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Mapping the patient journey is a way of investigating the experiences of people using older people's mental health services, particularly those with a dementia. It is a useful concept for patients and their families and enables them to tell their stories in a way which carries the potential for improving and developing the service. Similarly it is a useful concept for health and social care professionals in giving them the opportunity to understand, and reflect on, how their services work in practice for users and carers and how they might be improved. The collaboration between patients, carers and professionals may itself bring about broader benefits and changes in culture for the individuals and services involved. The West Midlands Older People's Mental Health Collaborative has encouraged the use of mapping by Collaborative teams in order to identify areas for improvement work. [ABSTRACT FROM AUTHOR]

The provision of integrated, person-centred care is particularly important for older people with mental health problems. Nevertheless, a series of reports at the end of the last century highlighted unacceptable differences in collaborative working practices in England, variations that a national service framework specifically aimed to address. This study utilized a cross-sectional survey of old age psychiatrists to explore the extent to which, some three years after the publication of this guidance, structures to deliver integrated care across the interfaces between specialist old age mental health and primary, acute and social care services were in place. Three hundred and eighteen (72%) consultants responded. Measures to facilitate integrated practice were generally poorly developed: many areas missed targets to agree protocols for the management of older people with mental health problems with primary care; more than 45% of respondents reported the presence of fewer than two of four indicators of integration with the acute sector; and approaching 30% of respondents reported the presence of fewer than four of 13 markers of integration with social care. The implications of these findings and the challenges inherent in providing integrated care for this client group are discussed. [ABSTRACT FROM AUTHOR]

Globally, the call for Family-Friendly (FF) workplaces is loud and clear. However, this call is inaudible in medical workplaces, despite both well-established benefits of FF workplaces across businesses and well-known effects of work-family conflict on the well-being and practice of doctors. We aimed to use the Delphi consensus methodology to: (i) operationalise the Family-Friendly medical workplace and (ii) develop a Family-Friendly Self-Audit tool for medical workplaces. The expert medical Delphi panel was deliberatively recruited to capture a breadth of professional, personal, and academic expertise, diversity of age (35-81), life stage, family contexts and lived experience of dual commitments to work and family, and diversity of work settings and positions. Results reflected the inclusive and dynamic nature of the doctor's family and the need to adopt a family life cycle approach to FF medical workplaces. Key processes for implementation include holding firms to zero discrimination; flexibility and openness to dialogue and feedback; and a mutual commitment between the doctor and the department lead to best meet the doctor's individualised needs while still ensuring optimal patient care and team support and cohesion. We hypothesise that the Department Head may be the key to implementation but recognise the workforce constraints to realising these aspirational systemic shifts. It is time we acknowledge that doctors have families, to narrow the gap between identifying as a partner, mother, father, daughter, son, grandparent, and identifying as a doctor. We affirm the right to be both good doctors and good family members.

Objective: This article reflects on the relationship between doctors and their families and how it influences a doctor's health, well-being and practice and the health and well-being of other family members. It uses an established model for conceptualising this recursive relationship, drawing on systemic and communications theory, coordinated management of meaning. The article invites doctors to reflect on relational influences between them and their families across the course of their career and following retirement., Conclusion: Families are important to, and influence, the well-being of their doctor-members. Likewise, doctors are important to, and influence, the health and well-being of their families.

During the COVID-19 pandemic the risks to older adults of systemic abuse and neglect have become amplified, alongside increasing abuse and neglect in the community. Novel risks have also evolved involving cybercrime and the use of remote technologies in health and social care related to the pandemic. This commentary brings together lessons to be learned from these developments and initial ideas for actions to mitigate future risks.

