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A growing number of older people remain in custody each year resulting in an increasing number of common mental and physical health concerns. No prior evidenced-based targeted psychological interventions support this group of people, and little is known about their needs, current activities, and health-related problems. We addressed these gaps through a project involving older prisoners, prison staff and a project advisory group in one male and one female prison site in the North of England. Systematic review evidence supports the development of an implementation tool kit addressing strategies to develop and deliver interventions that are sustainable, acceptable, and feasible in the prison environment. Prison strategies need to specifically address the needs of older people in custody. Relatively inexpensive activities, with some thought to delivery and flexibility have the potential to benefit common mental and physical health, increasing quality of life, reducing high economic and social cost, mortality, and reoffending in this age group. [ABSTRACT FROM AUTHOR]

Background: Limited attention has been paid to how and why older adults choose to engage with technology-facilitated health care (e-health), and the factors that impact on this. This scoping review sought to address this gap.Methods: Databases were searched for papers reporting on the use of e-health services by older adults, defined as being aged 60 years or older, with specific reference to barriers and facilitators to e-health use.Result: 14 papers were included and synthesised into five thematic categories and related subthemes. Results are discussed with reference to the Unified Theory of Acceptance and Use of Technology2. The most prevalent barriers to e-health engagement were a lack of self-efficacy, knowledge, support, functionality, and information provision about the benefits of e-health for older adults. Key facilitators were active engagement of the target end users in the design and delivery of e-health programs, support for overcoming concerns privacy and enhancing self-efficacy in the use of technology, and integration of e-health programs across health services to accommodate the multi-morbidity with which older adults typically present.Conclusion: E-health offers a potential solution to overcome the barriers faced by older adults to access timely, effective, and acceptable health care for physical and mental health. However, unless the barriers and facilitators identified in this review are addressed, this potential will not be realised. [ABSTRACT FROM AUTHOR]

Mental health is a topic that has been at the forefront of medical and legal scholarship for the past few decades. For many elderly people of color, however, mental health and mental illnesses seem like a “personal weakness,” something they can get through on their own, or a medical issue that they simply cannot afford to treat. This Note explores the clear disparities in why elderly people of color have less access to mental health treatment options, why they may be less likely to seek mental health treatment options, and what can be done to assist people in gaining more access and awareness to these options in their communities. The avenues of Medicare, Medicaid, housing vouchers, nursing home training, and the collaborative care model are all explored. This Note recommends reforms in Medicare, the expansion of Medicaid, reforms in Section 8 housing vouchers, improvements in identifying mental health issues in nursing homes, expansion in the usage of and research into the collaborative care model, and a nationwide awareness campaign as ways to combat this ever‐growing issue for elderly communities of color. [ABSTRACT FROM AUTHOR]

Introduction: It has been suggested that depression is characterized by a high level of negative and low positive affect, and there is some evidence. However, the relationship between depressive symptomatology and both affects in older adults has been studied very little. Materials and methods: A sample of 113 participants was used, divided into two groups; A, n = 63, composed of older adults with probable depression and group B, n = 49 pairs without depression. Two scales were applied, the PANAS scale of positive and negative affect, and Yesavage Geriatric Depression scale that evaluates the presence of depressive symptoms. Results: Lower levels of positive affect and higher levels of negative affect were found in older adults with probable depression in a significant way. In addition, a moderate and negative correlation was observed between depressive symptomatology and positive affect. On the other hand, a low and positive correlation was found with negative affect (both significant). Discussion: The results support the tripartite model (Watson, Clark and Tellegen) in older adults. It is suggested that in the clinical setting it may be useful to evaluate the levels of positive affect in older adults to detect the presence of depression. [ABSTRACT FROM AUTHOR]

This article argues that there exist unnecessary gaps in the regulation of the use of physical, mechanical and chemical restraints in mental health and aged care settings. While the use of these forms of restraint may be rationalised on the basis of preventing harm to self or others, there are adverse consequences that necessitate the minimisation, if not elimination, of their use. The overuse of mechanical and chemical restraints at the Oakden Older Persons Mental Health Service in South Australia led to several scathing inquiries. This article looks at the lessons learned and suggests a multidimensional, consistent approach is overdue. [ABSTRACT FROM AUTHOR]

