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The article presents research papers on clinical observations and follow-up patients at the Bethlem Royal Hospital in London, England. There are eight chapters that presents background, aims, method and clinical characteristics of patients. In the first chapter, Felix Post summarizes present knowledge of late paraphrenia, drawing on the clinical descriptions of earlier workers and emphasizing the relative rarity of descriptions of schizophrenia occurring after the age of 50 or 60 and the difficulty early nosologists had in making the differentiation from senile psychosis.

Presents an article on pressing issues in the dementia and dementia services symposium at the Royal College of Physicians in London, England on January 28 to 29, 1999. Geographical inequities involving care for the elderly; Information on a survey conducted by the Alzheimer's Disease Society on Health Authorities' plans and purchasing intentions for dementia services.

Background: The COVID‐19 pandemic impacted on the provision of care and routine activity of all National Health Service (NHS) services. While General Practitioner referrals to memory services in England have returned to pre‐pandemic levels, the estimated dementia diagnosis rate (DDR) fell by 5.4% between March 2020 and February 2023. Methods: In this paper we explore whether this reduction is accurate or is an artefact of the way the NHS collects data. Results: We explore the processes that may have affected national dementia diagnosis rates during and following the COVID‐19 pandemic. Conclusions: We discuss what action could be taken to improve the DDR in the future. Key points: Despite General Practitioner (GP) referrals to memory services in England returning to levels seen before the pandemic, there was a decline of 5.4% in the estimated dementia diagnosis rate (DDR) from March 2020 to February 2023.This paper explores the factors which may have affected the national DDR reduction. These include a backlog in dementia referrals, a reduction in coding of diagnoses, or a decrease in true dementia prevalence secondary to excess COVID‐19 deaths which has yet to be reflected in the DDR denominator.Further work is suggested to accurately capture dementia prevalence in the United Kingdom (UK). These include an up‐to‐date multicentre population‐based cohort study and adjusting the DDR denominator for factors known to affect dementia susceptibility such as deprivation, rurality, and ethnicity. [ABSTRACT FROM AUTHOR]

Objectives: This paper considers home from the perspective of people living with dementia supporting ongoing discourse around ageing in place and the significance of creating more inclusive communities. Methods: Forty‐six home tour interviews led by people living with dementia were conducted in England and Scotland to better understand the connectivity between home and neighbourhood for people living with dementia. These interviews used a range of participatory and creative approaches including video, photographic images and in situ interviews. Data were analysed via reflexive thematic analysis. Results: Three themes were identified in data analysis. 1. Connected home and neighbourhood, where participants revealed the dynamic relationship between home and neighbourhood; 2. Practices of home, where participants discussed the everyday nature of their homes and routines; and 3. Displaying home and family, which reflected participant's biographical homes in the context of living with dementia. Discussion: The findings show that home holds multiple meanings for people living with dementia. For example, home is understood as a part of the neighbourhood and an extension of the home space into gardens and backyards, thus extending existing discourses that solely focus on the inside of people's homes. For people living with dementia, homes are also sites of negotiation and renegotiation where new meanings are created to reflect the changing nature and context of the home. There is not one fixed solution to these issues. Support and understanding for people living with dementia will need to evolve to adapt to the shifting dynamics and multiple meanings of home. Key points: Neighbourhoods begin within homes and are interconnected. This relationship has important implications for the discourse of ageing in place.'Home' for people living with dementia holds the same meanings for those without dementia, but with some notable differences. It is important to recognise the shifting dynamics of home and to recognise the complexity of home in the context of dementia. There is not a fixed solution to the challenges of ageing at home with dementia, but support and understanding need to evolve alongside people with lived experience.Homes are a site of renegotiation where new meanings are created to reflect the changing nature of home and the lived experience of home for those with dementia.The study has provided findings through innovation in the research design. The employment of creative methods enabled people living with dementia to participate in sharing their own narratives of home.The work provides evidence where there is a current gap in understanding 'what matters' about home for people living with dementia. [ABSTRACT FROM AUTHOR]

Objectives: Cognitive stimulation therapy (CST) is one of the few non‐pharmacological interventions for people living with dementia shown to be effective and cost‐effective. What are the current and future cost and health‐related quality of life implications of scaling‐up CST to eligible new cases of dementia in England? Methods/design: Data from trials were combined with microsimulation and macrosimulation modelling to project future prevalence, needs and costs. Health and social costs, unpaid care costs and quality‐adjusted life years (QALYs) were compared with and without scaling‐up of CST and follow‐on maintenance CST (MCST). Results: Scaling‐up group CST requires year‐on‐year increases in expenditure (mainly on staff), but these would be partially offset by reductions in health and care costs. Unpaid care costs would increase. Scaling‐up MCST would also require additional expenditure, but without generating savings elsewhere. There would be improvements in general cognitive functioning and health‐related quality of life, summarised in terms of QALY gains. Cost per QALY for CST alone would increase from £12,596 in 2015 to £19,573 by 2040, which is below the threshold for cost‐effectiveness used by the National Institute for Health and Care Excellence (NICE). Cost per QALY for CST and MCST combined would grow from £19,883 in 2015 to £30,906 by 2040, making it less likely to be recommended by NICE on cost‐effectiveness grounds. Conclusions: Scaling‐up CST England for people with incident dementia can improve lives in an affordable, cost‐effective manner. Adding MCST also improves health‐related quality of life, but the economic evidence is less compelling. Key points: There are few evidence‐based non‐pharmacological interventions for people living with dementia. Cognitive stimulation therapy (CST) is both effective and cost‐effective, but current availability is constrainedThis paper reports the cost and health‐related quality of life implications of scaling‐up cognitive stimulation therapy to eligible people with dementia in England over a 25 year periodScaling‐up CST would improve general cognitive functioning and health‐related quality of life, but also increase costs for health and social care services, and for family and other unpaid carers. Adding maintenance CST would also improve health‐related quality of life, with even greater cost increasesThe higher costs of scaling‐up CST to the full eligible population over a 25 year period would be considered worth paying by reference to criteria used by the National Institute for Health and Care Excellence (NICE) in England. The economic evidence for adding maintenance CST is less compelling [ABSTRACT FROM AUTHOR]

Describes the origins and the first phase of the psychiatric services provided by Goodmayes hospital in London, England. Extent of the services offered by the hospital in the psychiatric care of the elderly; Challenges posed by operating such service; Impact of the services provided by the said institution on the mental health of the elderly.