We explore barriers to enjoyment of human rights to sexuality of persons with dementia and remedies for addressing these. Enjoyment of sexuality is contingent upon actualization of rights to dignity, autonomy, respect for will and preferences, abuse safeguarding and equitable access to highest standards of sexual health. Persons with dementia living at home or in care face systemic barriers to enjoyment of sexuality fueled by ageism, apathy and ignorance, compounded by complex legal barriers in relation to consent. Such challenges can be tackled with awareness raising and education of care staff, families and physicians, including training for capacity assessment with dimensional, noncategorical conceptualization of capacity, leaving room for supported decision-making. These measures, together with strengthened legislative and human rights frameworks to cater to the specific needs of older people, may allow people to live well with dementia and exercise their human rights to enjoy sexuality in a safe and lawful manner., (Copyright © 2021 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: This research investigated narrative production and use with families living with dementia. We hypothesised that the process of narrative production would be beneficial to people with dementia and carers, and would elicit important learning for health and social care professionals., Method: Through third sector partners, we recruited community-dwelling people with dementia and carers who consented to develop written, audiotaped or videotaped narratives. Audio-taped narratives were transcribed verbatim and handwritten narratives word-processed. After checking by participants, completed narratives were analysed thematically using qualitative data analysis computer software. A summary of the analysis was circulated to participants, inviting feedback: the analysis was then reviewed. A feedback questionnaire was subsequently circulated to participants, and responses were analysed thematically., Results: Twenty-one carers and 20 people with dementia participated in the project. Four themes of support were identified: 'relationships', 'services', 'prior experience of coping' and having an 'explanation for the dementia'. Three themes were identified as possible additional stresses: 'emotions', 'physical health' and 'identity'. We suggest a model incorporating all these themes, which appeared to contribute to three further themes; 'experience of dementia', 'approaches to coping' and 'looking to the future'. In participant feedback, the main themes identified were 'emotions', 'putting things in perspective', 'sharing or not sharing the narrative' and 'actions resulting'., Conclusions: Producing a narrative is a valuable and engaging experience for people with dementia and carers, and is likely to contribute to the quality of dementia care. Further research is needed to establish how narrative production could be incorporated into routine practice., (© The Author(s) 2014.)

Objective: Psychiatrists appointed to National Health Service (NHS) consultant posts in the United Kingdom before a specific date in 1995 qualified for early retirement and this has implications for workforce planning., Methods: The author reflects on the implications this has for ageing psychiatrists and for relationships between psychiatrists and patients and families using mental health services, from the perspective of a psychiatrist who took advantage of the opportunity to retire early from a consultant post in the NHS and to develop a new career., Results: Older psychiatrists continuing to practise after retirement from consultant roles may bring disadvantages and advantages., Conclusions: Older psychiatrists may be a valuable resource for future mental health services, and they may be in a position to try out new ways of working which might be relevant to their younger colleagues in the uncertain future faced by mental health services at a time of austerity., (© The Royal Australian and New Zealand College of Psychiatrists 2015.)

The Gnosall Primary Care Memory Clinic has been operating since 2006 and adds the skills of a specialist old age psychiatrist to the extensive skills and knowledge available in primary care. Key to the organisation and function of the clinic is the eldercare facilitator, a new role situated in primary care and linking with the specialist and a wide range of other agencies and people. In order to facilitate replication of the model elsewhere, the function, role and competencies of existing and previous eldercare facilitators in the clinic have been reviewed, clarified and related to a competency framework and to similar initiatives in the literature. The selection and training of people with the attributes and skills required to become an eldercare facilitator will determine whether extension of the model is successful elsewhere., (© The Author(s) 2013.)

Background: We reviewed the literature on family therapy and dementia to investigate the following: what is known about the use of family therapy in the context of living with dementia; what are the challenges of working in this context; and what guidelines/models are available to guide family therapists working with families living with dementia., Methods: We searched English language literature from 1992 onwards, classified the resulting papers into broad categories of theoretical, expository, or research (descriptive, quantitative, or qualitative), and conducted a narrative review to draw learning points from the identified papers., Results: In total 31 papers were identified: five theoretical, 11 expository; and 15 research papers. Several papers described methodologies; psychotherapeutic interventions applied to family members; or complex intervention packages in which the role of family therapy could not be separately identified, rather than family therapy. A range of outcomes were investigated, often involving the caregiver. Several authors suggest areas in dementia care where family therapy is likely to be beneficial., Conclusions: Although the literature on family therapy and dementia has grown over the past 25 years and suggests potentially useful roles for therapy, a number of challenges exist in terms of context, family, and therapy itself. There is a need for further research, particularly into the following fields: How to evaluate the success of therapy; how to ensure treatment integrity; how to make techniques from family therapy available more widely; and how to train the health and social care workforce in working with families.