Purpose: To model the dynamic age-related rate of change in depressive symptomatology in later life and to test the hypothesis that low perceived neighbourhood social cohesion is associated with steeper trajectories of depressive symptoms in older adults.Methods: We analysed data on 11,037 participants aged 50+ from the English Longitudinal Study of Ageing. Perceived social cohesion (PSC) of participants' neighbourhoods was assessed at baseline (2002/2003). Depressive symptoms were measured using CES-D scores (ranging from 0 to 8) on 7 occasions from baseline to 2014/2015. Trajectories of depressive symptoms by baseline PSC were estimated using latent growth modelling.Results: At baseline, adults with low PSC had more depressive symptoms than age counterparts with high PSC. Consistent with the U-shaped trajectory of depressive symptoms by age, the association between PSC tertile and changes in depressive symptoms over follow-up was modified by age. Fifty-year-old participants with low PSC reported an average decrease in CES-D score from 0.66 to 0.54 during the 12-year follow up, compared to a change from 0.47 to 0.34 for age counterparts with high PSC. By contrast, in persons aged 85 at baseline, the mean CES-D score increased from 1.09 to 1.30 for participants with high PSC, while the rise was greater (from 1.49 to 2.03) among those with low PSC. The main effects and interaction of PSC with age were robust to adjustment for socio-economic and health characteristics.Conclusions: Depressive symptom trajectories by PSC appear to widen as adults reach old age. [ABSTRACT FROM AUTHOR]

Objective: Community Partners in Care, a community-partnered, cluster-randomized trial with depressed clients from 95 Los Angeles health and community programs, examined the added value of a community coalition approach (Community Engagement and Planning [CEP]) versus individual program technical assistance (Resources for Services [RS]) to implement depression collaborative care in underserved communities. This exploratory subanalysis examines 6- and 12-month outcomes among CPIC participants aged >50 years.Design: Community-partnered, cluster-randomized trial conducted between April 2010 and March 2012.Setting: Hollywood-Metropolitan (HM) and South Los Angeles (SLA) Service Planning Areas (SPAs), Los Angeles, California.Participants: 394 participants aged >50 years with depressive symptoms (8-item Patient Health Questionnaire score ≥ 10).Intervention: A community-partnered multi-sector coalition approach (Community Engagement and Planning [CEP]) vs individual program technical assistance (Resources for Services [RS]) to implement depression collaborative care.Main Outcome Measures: Depressive symptoms (PHQ-8 score), mental health-related quality of life (MHRQL), community-prioritized outcomes including mental wellness, homelessness risk and physical activity, and services utilization.Results: At 6 months, CEP was more effective than RS at improving MHRQL and mental wellness among participants aged >50 years; no differences were found in the effects of CEP vs RS on other outcomes. No significant outcome differences between CEP and RS were found at 12 months.Conclusions: A multisector community coalition approach may offer additional benefits over individual program technical assistance to improve outcomes among depressed adults aged >50 years living in underserved communities. [ABSTRACT FROM AUTHOR]

Objective: To survey the Psychiatry of Old Age (POA) services and workforce in New Zealand (NZ).Methods: The NZ branch of Faculty of POA contacted the POA lead clinician and/or service manager of the 20 district health boards (DHBs) and completed a survey based on variables used in two similar previous national surveys.Results: Seventeen services responded. We found acute inpatient beds and clinical staff time are funded differently across DHBs. Although there has been an increase in non-medical clinical staff time in the community teams, most DHBs are not planning to increase their medical staff time in the next 3 years. Specialist services for people with intellectual disabilities and young-onset dementia, and older people with substance use disorder are generally not provided within POA services.Conclusions: A wider POA and non-POA services mapping is required to determine the level of services for clinical populations that have high and complex clinical needs. DHB funders should review the expected population growth in people aged 65+ and consider increasing the funding for these under-served clinical populations. [ABSTRACT FROM AUTHOR]