Objectives: This paper aims to compare changes over 2 years in patients' health-related quality of life (HRQL) with the health and social care costs of diagnosis and treatment of people newly referred to memory assessment services (MAS).Methods: We analysed observational data from 1318 patients referred to 69 MAS who completed resource use and HRQL questionnaires at baseline 3, 6, 12, and 24 months. We reported mean differences in HRQL (disease-specific DEMQOL and generic EQ-5D-3 L), quality-adjusted life years (QALYs), costs and cost-effectiveness between baseline, and 2-year follow-up.Results: Two years after referral to MAS, patients reported a higher DEMQOL score (mean gain 4.47, 95% confidence interval, 3.08-5.90) and EQ-5D-3 L (0.014, -0.011 to 0.039). Mean total costs and QALYs over 24 months was £2411 (£1721-£2873) and 0.027 (0.003-0.051), respectively. Assuming that patients' HRQL would not have altered over the 2 years had they not attended MAS, these outcomes suggest an incremental cost-effectiveness ratio of £89 546 (£38 123-£145 864) based on changes in EQ-5D-3 L. If we assumed that patients' HRQL would have declined by about 10% over this period had they not attended MAS, the cost-effectiveness ratio would be £25 056. The largest MAS (N = 32; 46%) with over 50 new patients a month were more likely to be cost-effective than smaller ones (P < 0.01).Conclusions: MAS are effective and can be cost-effective for diagnosing and treating people with suspected dementia. Large variations in costs between clinics suggest that many MAS could improve their cost-effectiveness. [ABSTRACT FROM AUTHOR]

Objectives: The Covid‐19 pandemic has taken a heavy toll on many people living with dementia and carers. Caring for a person living with dementia at home with limited avenues for support and a break challenged many carers. Care homes in England closed to visitors, with very few offering opportunities for a short‐stay. We investigated impact of Covid‐19 on views and expectations of carers of people living with dementia about residential respite. Methods/Design: Qualitative interviews with 35 carers were conducted March–December 2020: 30 women and 5 men, with ages ranging 30–83 years. Interviews explored experiences, views of residential respite, and expectations post‐Covid. Data were thematically analysed and salient concepts were drawn out and discussed within the research team and study advisers. Results: Three themes were identified in transcripts, relating to impact of Covid‐19 on views and expectations of respite: (1) Carers described regularly negotiating risks and stresses of Covid, weighing up how to prevent infection and changing family arrangements to facilitate caring; (2) Carers were balancing different needs, prioritising needs of their relatives while bearing the impact of cumulative caregiving responsibilities. (3) Uncertainty about future residential respite continued, in terms of availability, ongoing restrictions and trustworthy information sources. Conclusions: Residential respite is a positive, acceptable option for some carers to get a break from caring. Covid‐19 may have heighted some of caregiving stressors and there may be an increased need for a break. Views of care homes developed during the pandemic suggest that individual confidence to use respite may need to be rebuilt. Key points: The Covid‐19 pandemic increased demands on carers of people living with dementia with fewer opportunities for social contact and breaksCarers described myriad ways to negotiate risks and stresses of Covid by developing ways to prevent infection and changing family arrangements. Carers also talked of balancing different needs, ways of prioritising the needs of their relatives while facing the impact of cumulative caregiving responsibilitiesThe uncertainty about future residential respite in terms of its availability, ongoing restrictions in care homes, and which sources of information to trust was noteworthyThe Covid‐19 pandemic may have heighted some demands of caregiving, and needs for a break may be greater. Individual confidence to use residential respite may need to be rebuilt [ABSTRACT FROM AUTHOR]

Objective: To investigate progress in joint working within community mental health teams for older people (CMHTsOP) against a range of national standards, and to consider team characteristics that may hinder or facilitate integrated practice. Methods: A postal questionnaire was sent to the managers of all CMHTsOP in England. A total of 376 teams responded representing a response rate of 87.7%. Hypothesis testing and regression analysis, using a composite score based on nine indicators of integration, were conducted to address the study’s aims. Results: Whilst the study suggests that progress was being made against a number of key standards of joint working, the study finds that most teams could not access local authority service user records, nor were health staff within most teams able to commission social care services. After controlling for other characteristics, teams with the lowest levels of integration tended to work across multiple local authorities; were managed by a nurse; had high referral rates and were located in formally integrated Care Trusts. Conclusions: Improved integration could develop by NHS Trusts and local authorities encouraging more information sharing, and further delegating powers to arrange social care services to CMHTOP members. The paper highlights team and locality features that appear to cause obstacles to joint working, but there is a clear gap in the evidence relating team structures and characteristics to the quality of patient care. [ABSTRACT FROM AUTHOR]