Background: The provision of mental health care for older people will become increasingly important with rising demand related to global demographic changes. This project aimed to identify changes in work patterns of UK consultant old age psychiatrists between 1993 and 2012., Method: A link to an online questionnaire was circulated to consultant old age psychiatrists through the Faculty of Old Age Psychiatry, Royal College of Psychiatrists., Results: In all 210 usable responses were received. On the survey day 71% of old age psychiatrists arrived at work before 9 am, and 40% left work after 6 pm. Over one-third (35%) worked for another hour or more at home. The range of activities was broader than previously reported. Administrative activity was undertaken by over 60% and acute ward work by only 26%. Few consultants reported time in long-stay care or day hospitals. Outpatient activity included Memory Clinics and Health Center Clinics. The main stressors reported by consultants were lack of resources and pressures from management-imposed, financially driven service changes. Relationships with people at work (including patients and their families) and outside work were the main identified support., Conclusions: Consultants' working hours have changed little since 1997, but the range and emphases of activities have changed. Changes in service organization are stressful and consultants are supported by relationships with colleagues and patients. Work patterns are changing in response to demands and constraints on the specialty. Research is needed into service design and work patterns, which can provide humane care in the current economic climate.

Background: The proportion of older people from black and minority ethnic (BME) groups in the United Kingdom (UK) is increasing steadily as the population ages. The numbers with dementia, depression, and other mental health problems are predicted to increase. Government policy documents have highlighted gaps in services for BME elders and/or the need to develop culturally appropriate services, in order to prevent people from BME communities from becoming socially excluded and finding services hard to access. This paper reviews published examples of innovative services and key learning points from them., Method: A search was carried out on Pubmed, Medline, and Google Scholar for service developments aimed at BME elders in the UK. Sixteen relevant papers and reports were identified and were analysed to identify learning points and implications for clinical practice and policy., Results: Commissioning issues included were forward planning for continuing funding and mainstreaming versus specialist services. Provider management issues included were employing staff from the communities of interest, partnership, and removing language barriers. Provider service issues included were education for service provider staff on the needs of BME elders, making available information in relevant languages, building on carers' and users' experiences, and addressing the needs of both groups., Conclusion: A model for structuring understanding of the underutilisation of services by BME elders is suggested. The main emphasis in future should be to ensure that learning is shared, disseminated, and applied to the benefit of all communities across the whole of the UK and elsewhere. Person-centred care is beneficial to all service users.

One of the biggest challenges facing health and social care in the United Kingdom is the projected increase in the number of older people who require dementia care. The National Dementia Strategy (Department of Health, 2009) emphasizes the critical need for a skilled workforce in all aspects of dementia care. In the West Midlands, the Strategic Health Authority commissioned a project to develop a set of generic core competencies that would guide a competency based curriculum to meet the demands for improved dementia training and education. A systematic literature search was conducted to identify relevant frameworks to assist with this work. The core competency framework produced and the methods used for the development of the framework are presented and discussed.