Older people with mental health problems are entitled to the same level and quality of care as younger people. Several factors continue to influence policy and delivery of older adults' mental health services in the UK. Following the introduction of the Equality Act 2010, there has been a drive to create an 'ageless' National Health Service. This has opened up the debate about whether such a service is best equipped to meet the specific needs of older adults. In this contribution we consider the concepts of 'old age' and 'frailty' and their clinical and service provision implications in psychiatry. The management of late-life depression and early-onset dementia, advance care planning and palliation in dementia are also considered. [ABSTRACT FROM AUTHOR]

Objective: This study compared health care access and utilization among adults with serious psychological distress by race-ethnicity and gender in years surrounding implementation of the Affordable Care Act.Methods: Data for adults ages 18 to 64 with serious psychological distress in the 2006-2015 National Health Interview Survey (N=8,940) were analyzed by race-ethnicity and gender on access and utilization indicators: health insurance coverage, insufficient money to buy medications, delay in health care, insufficient money for health care, visited a doctor more than ten times in the past 12 months, change in place of health care, change in place of health care because of insurance, saw a mental health provider in the past 12 months, and insufficient money for mental health care.Results: The proportions of white and black adults with serious psychological distress were largest in the South, the region with the largest proportion of persons with serious psychological distress and no health coverage. Multivariate models that adjusted for health coverage, sociodemographic characteristics, health conditions, region, and year indicated that whites were more likely than blacks to report insufficient money for medications and mental health care and delays in care. A greater proportion of whites used private coverage, compared with blacks and Hispanics, and blacks were more likely than all other racial-ethnic groups to have Medicaid.Conclusions: More research is needed on health care utilization among adults with serious psychological distress. In this group, whites and those with private coverage reported poor utilization, compared with other racial-ethnic groups and those with Medicaid, respectively. [ABSTRACT FROM AUTHOR]

The theory of gerotranscendence provides a lens counselors can use to view the aging process across the life span and the potential need for counseling services for aging individuals. The authors conducted this study to understand the experience of gerotranscendence among older adults. Thirteen descriptive psychosocial factors were examined in relation to gerotranscendence from data gathered through a 79‐question survey. The limitations of the study, implications for counseling practice, and recommendations for future research are discussed. [ABSTRACT FROM AUTHOR]

There is a push to change the focus of mental health delivery from symptom reduction to recovery orientation where self-determination and choice are central to programmes. Whilst there is a robust literature on recovery definition, assessment and training, this has not been matched with studies of recovery with older adult consumers or staff working in older adult settings. The purpose of this sequential explanatory study was to identify the recovery attitudes and practices of the staff from the Sydney Local Health District Specialist Mental Health Service for Older People (SMHSOP), Australia. Fourteen members of staff completed two self-report recovery measures and subsequently took part in focus group interviews. Results of this mixed methods study suggested that whilst mental health staff in this sample supported the self-definition and individuality aspects within the recovery model, risk management remains problematic with this population. Clinical experience mediated the extent of knowledge and practices within a recovery framework. Barriers to implementing recovery oriented practice included client incapacity and the expectation of consumers. The suitability of current recovery concepts and measures to older populations is discussed. [ABSTRACT FROM AUTHOR]

Adults aged 65 and over are a growing population in the United States today. This population is underrepresented in the mental health literature despite the high rates of depression and suicide. Additionally, the newest generation of older individuals is more likely to seek therapy than past generations, furthering the need for mental health professionals to be prepared for treating older individuals. Erikson in Childhood and society, Norton, New York, (1950) describes this time period as being critical in terms of the final identity crisis, integrity versus despair. Integrity is marked by a positive evaluation of the individual's entire life, less anxiety about death, and a feeling of gaining wisdom. Individuals who do not resolve this crisis can manifest despair in a number of ways, including depression, anger, and regret. This model proposes utilizing Narrative therapy (White in Maps of narrative practice, Norton, New York, 2007) to understand how elderly individuals evaluate their lives in reference to their environment. The model utilizes externalization, unique outcomes, and re-membering conversations to unlock subjugated stories and promote integrity. [ABSTRACT FROM AUTHOR]