Background This paper analyses the costs and benefits of commissioning memory services for early diagnosis and intervention for dementia. Method A model was developed to examine potential public and private savings associated with delayed admissions to care homes in England as a result of the commissioning of memory services. Findings The new services would cost around £220 million extra per year nationally in England. The estimated savings if 10% of care home admissions were prevented would by year 10 be around £120 million in public expenditure (social care) and £125 million in private expenditure (service users and their families), a total of £245 million. Under a 20% reduction, the annual cost would within around 6 years be offset by the savings to public funds alone. In 10 years all people with dementia will have had the chance to be seen by the new services. A gain of between 0.01 and 0.02 QALYs per person year would be sufficient to render the service cost-effective (in terms of positive net present value). These relatively small improvements seem very likely to be achievable. Interpretation These analyses suggest that the service need only achieve a modest increase in average quality of life of people with dementia, plus a 10% diversion of people with dementia from residential care, to be cost-effective. The net increase in public expenditure would then, on the assumptions discussed and from a societal perspective, be justified by the expected benefits. This modelling presents for debate support for the development of nationwide services for the early identification and treatment of dementia in terms of quality of life and overall cost-effectiveness. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: Excessive use of antipsychotic medication by older people is an international concern, but there is limited comparative information on their use in different residential settings. This paper describes and compares antipsychotic prescribing to older people in care homes and the community in England and Wales. Method: Analysis of a primary care database (THIN) with 403 259 community and 10 387 care home residents aged 65–104 years in 2008–9. Results: 3677 (0.9%) patients in the community and 2173 (20.9%) in care homes (20.5% in residential homes, 21.7% in nursing homes) received an antipsychotic medication prescription in the last 90 days. Most patients had received prescriptions for more than three months and 60% of prescriptions were for atypical antipsychotics. In patients without severe mental illness, 2367 (0.6%) patients in the community and 1765 (18.2%) in care homes received antipsychotic medication; such prescribing was common for patients with recorded dementia (30.2% in care home, 10.1% in the community). In care homes, younger age and living in the North of England predicted prescribing, but care home type did not. In the community, female gender, increasing age, living in a deprived area and the North predicted prescribing. Conclusions: Despite safety concerns, antipsychotic prescribing is markedly higher in care homes than in the community, and strongly associated with dementia in both settings. In England and Wales, we estimate that 54 000 older care home patients and 50 000 community patients receive antipsychotic medication without a diagnosis of severe mental illness with important implications for health and social services. Copyright # 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background This paper provides an initial evaluation of the impact of the Single Assessment Process (SAP) in England upon practice regarding multidisciplinary assessment. Objectives To investigate changes in recorded health needs of older people and in the number of multidisciplinary assessments undertaken using social care agencies' case files. To examine differences in approaches to the use of multidisciplinary assessment for older people with different health needs. Methods An audit of case files of older people living in the community in receipt of social care in three areas carried out at two time periods before and after implementation of the SAP in 2004. Information extracted from files covered a number of domains including evidence of multidisciplinary assessments, and presence of mental and physical health problems. Results Data from 144 files at Time 1 were compared with 145 files from Time 2. Little evidence emerged that older people at Time 2 were more dependent. However, significantly more multidisciplinary assessments were undertaken following the introduction of the SAP, in particular by occupational therapists and secondary health care teams. Cognitive impairment was a significant predictor of multidisciplinary assessment at both time periods. Conclusions The impact of the introduction of the SAP has been mediated by the influence of other policies in England: intermediate care and integrated health and social care provision. Nevertheless, the data suggest that consideration be given to more effective targeting of multidisciplinary assessments on the grounds of both cost and more accurate identification of those who will benefit from the process. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background 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. Methods 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. Results 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. Conclusions 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. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper seeks to address whether integrated structures are associated with more integrated forms of service. Northern Ireland has one of the most structurally integrated and comprehensive models of health and personal social services in Europe. Social and health services are jointly administered and this arrangement should, in theory, promote collaborative working and interdisciplinary arrangements. The study employed a cross-sectional survey of consultants in old age psychiatry in England and Northern Ireland. Potential respondents were sourced from the UK Royal College of Psychiatrists membership list and locally collected information. A self-administered postal questionnaire. Along with general service arrangements, the domains measured reflect core policy issues for older people''s services. Under particular scrutiny in this study were the degree of integration of health and social service provision, as well as inter-professional team working. The integrated health and social care services in Northern Ireland do appear to provide more integrated patterns of working, primarily in managerial arrangements and in the location of staff. There was no evidence of the impact of integration on practice in areas such as: assessment, referral and medical screening. The factors found to be associated with greater integration of health and social care in the prediction model fell into three categories: provision of specialist services; provision of outreach activities; and shared policies by which the whole team worked. Health and personal social services in Northern Ireland have a distinct advantage over their counterparts in comparable areas of England. The results indicate that integrated structures in old age psychiatry services are associated more with integrated management systems and less with integrated practice-related activities. Further research is required on the effectiveness and cost effectiveness of integrating services in general. It is important that future intervention studies systematically measure the component parts, nature and extent of integration and their individual and joint contribution to the effectiveness and efficacy of services. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Presents a commentary regarding the psychiatric services provided by the Goodmayes Hospital for the elderly in London, England. Appreciation of the services provided by the said institution; Quality of medical care provided by the hospital staff; Relevance of the services offered by the hospital in the promotion of mental health among the elderly.

Looks into the psychiatric services for old people offered by the Goodmayes Hospital in London, England. Purpose of creating the Goodmayes service; Scope of services offered by the said institution; Benefits provided by Goodmayes service.

Background: Global initiatives that promote public health responses to dementia have resulted in numerous countries developing new national policies. Current policy guidelines in England, for example, recommend that people diagnosed with mild-to-moderate dementia receive information and psychosocial interventions to improve their ability to 'live well'. However, it remains unclear to what extent these recommendations are being achieved.Methods: Self-reported information from 1537 people living with dementia and informant-reported information from 1277 carers of people living with dementia was used to quantify receipt of community-based dementia support services, including health and social care services provided by statutory or voluntary-sector organisations, in Britain from 2014 to 2016. Demographic factors associated with differences in receipt of support services were also investigated to identify particularly vulnerable groups of people living with dementia.Results: Both self- and informant reports suggested that approximately 50% of people living with dementia received support services for dementia. Receipt of support services was lower among people living with dementia who are older, female, and have fewer educational qualifications. Receipt of support services also differed according to diagnosis and carer status, but was unrelated to marital status.Conclusions: Limited receipt of dementia support services among people living with dementia in Britain provides a baseline to assess the efficacy of current policy guidelines regarding provision of information and support. Targeted efforts to facilitate receipt of support services among the particularly vulnerable groups identified in the current study could improve the efficacy of dementia support services both in Britain and internationally, and should inform policy development. [ABSTRACT FROM AUTHOR]