Background: Sexuality in later life and its relationship to dementia is a neglected topic: greater understanding of the area has the potential to contribute to the quality of life of people with dementia, their family members, and formal carers. We review current knowledge about sexuality, aging, and dementia., Methods: We undertook a review of the recent literature to examine of the following areas: what is known about sexuality and aging, and about attitudes to sexuality and aging; what is known about the relevance of sexuality and aging to people living with dementia and their care; and the management of sexual behaviors causing concern to others., Results: Sexual activity decreases in frequency with increasing age but many older people remain sexually active; there is no age limit to sexual responsiveness; and sexuality is becoming more important to successive cohorts of older people, including people living with dementia and gay, lesbian, bisexual, and transgendered elderly people. Attitudes and beliefs toward sexuality and aging are strongly influenced by stereotypes and myths, not only among the general public but also among those working in health and social care., Conclusions: Professional bodies should include sexuality, aging, and dementia in their training curricula. More work is needed on the impact of environmental issues, particularly in group living situations, on older adults' sexuality, and on consent issues. Ethical decision-making frameworks can be useful in practice. Organizations should investigate how to support staff in avoiding a problem-orientated approach and focus on providing holistic person-centered care.

Background: There are a number of models of patient and carer participation. Their usefulness and applicability to old age psychiatry is considered., Methods: Models of participation are reviewed and related to examples of participation initiatives drawn from the author's work in the context of the National Health Service in the United Kingdom., Results: Models of participation which emphasize collaboration and partnership are found to be useful. Simple interventions such as copying letters to patients and/or carers can lead to change in the balance of power between staff and patients/carers. Initiatives which draw on the experiences of patients and carers can facilitate organizational learning and development. Involving patients and carers in education offers a way to influence services and the staff working in them., Conclusion: Participation is better understood as a spectrum rather than a hierarchy. Old age psychiatry services would benefit from developing greater patient and carer participation at all levels.

Background: Patient and carer participation in old age psychiatry is less developed than in other areas of mental health. What can we learn from the historical context about increasing participation and how can it be conceptualized?, Methods: The historical and policy context of patient and carer participation in the National Health Service is reviewed and related to the development of old age psychiatry in England and the parallel development of the mental health user movement., Results: Systemic theory is offered as a way of understanding how partnership between healthcare professionals, patients and carers might lead to service evolution by bringing a range of perspectives together in order to co-construct a mutually influenced outcome. It is further suggested that this might empower not only patients and carers but also healthcare staff at a time when they are under increasing pressures., Conclusions: Old age psychiatry patients and carers struggle to be heard but have much to offer to services in partnership with healthcare professionals as partners and allies in service development.

Background: Carers who wished to share their experiences with a national working group (the Consumer Group) prepared narratives as a way of identifying areas for discussion., Methods: The narratives were submitted to one author and subjected to thematic qualitative analysis. The themes were fed back to the Group for discussion., Results: Five main themes were identified: difficulties in obtaining a diagnosis; acting as an advocate; stresses of caring; practical problems with social care; and emotions experienced by carers., Conclusions: The narratives provided a means of sharing carers' experiences and creating initiatives for further action by the Group. They have an impact on the people who hear or read them but may also be therapeutic for those who produce them. Narratives can also be a powerful tool in teaching and training, and in identifying areas for service and professional improvement.

Memory clinics were first described in the 1980s. They have become accepted worldwide as useful vehicles for improving practice in the identification, investigation, and treatment of memory disorders, including dementia. They are provided in various settings, the setting determining clientele and practice. All aim to facilitate referral from GPs, other specialists, or by self referral, in the early stages of impairment, and to avoid the stigma associated with psychiatric services. They bring together professionals with a range of skills for the benefit of patients, carers, and colleagues, and contribute to health promotion, health education, audit, and research, as well as service to patients.