Background: Frailty is a common problem among older people and it is associated with an increased risk of death and long-term institutional care. Early identification of frailty is necessary to prevent a further decline in the health status of home care clients. The aims of the present study were to determine the prevalence of frailty and associated factors among 75-year-old or older home care clients.Methods: The study participants were 75-year-old or older home care clients living in three cities in Eastern and Central Finland. Home care clients who had completed the abbreviated Comprehensive Geriatric Assessment (aCGA) for frailty (n = 257) were included in the present study. Baseline data were obtained on functional status, cognitive status, depressive symptoms, self-rated health, ability to walk 400 m, nutritional status, drug use and comorbidities.Results: Most of the home care clients (90%) were screened for frailty using the aCGA. Multivariate analysis showed that the risk of malnutrition or malnutrition (OR = 4.27, 95% CI = 1.56, 11.68) and a low level of education (OR = 1.14, 95% CI = 1.07, 1.23) were associated with frailty.Conclusion: Frailty is a prevalent problem among home care clients. The risk of malnutrition or malnourishment and a lower level of education increase the risk of frailty. Screening for frailty should be done to detect the most vulnerable older people for further intervention to prevent adverse health problems.Trial Registration: ClinicalTrials.gov: NCT02214758 . [ABSTRACT FROM AUTHOR]

Mental healthcare is a critical but largely unexplored application domain for human factors/ergonomics. This paper reports on a work system evaluation of a home-based dementia and depression care program for older adults, the Aging Brain Care program. The Workflow Elements Model was used to guide data collection and analysis of 59 h of observation, supplemented by key informant input. We identified four actors, 37 artifacts across seven types, ten action categories, and ten outcomes including improved health and safety. Five themes emerged regarding barriers and facilitators to care delivery in the program: the centrality of relationship building; the use of adaptive workarounds; performance of duplicate work; travel and scheduling challenges; and communication-related factors. Findings offer new insight into how mental healthcare services are delivered in a community-based program and key work-related factors shaping program outcomes. [ABSTRACT FROM AUTHOR]

Background: Older people with common mental health problems (CMHPs) are known to have reduced rates of referral to psychological therapy.Aim: To assess referral rates to the Improving Access to Psychological Therapies (IAPT) services, contact with a therapist, and clinical outcome by age.Design and Setting: Empirical research study using patient episodes of care from South West of England IAPT services.Method: By analysing 82 513 episodes of care (2010-2011), referral rates and clinical improvement were compared with both total population and estimated prevalence in each age group using IAPT data. Probable recovery of those completing treatment was calculated for each group.Results: Estimated prevalence of CMHPs peaks in 45-49-year-olds (20.59% of population). The proportions of patients identified with CMHPs being referred peaks at 20-24 years (22.95%) and reduces with increase in age thereafter to 6.00% for 70-74-year-olds. Once referred, the proportion of those attending first treatment increases with age between 20 years (57.34%) and 64 years (76.97%). In addition, the percentage of those having a clinical improvement gradually increases from the age of 18 years (12.94%) to 69 years (20.74%).Conclusion: Younger adults are more readily referred to IAPT services. However, as a proportion of those referred, probabilities of attending once, attending more than once, and clinical improvement increase with age. It is uncertain whether optimum levels of referral have been reached for young adults. It is important to establish whether changes to service configuration, treatment options, and GP behaviour can increase referrals for middle-aged and older adults. [ABSTRACT FROM AUTHOR]

The article offers the author's insights on the electronic-mental (e-mental) health care for elderly patients. Topics mentioned include the use information and communication technologies in delivering services in mental health, the challenges faced by healthcare providers in the integrated primary care settings, and the self-management that can improve the self-efficacy of elders.

This study explored (1) the incidence of posttraumatic stress disorder (PTSD) resulting from past trauma among older patients with COPD and (2) whether PTSD and COPD severity would relate to psychiatric co-morbidity and health-related quality of life. Eighty-five older patients completed the Hospital Anxiety and Depression Scale, the Chronic Respiratory Questionnaire, the Posttraumatic Stress Diagnostic Scale and the Medical Outcomes Short Form 12. The results showed that 55, 39 and 6 % had no, partial and full-PTSD respectively. Partial least squares showed that PTSD was significantly correlated with COPD severity which in turn was significantly correlated with health-related quality of life and psychiatric co-morbidity. Mediational analysis showed that the emotional symptoms of COPD mediated between PTSD and the mental health functioning of health-related quality of life and between PTSD and depression. To conclude, PTSD from past trauma was related to the severity of COPD for older patients. In particular, it impacted on the elevated emotional arousal of COPD severity. In turn, COPD severity impacted on older patients' general psychological well-being and depression. [ABSTRACT FROM AUTHOR]

