Framework for the elderly have caused many old age psychiatrists to be concerned. The recent Audit Commission report, entitled 'Forget Me Not: Mental Health Services for Older People', gives us much encouragement that the needs of older adults have not been forgotten.
The neglect of somatoform disorders by old age psychiatry: some explanations and suggestions for future research
- Authors:
- WIJERATNE Chanaka, BRODATY Henry, HICKIE Ian
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(9), September 2003, pp.812-819.
- Publisher:
- Wiley
The somatoform disorders have long been ignored by old age psychiatry. The main aim of this paper is to identify and examine possible reasons for this neglect. Significant conceptual, diagnostic and classificatory problems have impeded the consideration of somatoform disorders in older people. There is a perception that somatoform disorders are infrequent and have not been validated as independent clinical disorders. However, we present evidence that the more broadly defined somatoform disorders are common in all age groups in primary care and meet criteria for the determination of clinical validity. General difficulties in the assessment of psychiatric disorders in primary care, the setting in which somatoform disorders are most common, are compounded by a lack of support from old age psychiatry services. Effective psychological therapies may not be readily available to sufferers. There is a need for change in the conceptualisation and nosology of the somatoform disorders. The formulation of age appropriate diagnostic criteria and presentations is a prerequisite for determining the clinical validity of these disorders in older people. This can be followed by study of their frequency, associated risk factors and treatment. A system of education that enhances the management of these disorders within primary care and old age psychiatry services is needed.
Practical management of depression in older people
- Editors:
- CURRAN Stephen, WATTIS John, LYNCH Sean
- Publisher:
- Arnold
- Publication year:
- 2001
- Pagination:
- 191p,bibliog.
- Place of publication:
- London
Provides an overview of the different treatments available and the contributions difficult disciplines can bring to the problem of managing depression in older people. Practical implications of physical and psychotherapeutic treatments are discussed. The roles of the family practitioner, clinical psychiatrist, nurse and occupational therapist are explored within the context of a multidisciplinary team. Guidelines for diagnoses are outlined.