Background: One of the main concerns about ECT is its use for people with concurrent medical illnesses. Geriatric psychiatrists are more often likely to encounter this situation in working with older age groups. Drawing on the collective experience of all UK geriatric psychiatrists may allow a better understanding of the use of ECT for people with major medical illness., Methods: A postal questionnaire was used to seek the views of all consultant geriatric psychiatrists in the UK on the use of ECT in the presence of major illness. The questionnaire was developed from previous literature on the subject, a previous pilot study, published guidelines and clinical experience of the authors., Results: Geriatric psychiatrists most often favour bilateral ECT. They are likely to carry out physical examination, chest X-ray, ECG, haemoglobin estimation, urea and electrolytes, thyroid and liver function tests in medically ill people before considering ECT. They are more likely to change their ECT assessment procedures when dealing with medical illness, rather than any other aspect of treatment, and are unlikely to change any aspect of ECT treatment in someone of advanced age., Conclusions: Geriatric psychiatrists see their roles in relation to ECT as primarily that of assessment, and rely on others to advise on anaesthetic drug use, treatment technique, concurrent drug treatment and post-ECT management. It is important that the ECT consultant and ECT anaesthetist are aware of their role and prepared to offer appropriate advice. The role of the ECT consultant in relation to the responsible medical officer requires clarification., (Copyright 2002 John Wiley & Sons, Ltd.)

Objective: to investigate the relationship between work patterns, burnout and stress in consultant old age psychiatrists., Methods: we sent a postal survey to all old age psychiatrists on the Faculty of Old Age Psychiatry, Royal College of Psychiatrists, list. Participants completed a workload questionnaire, the Stress Checklist and the Maslach Burnout Inventory during a specified week., Results: burnout scores were unaffected by gender and team working, but old age psychiatrists scoring within the high burnout range were younger, scored highly on stress, spent less time on research, study and audit, and more time travelling. The whole group scored highly on emotional exhaustion., Conclusions: job plans should encourage research/study and audit, and cut down travelling. The finding related to age is not fully understood, but suggests consideration of support groups for new consultants and review of whether current training programmes adequately prepare people for work as a consultant., (Copyright 2002 John Wiley & Sons, Ltd.)

Changing Minds--Every Family in the Land is a national campaign launched by the Royal College of Psychiatrists which aims to reduce discrimination against people who suffer from mental disorders. One of its target areas is dementia. What is the stigma associated with Alzheimer's disease and how can hospital doctors challenge it in everyday practice?

The term 'Alzheimer's disease' has entered the vocabulary of ordinary people. This has been useful, encouraging patients and families to seek medical help for conditions that were previously neglected as inevitable consequences of old age. Yet Alzheimer's itself can carry negative connotations. Some people who believe they have Alzheimer's disease are suffering from less sinister and more easily treated conditions. Even when the diagnosis is confirmed, many months of happy and worthwhile life continue for most patients and families if they are given appropriate information and support. It is important that neither families nor clinicians see life with presumed Alzheimer's disease as of no value.

Objective: To investigate work patterns and stress in consultant old age psychiatrists over a period of 1 week and to attempt to identify areas amenable to change., Design: Postal survey., Participants: Full-time old age psychiatrists on the list held by the Faculty of Old Age Psychiatry, Royal College of Psychiatrists., Main Outcome Measures: Hours spent on different work activities during a period of 1 week, Stress Checklist score, stressors perceived by respondents., Main Results: Men and women doctors did not differ in numbers of hours worked. Consultants working with colleagues worked similar hours to single-handed consultants. Community activity was greater among consultants working with colleagues than among single-handed doctors, whose work was based more in outpatient clinics. For the whole group, time in acute ward rounds correlated positively with stress score and time spent on research at home correlated negatively with stress score., Conclusions: Doctors spending more than 50 hours at work might be advised to review their work pattern. Excessive time on administrative activities should be reduced. Peer support should be encouraged. Consultants and managers should be sensitive to work patterns and possible sources of stress., (Copyright 1999 John Wiley & Sons, Ltd.)

Objectives: To review the literature on burnout and consider its relevance to old age psychiatry and the role of the consultant., Data Sources: Medline and PsychLit computerized databases., Data Synthesis: Burnout is a syndrome of emotional exhaustion, depersonalization and decreased sense of personal accomplishment which is recognized in people working in the human service professions and can have adverse effects on the workforce. There is little evidence of unique stressors related to care of elderly mentally ill people. Burnout is likely to be modified by workplace interventions. Relevant areas for intervention are political and social, organizational and management, training and personal issues. Support to consultants and their continuing professional development need to be radically reviewed.