Using the 2004-2007 Medical Expenditure Panel Survey data that are linked to county-level data from the Area Health Resources Files, this study examined whether the healthy immigrant effect applies to mental health of foreign-born older adults. Additionally, testing a protective ethnic density effect on older foreign-born individuals' mental health, this study examined how the percentage of foreign-born population in the county affected the relationship between older adults' immigration status (U.S.-nativity and length of residence in the U.S.) and their mental health status. The sample included 29,011 individuals (level-1) from 920 counties (level-2) across 50 states and D.C. Using the Mental Component Summary of the Short-Form 12, the Kessler Index (K-6), and the Patient Health Questionnaire (PHQ-2), U.S.- born individuals (n = 24,225), earlier immigrants (≥15 years in the U.S.; n = 3866), and recent immigrants (<15 years in the U.S.; n = 920) were compared. The results indicate that recent immigrants showed worse mental health on all three measures compared with U.S.-born individuals and on the K-6 and PHQ-2 compared with earlier immigrants. Higher county-level foreign-born densities were associated with worse mental health status of individuals. However, the significant interactions found in the full conditional multilevel models indicated that the high foreign-born density functioned as a risk factor for worse mental health only among recent immigrants but not among the U.S.-born. In conclusion, the results revealed the vulnerability of older recent immigrants, especially those living in the counties with high foreign-born densities. [ABSTRACT FROM AUTHOR]

With the population aging, the legal and mental health systems need to be prepared for cases that involve older adults beyond the customary matters of guardianship and competency. Assessing older adults with the current tests raises concerns because these measures may not be adequately normed for this age group. Malingering, factitious disorders, and somatoform disorders are discussed due to health-related issues of normal aging. These topics complicate the assessment procedure and need consideration because they may affect the claimant's performance or symptom presentation. Although claims of posttraumatic stress disorder (PTSD) are common in civil litigation cases, it can be additionally complex in older adults. The evaluator needs to weigh not only factors related to the normal biological process of aging but also those that are attendant with the litigation. [ABSTRACT FROM AUTHOR]

The development of an operational currency and tariff system for forensic mental health services has been underway in the United Kingdom since 2011, in line with government targets. A successful approach to the currency and tariff agenda requires both a way of capturing patient's needs and resource requirements while providing a way of evidencing outcomes to support payment. The focus of the work to date has been to establish a methodology that quantifies patient's clinical and resource needs but has yet to explore outcome methodology. In 2015, Speak, Hay, and Muncer developed a 4-factor model of the Health of the Nation Outcome Scales, which was mandated for evaluating outcomes in adult and older person services. The focus of this article was to explore the Speak et al. (2015) 4-factor model of the HoNOS as an approach to evaluating outcomes in a forensic inpatient population. A national pilot study of 2,468 patients was used. Confirmatory factor analysis and exploratory factor analysis techniques were employed and indicated that the Speak et al. (2015) factor model did not provide an adequate fit to the forensic data. A new factor structure emerged that revealed potential domains for evaluation of outcome in forensic populations. [ABSTRACT FROM AUTHOR]

Objectives This study examined potential barriers to mental healthcare use of older adults from diverse ethnic and racial backgrounds. Design Data were obtained from the 2007, 2009, 2011-12, and 2013-14 California Health Interview Survey ( CHIS), a population-based survey representative of California's noninstitutionalized population. Participants The total sample consisted of 75,324 non-Hispanic white ( NHW), 6,600 black, 7,695 Asian and Pacific Islander ( API), and 4,319 Hispanic adults aged 55 and older. Results Results from logistic regression analyses that controlled for multiple demographic and health status characteristics revealed ethnic and racial differences in reasons for not seeking treatment and for terminating treatment. Specifically, API and Hispanic adults had greater odds than NHWs of endorsing feeling uncomfortable talking to a professional as a reason for not seeking treatment. Hispanic respondents had lower odds of endorsing concerns about someone finding out than APIs, and APIs and blacks had significantly greater odds of endorsing this concern as a reason for not seeking treatment than NHWs. When asked about reasons for no longer receiving treatment, all respondents, irrespective of race or ethnicity, endorsed that they no longer needed treatment as the most frequent reason for terminating treatment, although specific ethnic and racial differences emerged with respect to perceptions of not getting better, lack of time or transportation, and lack of insurance coverage as reasons for no longer seeking treatment. Conclusion Understanding how barriers to mental health treatment differ for older adults from diverse ethnic and racial backgrounds is an important step toward designing interventions to overcome these obstacles and improve mental health outcomes. [ABSTRACT FROM AUTHOR]