Background Recent increases in care home closures suggest that homes may not be able to balance pressures to reduce costs against pressures to increase standards. Commissioning requires an understanding of the factors affecting costs and how they change over time. Methods A survey of care homes for older people was conducted in 21 local authorities in England in 1996. A complete response was obtained for 618 homes (75%) and 11,900 residents. Findings were compared with surveys conducted in 1986 and 1988. Results Dependency was significantly related to prices, primarily due to the differential payments to nursing and residential homes. Home characteristics were also related to price, the proportion of single rooms having the largest impact. However, prices were most sensitive to local wage rates, particularly in residential homes. Compared with previous surveys levels of dependency had increased, particularly in voluntary residential homes and nursing homes. Independent homes were more likely to be purpose built, and a higher proportion of beds were in single rooms, although only 30% of private residential, dual registered and nursing homes achieved the proposed level of 80% of beds in single rooms. Staffing ratios appeared to have increased, but price rises were modest, particularly for nursing homes. Conclusions Standards of provision have improved over time, although prices appear to have been kept below those expected from increases in costs. Continuing pressures on costs and prices are likely to lead to further closures and a restriction of choice for older people. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article presents report on the conference "Depression and suicide in older people," held at the Ciba Foundation, London on November 11, 1994. It presented reasons why some studies have found the prevalence of major depression among older adults to be lower than for other age groups. Lowered survival due to suicide and physical illness may also contribute to apparent low prevalence, as can effects relevant to the unique historical experience of different birth cohorts. A recent study has shown an association between depressive symptoms and increased age to be reversed when factors such as low income, physical disability, cognitive impairment and poor social support are simultaneously controlled.

Based on a subsample of 61 cases of dementia in an intensive interview study conducted in Liverpool, this article looks at the availability of family care, the characteristics of carers, the problems they face and the service support they receive. The findings confirm those of earlier studies: only two-thirds of dementia sufferers living in the community have identifiable carers; the average age of carers was 65: dementia cases demonstrated a high level of dependency and need for supervision; and the level of input of domiciliary services was low. It was also found that a substantial proportion of sufferers live alone but most are not without supporters. GPs are identified as the key professionals who act as gatekeepers to other services. It is suggested that presently available services are inappropriate for some carers and that packages of care and support need to be flexible and better tailored to carers' needs. [ABSTRACT FROM AUTHOR]

Objective: The decision about the best time for a person living with dementia to move to a care home involves the individual and others, particularly family. However, little is known about care professionals' views on the best time to move, particularly those with decision‐making authority. This study investigated social workers' and care home managers' views on whether there is an "optimal time" for a move. Methods: A qualitative, phenomenological approach was employed, using semi‐structured interviews with 20 social workers and 20 care home managers in England; all with experience of advising people living with dementia about a care home move and making decisions about funding or acceptance. Interviews were audio‐recorded, transcribed, and analyzed thematically. Results: Four overarching themes emerged from the data: (1) staying at home for as long as possible but avoiding crisis, (2) balancing risks proactively and anticipating triggers, (3) desires for the person living with dementia to be involved in the decision, and (4) the significance of funding in enabling choices about a care home move. Conclusions: Deciding on the timing of a care home move is context and person specific. Two professional groups with substantial experience of this among their client group both recommended proactive deliberation but funding was overall the deciding factor in the extent to which they considered choice was possible. Future research should avoid seeing all care home moves as negative and explore how practitioners can best encourage discussions prior to crisis point about care home options. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to investigate the occurrence rates of clinical events and their associations with comfort in dying nursing home residents with and without dementia.Methods: Epidemiological after-death survey was performed in nationwide representative samples of 322 nursing homes in Belgium, Finland, Italy, the Netherlands, Poland, and England. Nursing staff reported clinical events and assessed comfort. The nursing staff or physician assessed the presence of dementia; severity was determined using two highly discriminatory staff-reported instruments.Results: The sample comprised 401 residents with advanced dementia, 377 with other stages of dementia, and 419 without dementia (N = 1197). Across the three groups, pneumonia occurred in 24 to 27% of residents. Febrile episodes (unrelated to pneumonia) occurred in 39% of residents with advanced dementia, 34% in residents with other stages of dementia and 28% in residents without dementia (P = .03). Intake problems occurred in 74% of residents with advanced dementia, 55% in residents with other stages of dementia, and 48% in residents without dementia (P < .001). Overall, these three clinical events were inversely associated with comfort. Less comfort was observed in all resident groups who had pneumonia (advanced dementia, P = .04; other stages of dementia, P = .04; without dementia, P < .001). Among residents with intake problems, less comfort was observed only in those with other stages of dementia (P < .001) and without dementia (P = .003), while the presence and severity of dementia moderated this association (P = .03). Developing "other clinical events" was not associated with comfort.Conclusions: Discomfort was observed in dying residents who developed major clinical events, especially pneumonia, which was not specific to advanced dementia. It is crucial to identify and address the clinical events potentially associated with discomfort in dying residents with and without dementia. [ABSTRACT FROM AUTHOR]

Objectives: Hearing, vision, and cognitive impairment commonly co-occur in older adults. Improving sensory function may positively impact outcomes in people with dementia (PwD). We developed a "sensory intervention" (SI) to support hearing and vision in PwD. Here, we report the findings of an international open-label field trial, and nested case series, to explore the impact of the SI on dementia-related outcomes.Methods: This was a home-based trial conducted in France, England, and Cyprus. Participants were people with mild-to-moderate dementia and hearing and/or vision impairment (n = 19) and their study partners (unpaid carers; n = 19). The "basic" SI included a hearing and vision assessment and provision of glasses and/or hearing aids. A subsample received the "extended" SI with additional weekly visits from a sensory support therapist (SST). Exploratory analyses of dementia-related, health utility and resource utilisation outcomes were performed.Results: Quality of life (QoL) and sensory functional ability improved. Change in QoL exceeded the threshold for a minimum clinically important difference. There was a modest improvement (in absolute terms) post intervention in behavioural disturbance, self-efficacy, and relationship satisfaction. Study partner time assisting instrumental activities of daily living (iADL) and supervision decreased by about 22 and 38 hours per month, respectively, although time for personal ADL support increased. Qualitative data supported effectiveness of the intervention: PwD were more socially engaged, less isolated, less dependent on study partners, and had improved functional ability and communication.Conclusions: These findings support the need for a definitive randomised controlled trial (RCT) to evaluate the effectiveness of the intervention. [ABSTRACT FROM AUTHOR]