Objective: To assess and describe service changes when a psychiatric consultation liaison nursing service is introduced., Design: Prospective collection of basic service data before and after implementation of the service change., Setting: A newly established comprehensive old age psychiatry service., Patients: People on medical and surgical wards aged over 65 years referred for psychiatric assessment., Outcome Measures: Numbers of referrals made and patients seen, details of psychiatric diagnoses made and follow-up offered before and after the change in the service., Results: Within 6 months there was an increase in liaison referrals to the service. The proportion of people offered follow-up showed little change and delay before assessment decreased substantially with the PCLN service., Conclusions: A psychiatric consultation liaison nursing (PCLN) service was successfully initiated. Numerous difficulties were encountered but this is a useful model for old age psychiatry services to consider researching and developing further.

Objective: To examine the main sources of stress for practising old age psychiatrists., Design: Postal survey., Setting: Old age psychiatry services in England and Wales., Participants: Old age psychiatrists on the list held by the Section of Old Age Psychiatry, Royal College of Psychiatrists., Main Outcome Measures: Number and nature of stresses identified by respondents., Main Results: One hundred and thirty-eight old age psychiatrists identified a mean of 5.1 stresses per respondent, which fell into seven broad categories: changes within the health service, community care changes, personal, management-related, resource-related, related to time pressures, overwork and others., Conclusions: Unavoidable stresses were rarely listed. Most were related to work overload and organizational structure and climate. More research is needed on stress in other areas of psychiatry, ways to minimize/prevent stress and how to optimize the balance between work and home life.

A workload questionnaire, detailing activities undertaken over a specified 7-day period, was circulated by post to geriatric psychiatrists on the list held by the Section of Old Age Psychiatry, Royal College of Psychiatrists. One hundred and thirty-eight responses have been analysed to show patterns of work over the days of the week. Much of the respondents' time is concentrated on clinical work. Administration and committee work extends into every day of the week, but personal study and research are only reported by small numbers of respondents.

Sexual abuse of the elderly may occur more commonly than is recognized. Reasons for the neglect of this area and possible risk factors are discussed. A definition of elder sexual abuse is proposed, and four case histories, each of which raises various issues about the nature, detection and management of sexual abuse, are described. In the absence of procedures for dealing with elder sexual abuse, professional staff need to be open to its occurrence and to be prepared to carry out thorough, sympathetic, collaborative assessments of both parties involved where it is suspected.

In a prospective study, 32 patients with depressed mood and cerebral pathology were compared over one year with 66 depressed patients who were cerebrally intact. The hypothesis that the former would have a poorer outcome for depression was not confirmed, although the group with cerebral pathology had a significantly higher than expected death rate. Prognostic factors were identified only for the cerebrally intact group. Those who had major depression were more likely than those with minor depression to be given physical treatments, irrespective of which group they belonged to.

Opinion of electroconvulsive therapy (ECT) and ECT-related psychiatric knowledge among anesthetists working in the North Western Health Region of England were investigated; 261 anesthetists returned usable questionnaires. The majority were in favor of ECT for patients as recommended by psychiatrists, and possessed a reasonable knowledge base about related psychiatric issues. A minority were opposed to the use of ECT, lacked rudimentary psychiatric knowledge and held negative misconceptions. Although this does not compromise anesthetic ability, it may have adverse consequences. In particular anesthetists may not appreciate the importance of their role in ECT and may be reluctant to become involved in ECT clinics and research. Attitude and knowledge did not differ significantly when respondents with extensive and recent ECT experience were compared with the remainder. Two thirds of respondents favored anesthetic training including more information about psychiatric aspects of ECT. We recommend improved liasion between anesthetists and psychiatrists during training and in clinical practice.

Depressive illness in late life may present to doctors in the community or on general hospital wards. Management often involves physical treatments, but social and psychological approaches may also be important. This article considers acute treatment, continuation treatment (to prevent relapse) and the treatment of resistant depressive illnesses.