Subjective well-being (SWB) of older adults could be affected by both individual and community characteristics. However, the effect of community characteristics, such as population aging in local areas, remains unclear. This study examined the cross-sectional and longitudinal associations between the area-level population aging and SWB of older individuals from two distinct surveys. Those analyzed were 572 respondents aged 75 years and older for a cross-sectional survey in a metropolitan area in Tokyo, Japan (Study 1) and 1,257 and 859 respondents for a cross-sectional and longitudinal analysis, respectively, for a 2-year longitudinal survey project in urban and rural areas of Fukui Prefecture (Study 2). Area-level population aging was assessed by the number of people aged 65 years or older per 100 residents. SWB was assessed with the Life Satisfaction Index-A (LSIA). Multilevel analysis was performed to examine unconditional and conditional associations between the area-level number of older adults per 100 residents and the individual-level LSIA scores. The area-level number of older adults per 100 residents was significantly and positively associated with the LSIA scores in Study 1 (p = 0.042), even after controlling for the area- and individual-level covariates. In Study 2, we also found a significant effect of the area-level number of older adults per 100 residents on LSIA scores in the longitudinal multivariate analysis (p = 0.049). Findings from two survey projects suggested cross-validity in the positive effect of area-level population aging on older adults' SWB. Policymakers should consider older citizens' SWB in the recent urban-to-rural migration governmental policy as well as in urban renovation planning. [ABSTRACT FROM AUTHOR]

Medicare reimbursement for counselors would expand older adults' access to mental health services and increase counselors' professional opportunities. To enhance advocacy efforts, the author reviews Medicare's current role in meeting older adults' mental health needs, examines the program's unique political development, and identifies contemporary values that may influence Medicare's future. Implications for counselor advocacy efforts are discussed. [ABSTRACT FROM AUTHOR]

Context: Older adults are at risk for greater chronic stress and cognitive decline. Training in mindfulness meditation (MM) may help reduce stress and, thus, cognitive decline in older adults, but little research has explored that hypothesis.Objective: The current study's primary aim was to evaluate the feasibility and acceptability for use by older adults of the Internet Mindfulness Meditation Intervention (IMMI), a program that had been developed by the research team, as well as of an Internet-based health-and-wellness education program, the control. The secondary aim was to collect preliminary pre- and postintervention data on mood and cognitive function.Design: The study was a randomized, controlled trial (RCT), a pilot study, with participants randomized either to the meditation group or the education group.Setting: Participants obtained access to the programs from their homes, and the baseline and endpoint assessments occurred in their homes as well.Participants: Older adults aged 65-90 y were recruited from the Portland, OR, metropolitan area. Twenty-one people enrolled in the study.Intervention: Participants in both groups took part in a 1-h online session each week for 6 wk, with 30 min of daily home practice.Outcome Measures: Feasibility and acceptability were assessed through measures of adherence to the protocol and a client satisfaction questionnaire. Mood and cognitive outcomes were also evaluated before and after the interventions.Results: Sixteen participants completed the study, 8 in each group, and 5 dropped out, for a 76% completion rate. Participants' mean age was 76.2 y; 88% were Caucasian, and 50% were female. Acceptability was high for the interventions, based on above-average scores on the client satisfaction questionnaire. The IMMI participants completed (1) 4.25 ± 2.4 sessions, with a range of 0-6; (2) 604 ± 506 home-practice minutes, with a range 0-1432; and (3) 21.3 ± 15.5 d of practice, with a range of 0-46. The education group completed (1) 4.75 ± 1.8 sessions, with a range of 2-6; (2) 873 ± 395 home-practice minutes, with a range of 327-1524; and (3) 25.6 d of practice, with a range of 11-35. The intervention and control formats were both feasible, and the control group was appropriate. As expected due to the pilot nature of the study, no differences existed between groups for the mood or cognitive outcomes.Conclusions: Administering interventions via the Internet to older adults is feasible. The 2 interventions were acceptable to participants and equal with regard to perceived credibility and acceptability. Future RCTs are planned to evaluate the clinical efficacy of the 2 interventions. [ABSTRACT FROM AUTHOR]