Objectives: The European RHAPSODY project sought to develop and test an online information and support programme for caregivers of individuals diagnosed with young onset dementia. The objectives were to assess user acceptability and satisfaction with the programme and to test outcome measures for a larger effectiveness study.Design: A pilot randomised controlled trial in England, France, and Germany was conducted with 61 caregivers for adults with young onset Alzheimer's disease or frontotemporal degeneration. Evaluations at baseline, week 6, and week 12 assessed user acceptability and satisfaction. Use of the programme was measured from online back-end data. Qualitative feedback on user experiences was collected via semi-structured interviews. Measures of caregiver well-being (self-efficacy, stress, burden, frequency of patient symptoms, and caregiver reactions) were explored for use in a subsequent trial.Results: Participants logged in online on average once a week over a 6-week period, consulting approximately 31% of programme content. Seventy percent of participants described the programme as useful and easy to use. Eighty-five percent expressed intent to use the resource in the future. Reductions in reported levels of stress and caregivers' negative reactions to memory symptoms were observed following use of the programme.Conclusions: Results indicated that the RHAPSODY programme was acceptable and useful to caregivers. The programme may be complementary to existing services in responding to the specific needs of families affected by young onset dementia. Distribution of the programme is underway in England, France, Germany, and Portugal. [ABSTRACT FROM AUTHOR]

Objectives: To describe the characteristics of Dementia Friendly Communities (DFCs) across England in order to inform a national evaluation of their impact on the lives of those affected by dementia.Methods: DFCs in England were identified through online searches and Alzheimer's Society records. A subsample (n = 100) were purposively selected for in-depth study based on online searches and, where necessary, follow-up telephone calls. Data collection and analysis were guided by a pilot evaluation tool for DFCs that addressed how DFCs are organised and resourced and how their impact is assessed. The evidence was predominantly qualitative, in addition to some descriptive quantitative information.Results: Of 284 DFCs identified, 251 were defined by geographical location, while 33 were communities of interest. Among 100 sampled DFCs, 89 had been set up or started activities following policy endorsement of DFCs in 2012. In the resourcing of DFCs, statutory agencies and charities played an important role. Among DFC activities, awareness raising was cited most commonly. There was some evidence of involvement of people living with dementia in organisational and operational aspects of DFCs. Approaches to evaluation varied, with little evidence of findings having effected change.Conclusions: DFCs are characterised by variation in type, resourcing, and activities. England has policy endorsement and a recognition system for DFCs. These can be important catalysts for initiation and growth. A systematic approach to evaluation is lacking. This would enable DFCs to be consistent in how they demonstrate progress and how they enable people living with dementia to live well. [ABSTRACT FROM AUTHOR]

Objectives: This study measures the average per person and annual total costs of dementia in England in 2015.Methods/design: Up-to-date data for England were drawn from multiple sources to identify prevalence of dementia by severity, patterns of health and social care service utilisation and their unit costs, levels of unpaid care and its economic impacts, and other costs of dementia. These data were used in a refined macrosimulation model to estimate annual per-person and aggregate costs of dementia.Results: There are around 690 000 people with dementia in England, of whom 565 000 receive unpaid care or community care or live in a care home. Total annual cost of dementia in England is estimated to be £24.2 billion in 2015, of which 42% (£10.1 billion) is attributable to unpaid care. Social care costs (£10.2 billion) are three times larger than health care costs (£3.8 billion). £6.2 billion of the total social care costs are met by users themselves and their families, with £4.0 billion (39.4%) funded by government. Total annual costs of mild, moderate, and severe dementia are £3.2 billion, £6.9 billion, and £14.1 billion, respectively. Average costs of mild, moderate, and severe dementia are £24 400, £27 450, and £46 050, respectively, per person per year.Conclusions: Dementia has huge economic impacts on people living with the illness, their carers, and society as a whole. Better support for people with dementia and their carers, as well as fair and efficient financing of social care services, are essential to address the current and future challenges of dementia. [ABSTRACT FROM AUTHOR]

Objective: Integrated community mental health teams (CMHTs) are a key component of specialist old age psychiatry services internationally. However, in England, significant shifts in policy, including a focus on dementia and age inclusive services, have influenced provision. This study portrays teams in 2009 against which subsequent service provision may be compared.Methods: A bespoke national postal survey of CMHT managers collected data on teams' structure, composition, organisation, working practices, case management, and liaison activities.Results: A total of 376 CMHTs (88%) responded. Teams comprised a widespread of disciplines. However, just 28% contained the full complement of professionals recommended by government policy. Over 93% of teams had a single point of access, but some GPs bypassed this, and 40% of teams did not accept direct referrals from care homes. Initial assessments were undertaken by multiple disciplines, and 71% of teams used common assessment documentation. Nevertheless, many social workers maintained both NHS and local authority records. In 92% of teams, nominated care coordinators oversaw the support provided by other team members. However, inter-agency care coordination was less prevalent. Few teams offered the range of outreach/liaison activities anticipated in the national dementia strategy.Conclusions: Compared with previous studies, teams had grown and changed, with a clear increase in non-medical practitioners, particularly support workers. Measures to facilitate integrated care within CMHTs (eg, common access and documentation) were widespread, but integration across health and social care/primary and secondary services was less developed. Consideration of barriers to further integration, and the impact of current reforms is potentially fruitful. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to establish the feasibility and initial effectiveness of training and support intervention for care staff to improve pain management in people with dementia living in care homes (PAIN-Dem).Methods: PAIN-Dem training was delivered to care staff from three care homes in South London, followed by intervention support and resources to encourage improved pain management by staff over 4 weeks. Feasibility was assessed through fidelity to intervention materials and qualitative approaches. Focus group discussions with staff explored the use of the PAIN-Dem intervention, and interviews were held with six residents and family carers. Pain was assessed in all residents at baseline, 3 and 4 weeks, and goal attainment scaling was assessed at 4 weeks.Results: Delivery of training was a key driver for success and feasibility of the PAIN-Dem intervention. Improvements in pain management behaviour and staff confidence were seen in homes where training was delivered in a care home setting across the care team with good manager buy-in. Family involvement in pain management was highlighted as an area for improvement. Goal attainment in residents was significantly improved across the cohort, although no significant change in pain was seen.Conclusions: This study shows good initial feasibility of the PAIN-Dem intervention and provides valuable insight into training and support paradigms that deliver successful learning and behaviour change. There is a need for a larger trial of PAIN-Dem to establish its impact on resident pain and quantifiable staff behaviour measures. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives: To examine the cost of care for people with dementia in institutional care settings, to understand the major cost drivers and to highlight opportunities for service development.Methods: Data on 277 residents with dementia in 16 UK residential or nursing homes were collected. We estimated care and support costs and fitted models to the data. Sensitivity analyses were also conducted.Results: Care home residents cost £792 weekly: 95% of the costs accounted for by direct fees. Hospital contacts contributed the largest proportion of the additional costs. Having an established diagnosis of dementia (b = 0.070; p < 0.05) was associated with higher costs. No association was found between cost and needs (b = -0.002; p = 0.818).Conclusion: The absence of an association between cost and needs emphasizes the importance of a more needs-based costing system which could result in clinical and economic advantages. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: Most investigations of pharmacotherapy for treating Alzheimer's disease focus on patients with mild-to-moderate symptoms, with little evidence to guide clinical decisions when symptoms become severe. We examined whether continuing donepezil, or commencing memantine, is cost-effective for community-dwelling, moderate-to-severe Alzheimer's disease patients.Methods: Cost-effectiveness analysis was based on a 52-week, multicentre, double-blind, placebo-controlled, factorial clinical trial. A total of 295 community-dwelling patients with moderate/severe Alzheimer's disease, already treated with donepezil, were randomised to: (i) continue donepezil; (ii) discontinue donepezil; (iii) discontinue donepezil and start memantine; or (iv) continue donepezil and start memantine.Results: Continuing donepezil for 52 weeks was more cost-effective than discontinuation, considering cognition, activities of daily living and health-related quality of life. Starting memantine was more cost-effective than donepezil discontinuation. Donepezil-memantine combined is not more cost-effective than donepezil alone.Conclusions: Robust evidence is now available to inform clinical decisions and commissioning strategies so as to improve patients' lives whilst making efficient use of available resources. Clinical guidelines for treating moderate/severe Alzheimer's disease, such as those issued by NICE in England and Wales, should be revisited. © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the association between the degree of integration in community mental health teams (CMHTs) and: (i) the costs of service provision; (ii) rates of mental health inpatient and care home admission.Methods: An observational study of service use and admissions to institutional care was undertaken for a prospectively-sampled cohort of patients from eight CMHTs in England. Teams were chosen to represent 'high' or 'low' levels of integrated working practice and patients were followed-up for seven months. General linear models were used to estimate service costs and the likelihood of institutional admission.Results: Patients supported by high integration teams received services costing an estimated 44% more than comparable patients in low integration teams. However, after controlling for case mix, no significant differences were found in the likelihood of admission to mental health inpatient wards or care homes between team types.Conclusions: Integrated mental health and social care teams appeared to facilitate greater access to community care services, but no consequent association was found with community tenure. Further research is required to identify the necessary and sufficient components of integrated community mental health care, and its effect on a wider range of outcomes using patient-reported measures. © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: South Asian older adults access services for mental health problems and dementia less than other older people in the UK, unlike for physical health problems. This pilot study investigated how South Asians with self-defined memory problems, with and without GP consultation, construe the symptoms, causes, consequences and treatment of the condition.Methods: Participants were recruited through community centres, their networks and memory clinics in Greater Manchester. The newly developed Barts Explanatory Model Inventory for Dementia (BEMI-D) was administered to 33 (18 M, 15 F) older South Asians aged 65 or above with memory problems in English, Gujarati or Urdu. Furthermore, cognition, executive function and depression were assessed.Results: Perceptions of dementia varied by GP consultation for memory problems. A greater proportion of older adults without a consultation considered memory problems to be given by God, saw acceptance of fate as an alternative treatment and did not identify medical support as appropriate. Forgetfulness and loss of social meaning were identified as symptoms of dementia more by those with a consultation. Higher levels of diabetes, heart disease and depression were found in those without a consultation.Conclusions: Differences in perceptions may influence the decision about consulting a GP. Similarly, consultation for memory problems appears linked to extent physical health problems and mental health consultation (depression). These variations reported on a small scale in this pilot study suggest the need to explore the impact of perceptions on rates of GP consultation, so as to improve timely diagnosis and access to appropriate services. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to identify the factors determining carer burden in a group of carers supporting people with dementia (PwD) deemed to be at high risk of moving to long-term residential or nursing home care.Design: National data collected as part of the European RightTimePlaceCare project were analysed. This included 81 dyads of community-dwelling people with dementia and their informal carers.Methods: Structured face-to-face interviews were conducted in North West England between June 2011 and April 2012. Interviews collected data relating to the person with dementia (cognitive functioning, activities of daily living, neuropsychiatric symptoms and formal and informal dementia care resource use) and carers' level of burden (22-item Zarit Burden Index), hours spent caring and availability of additional informal support.Results: Logistic regression analysis identified five factors associated with high carer burden: neuropsychiatric symptomatology in the PwD, intensive supervision of the PwD by the carer, being a female carer, being an adult-child carer and absence of informal carer support. Use of home care or day care services was unrelated to burden.Conclusion: Support programmes focusing on challenging behaviours and risk management may be of benefit to carers. More individually tailored interventions for specific carer groups including female or younger carers may be warranted. The implementation of peer support networks could be beneficial to carers who lack additional family support. [ABSTRACT FROM AUTHOR]

Focuses on old age mental disorders in Newcastle Upon Tyne, England. Prevalence of psychiatric disorder among subjects; Most common organic brain syndromes in the area of study; Nature of care received by older people with psychiatric disorders in the area.