In the 1950s, the population aged over 65 years continued to increase, and older people occupied mental hospital beds disproportionately. A few psychiatrists and geriatricians demonstrated what could be done to improve the wellbeing of mentally unwell older people, who were usually labelled as having irreversible ‘senile dementia’. Martin Roth demonstrated that ‘senile dementia’ comprised five different disorders, some of which were reversible. These findings challenged established teaching and were doubted by colleagues. Despite diagnostic improvements and therapeutic successes, clinical practice changed little. Official reports highlighted the needs, but government commitment to increase and improve services did not materialize. [ABSTRACT FROM AUTHOR]

Attitudes towards autonomy and personal freedom changed in the 1960s in England, but hardly touched the needs of dependent older people. In particular, deeply embedded public and professional attitudes and priorities linked to little change in ‘psychogeriatric’ treatment for those who were mentally unwell. Total beds in psychiatric hospitals decreased, but those remaining were increasingly and disproportionately occupied by older people receiving custodial care, often long term, despite evidence that appropriate treatment could prevent admission and facilitate discharge. Widely publicised scandals of inhumane care of older people in psychiatric hospitals prompted a more responsive government approach to improving services. [ABSTRACT FROM PUBLISHER]

Background: Behavioral health (BH)-related visits to the emergency department (ED) by older adults are increasing. This population has unique challenges to providing quality, timely care.Objective: To characterize older adults with BH-related ED visits and determine risk factors associated with prolonged length of stay (LOS) and adverse events (AEs).Methods: We performed a retrospective electronic health record review of all patients ≥65 years who presented to our ED from September 2011 to August 2012 for BH-related complaints. Sociodemographic, clinical, and utilization data were tested for association with LOS and AE.Results: The 213 elder BH patients represented 4% of the 5267 total elder visits during the study period. Median age was 75 (interquartile range [IQR] 70-82); largely white (84.5%), female (58.7%), and non-Hispanic (69.5%). There was a median of two comorbidities (IQR 1-3), and 46.9% were cognitively impaired. Most (71.5%) were being evaluated on an involuntary basis. Median LOS was 16.2 h (IQR 9.7-29.7). Increased LOS was associated with involuntary status (12.4 h, 95% confidence interval [95% CI] 6.4-18.4); use of restraints (11.9 h, 95% CI 5.7-18.2); and failed discharge (28.8 h, 95% CI 21.2-36.6). For every 10 additional hours in the ED, the risk for an AEs (p = .002) or potential AEs (p = .01) increased 20%.Conclusion: Elderly ED patients with BH complaints had high rates of cognitive impairment and multiple comorbidities. LOS was prolonged, and there were multiple contributing factors including involuntary status, chemical or physical restraint, and failed discharge. Patients with longer LOS were at increased risk of an AE or potentially AEs. [ABSTRACT FROM AUTHOR]

The article examines psychological therapy for older adults in Great Britain. Topics covered include analysis of whether the National Health Service should allocate therapy resources to older adults or therapy is wasted on older adults, key biases against older persons in health care and the importance of research and clinical intervention and theory development in older adults.