Objectives To compare the rate of referrals of older people for consultation-liaison psychiatry services over time within Liverpool and with the literature. Methods All referrals to the liaison psychiatry service for older people in Liverpool between 1999 and 2004 were used to calculate referral rates and compared with data from the same hospital from 1981 to 1989 previously published. Data related to referral rates was extracted from other published studies to allow cross-national comparisons over time. Results Between 1999 and 2004 there were 2760 referrals to the Liverpool liaison psychiatry service for older people producing an average annual referral rate of 2.89%. This compares to a referral rate of 0.7% in 1981 and 1.34% in 1989. Comparison with studies from the UK, North America, Europe, Singapore and Taiwan shows an increasing trend across a 30 year period. The rate of referral increases with increasing age up to age 90. Conclusion Trends indicate increasing rates of referral of older people to consultation-liaison psychiatry services with greater representation of the older old. Similar effects are likely to be experienced in all nations with an ageing population. Liaison psychiatry services will need professionals trained in old age psychiatry if the needs of this increasing elderly population are to be addressed. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: To consider the characteristics of first episode psychosis in older adults in a county in North East England. Method/Design: The present study used a naturalistic design to compare individuals aged 65 years and over with those under 65, with a first episode psychosis. Data were collected on demographics, diagnosis at presentation and hospital admissions in the first year. Results: Almost a quarter of all patients were aged 65 years or older. The older group were admitted later on after presentation, but with longer average hospital stays (p < 0.01 ), compared to the younger group, with no difference in the use of the Mental Health Act. Late onset schizophrenia (40-59 years) and very late onset schizophrenia-like psychosis (60 + years) formed a considerable proportion of patients. Conclusions: There is a substantial proportion of older people with first episode psychosis, with a significant use of hospital bed days. There are large gaps in services for this group who often do not have the same access to those offered to younger people, e.g. Assertive Outreach or crisis teams, access to Clozapine and CBT. Ageism exists in all forms; the elderly are doubly disadvantaged in view of their age and mental illness. In view of the Age Discrimination Act (2006) the elderly functionally ill group of patients should be entitled to the same level of care and equal access to services as younger people. More attention and interventions need to be focused on this overlooked group. © Crown copyright 2009. Reproduced with the permission of Her Majesty's Stationery Office. [ABSTRACT FROM AUTHOR]

Background Projections are presented of future numbers of older people with cognitive impairment (CI) in England, their demand for long-term care (LTC) services and future costs of their care. The sensitivity of the projections to factors that are likely to affect future LTC expenditure is explored. These factors include future numbers of older people, prevalence rates of CI, trends in household composition, informal care provision, care service patterns and unit costs. Methods A macrosimulation (or cell-based) model was developed to produce the projections, building on an earlier PSSRU model. Base case assumptions are made about trends in key factors expected to impact on future LTC expenditure, and variant assumptions about the key factors are introduced to test for sensitivity. Results Expenditure on LTC services for older people with CI is projected to rise from 0.60% of Gross Domestic Product (GDP) (£5.4 billion) in 2002 to 0.96% of GDP (£16.7 billion) in 2031, under base case assumptions. Under variant assumptions, the projection for 2031 ranges from 0.83% to 1.11% of GDP. These figures do not include the opportunity costs of informal care. Conclusions Sensitivity analysis shows that projected demand for LTC is sensitive to assumptions about the future numbers of older people and future prevalence rates of CI and functional disability. Projected expenditure is also sensitive to assumptions about future rises in the real unit costs of services. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background The large majority of people with dementia receive nothing in the way of specialist assessment and care at any stage of their illness. There is a particular lack of services focussed on early identification and intervention in dementia where there is the possibility of long-term harm reduction for people with dementia and their family carers. We have developed a model of care that is complementary to local systems of health and social care (The Croydon Memory Service Model [CMSM]). This is a low-cost, high-throughput, generic service to enable early identification and intervention in dementia. It is a multi-agency approach with joint ownership by health services, social services and the voluntary sector with embedded specifically-tailored approaches to primary care and minority ethnic communities. Method We completed a service evaluation of the introduction of the CMSM in a single borough in South London. Six predefined service goals were set: high acceptability; high appropriate referral rate; successful engagement with people from minority ethnic groups; successful engagement with people with young onset dementia; focus on engagement with mild cases to enable early intervention; and an increase in the overall number of new cases of dementia seen. Mixed qualitative and quantitative methodologies were used including a description and 6-month follow-up of a cohort of 290 consecutive referrals. Results All key predefined service goals were met: 95% acceptability; 94% appropriate referrals; successful engagement with minority ethnic groups (two-fold greater number compared with that expected from general population demographic data); 17% of referrals under 65 years of age; 68% referrals with mild or minimal dementia severity; and an estimated 63% increase in the number of new cases of dementia seen in Croydon. At 6-month follow up, those referred to the service had decreased behavioural disturbance and increased quality of life compared with baseline. Conclusions Specific services for early dementia, which deliver diagnosis and care, can be established. These services can increase the numbers of people with early dementia identified and provided with care. Those receiving such services appear to improve in terms of quality of life and behavioural and psychological symptoms of dementia. Next steps should include the establishment of such services in other representative areas and evaluation of their effectiveness in comparison with other models of care. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Current policy in England emphasises the importance of caring for highly dependent older people for as long as possible at home. It is therefore crucial that day care services are effective and widely available. Aim To compare the type and standard of care provided for older people with dementia in day centre and day hospital settings. Methods A cross-sectional postal survey design was employed. Representatives from three-quarters of identified specialist day care services for older people with dementia in the North West of England provided information on a range of indicators including: basic structural features; delivery of care; service content; and quality measures. Results Day hospitals tended to have more day care places and a greater number of attendees, but lower occupancy rates than day centres. Day hospitals reported higher standards of care in relation to systematic assessment and care planning, promotion of rehabilitation, carer involvement and individualised provision of care. They were also more likely to employ building design features to encourage independence and choice for people with dementia. A higher proportion of day centres provided services exclusively to older people with dementia and a greater proportion of staff in day centres had undergone specific training in caring for people with dementia. Day centres were also more likely to have effective transport arrangements in place. Conclusion The standards developed for the study were sufficiently reliable to allow for an acceptable estimate of quality. Day centres and day hospitals appeared to perform two distinct, but complementary functions. These results provide key material for shaping the provision of day care for older people with dementia, especially given the absence of national standards in this area. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Drug overdose is a common method of suicide in the elderly. Hence, an understanding of current trends in epidemiology of these deaths is important when considering measures to decrease suicide rates. Methods Analysis of the Office for National Statistics (ONS) database of deaths from overdose and poisoning. Suicide and undetermined deaths from drug overdose between 1993–1999 in the over 65 year olds were studied. Socio-demographic data from the four drug groups most commonly used in overdose were extracted, and age and sex specific mortality rates calculated. Enumeration districts were ranked into five quintiles based on their Carstairs scores, and death rates in each quintile for men and women calculated. Results There were 1864 deaths from drug overdose during the study period. Suicide and undetermined death rates from drug overdose remained stable between 1993–1999. Drugs most commonly used in overdose were (in order) paracetamol (and related compounds), benzodiazepines, antidepressants, and opiates. Women comprised 62% of deaths. Death rates increased with age, with highest rates in men over 75 (37.7 deaths per million). Benzodiazepines showed the most marked increase with age. Co-proxamol comprised 32% of deaths from paracetamol compounds, and 95% of antidepressant deaths were due to tricyclic antidepressants. There was no association in women between Carstairs area deprivation and suicide rates; in men rates were highest in the most deprived areas. Conclusion Suicides in the over 65 year olds may be decreased by changes in prescription practice. Paracetamol, co-proxamol, tricyclic antidepressants and benzodiazepines should be prescribed with caution to the elderly with depression or at high risk of depression. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The proportion of elderly in the population is increasing due to increased life expectancy and falling birth rate, and suicide rates increase with age. This study examined the following in England and Wales: (i) recent trends in the elderly suicide rate; (ii) recent trends in method-specific elderly suicide rate; (iii) the relationship between elderly population size and elderly suicide rate in recent years; and (iv) the sex difference in overall and method-specific elderly suicide rate. Data on the various suicide variables were ascertained from the annually published mortality data for years 1985 to 1996. The main findings of this study were: (i) there is a trend towards decline in the overall pure and combined suicide rates for elderly men and women over the 12 year study period; (ii) the main contributors to this decline are suicides due to poisoning by solid and liquid substances (E950), hanging, strangulation and suffocation (E953), drowning (E954), firearms and explosives (E955), and jumping from high places (E957); (iii) the overall pure and combined suicide rates and that for most categories of suicide was higher in men compared to women; and (iv) suicide rates decreased with an increase in the elderly population size. Suicide rates can decline due to a number of reasons. The challenge now is to ensure further decline in suicide rates to meet the Our Healthier Nations target. Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Sociodemographic characteristics in later life are associated with differentials in both health status and the need for health and other services. An understanding of how sociodemographic changes affect both ageing individuals and the elderly population is therefore important for health care planning. Three aspects of this issue are considered. Changes in the demographic composition of the elderly population, including projected increases in the number of very old people and in the ratio of men to women, are discussed in the first section. The second section based on longitudinal data, concerns sociodemographic differentials in age-related household changes, and shows that, for example, both housing tenure and density of the local elderly population seem to be associated with differentials in the probability of moving into an institution. In the third section possible influences on the supply of informal support are considered. At the moment there is no evidence that working women or the divorced are less likely than others to live with an elderly parent (including an elderly parent they care for), but further work in this area is needed. [ABSTRACT FROM AUTHOR]

The article presents an interview with psychiatrist Brice Pitt on his retirement from the post of professor of Psychiatry of Old Age, St Mary's and the Royal Postgraduate Medical Schools, University of London, England. A well-known figure in British psychiatry, he has pursued "triple" careers as a psychiatrist for the elderly, a psychiatrist with a special interest in postnatal disorders and an actor. He qualified at Guy's Hospital Medical School in 1955, trained in psychiatry first in the army, then in London, and had six different consultant posts before being appointed to the foundation chair at St Mary's and the Hammersmith.

This article reports a survey by the Team for the Assessment of Psychiatric Services (TAPS)&lowest; of all inpatients aged 70 years or more resident in Claybury Hospital, London, for more than 12 months. Age, sex, total length of inpatient stay and type of care received were recorded for each subject, and assessment using the Mini-Mental State Examination (MMSE) and Modified Crighton Royal Behavioural Rating Scale (MCRBRS) were performed. Of 189 inpatients who completed the assessments, 142 (75%) showed unequivocal, severe cognitive disability (MMSE ≤ 17). Patients were assigned to ‘functional’, ‘organic’, or ‘mixed’ diagnosis groups by staff report and case not review. A staff report of ‘mixed’ diagnosis missed a large number of patients who had an original diagnosis of functional psychiatric disorder plus severe measure cognitive disability. Sixty-five per cent of patients with an original diagnosis of functional psychiatric disorder fell into this category. After controlling for age, sex and total length of inpatient stay, patients with a severe degree of reported behavioural problems (MCRBRS ≥ 17) were almost 23 times (95% CI 6.6–79.4) more likely to receive specialized psychogeriatric care than other patients. Severe cognitive disability was not associated with type of care received. Issues related to measurement of cognitive disability across disparate diagnostic groups are discussed. [ABSTRACT FROM AUTHOR]

All patients in continuing care geriatric beds in a London Health District were screened for psychiatric morbidity and physical dependency in 1990. This sample was followed up 1 year after screening. forty-four per cent (32/72) were dead at follow-up. Patients in hospital-based continuing care beds had higher mortality than those in health authority beds in a private nursing home. Dementia, physical dependency and depression measured by Depressive Signs Scale (DSS) were associated with mortality. Using multivariate analysis, to partial out independent effects, depressive signs score measured by the DSS was the only significant predictor of mortality. [ABSTRACT FROM AUTHOR]

A 1-year follow-up study was undertaken of a random sample of 40 elderly patients living at home given a diagnosis of ‘dementia’ after referral to the Psychogeriatric Department at St Charles' Hospital, London, W10. Eighteen (45%) patients were admitted to institutional care. There was an association between physical disability and institutionalization. A similar tendency was observed for social disturbance and hospital admission. The 1-year survival rate for the sample was 82.5%. All the seven patients who died were moderately/severely demented. Twenty-three patients (55%) had informal key caters. Half of these showed considerable stress according to the General Health Questionnaire and the Strain Scale scores. All the recommendations made by the psychogeriatric team were carried out without much delay. [ABSTRACT FROM AUTHOR]

Presents an article about the psychogeriatric service in London, England. Challenges associated with mental health services administration; Comparison between the psychogeriatric services offered in Melbourne, Victoria and London; Role of general practitioner in geriatric psychiatry.