Background: The decline in cognition and physical fitness is common in advanced age. Objective: The relationship between cognition and aerobic capacity was compared to the relationship between cognition and balance. Methods: Twenty one females and six male residents of a Czech senior center participated in the study (mean age: 77.5 ± 7.0; range: 62-86 years). The Mini Mental State Examination (MMSE) was used for assessing cognition, the Berg Balance Scale (BBS) for assessing balance, and the 6-Minute Walk Test (6MWT) assessed physical fitness. Based on the MMSE scores, two groups of cognitive functioning were formed - high and low. Results: Participants in the "high MMSE" group reached a significantly higher score on the 6MWT (p = .01) than the "low MMSE" group. Group differences on the BBS were marginally significant (p = .07, d = 0.6). Conclusions: Based on this sample, the level of physical fitness can be explained by cognitive functioning, while that of balance should be further studied in its relationship to cognitive functioning. [ABSTRACT FROM AUTHOR]

Background: Proxy responses are very common when surveys are conducted among the elderly or disabled population. Outcomes reported by proxy may be systematically different from those obtained from patients directly. The objective of the study is to examine the presence, direction, and magnitude of possible differences between proxy-reported and patient-reported outcomes in health and functional status measures among Medicare beneficiaries. Methods: This study is a pooled cross-sectional study of a nationally representative sample of community-dwelling Medicare beneficiaries from 2006 to 2011. Survey respondents can respond to the Medicare Current Beneficiary Survey either by themselves or via proxies. Health and functional status was assessed across five domains: physical, affective, cognitive, social, and sensory status. Propensity score matching was used to get matched pairs of patient-reports and proxy-reports. Results: After applying the propensity score matching, the study identified 7,780 person-years of patient-reports paired with 7,780 person-years of proxy-reports. Except for the sensory limitation, differences between proxy-reported and patient-reported outcomes were present in physical, affective, cognitive, and social limitations. Compared to patient-reports, a question regarding survey respondents' difficulties in managing money was associated with the largest proxy response bias (relative risk, RR = 3.83). With few exceptions, the presence, direction, and magnitude of differences between proxy-reported and patient-reported outcomes did not vary much in the subgroup analysis. Conclusions: When there is a difference between proxy-reported and patient-reported outcomes, proxies tended to report more health and functional limitations among the elderly and disabled population. The extent of proxy response bias depended on the domain being tested and the nature of the question being asked. Researchers should accept proxy reports for sensory status and objective, observable, or easy questions. For physical, affective, cognitive, or social status and private, unobservable, or complex questions, proxy-reported outcomes should be used with caution when patient-reported outcomes are not available. [ABSTRACT FROM AUTHOR]

Background: Local language screening instruments can be helpful in early assessment of depression in the elderly in the community and primary care population. This study describes the validation of a Tamil version of Geriatric Depression Scale (short form 15 [GDS-15] item) in a rural population. Materials and Methods: A Tamil version of GDS-15 was developed using standardized procedures. The questionnaire was applied in a sample of elderly (aged 60 years and above) from a village in South India. All the participants were also assessed for depression by a clinical interview by a psychiatrist. Results: A total of 242 participants were enrolled, 64.9% of them being females. The mean score on GDS-15 was 7.4 (±3.4), while the point prevalence of depression was 6.2% by clinical interview. The area under the receiver-operator curve was 0.659. The optimal cut-off for the GDS in this sample was found at 7/8 with sensitivity and specificity being 80% and 47.6%, respectively. Conclusion: The Tamil version of GDS-15 can be a useful screening instrument for assessment of depression in the elderly population. [ABSTRACT FROM AUTHOR]

Objectives The study sought to identify the characteristics of community-dwelling older people supported by community mental health teams (CMHTs) in England and, in particular, to determine whether there is a common threshold for CMHT entry and/or a core client group. Methods Data were collected about a random sample of 15 CMHTs' caseloads, including information about their sociodemographic characteristics, physical health, dependence, mental health, risks and service receipt. The sample was divided into 16 subgroups of people with similar needs for care (case types), and differences between teams were explored. Results Information was obtained for 1396 patients. Just under half had a functional mental health problem, slightly over a third an organic disorder, seven per cent both, and nine per cent no diagnosis. Considerable variation was found in teams' caseloads, and there was no evidence of a common caseload threshold. Two of the commonest case types represented people with functional diagnoses who were independent in activities of daily living (ADL) and had no/low levels of challenging behaviour. Another representing people with organic/mixed diagnoses, ADL dependence, challenging behaviour and at least one medium risk was also fairly common. The two case types that represented patients with the most complex needs accounted for more than a quarter of some teams' caseloads but less than a tenth of others. Conclusions It is wrong to assume that CMHTs all have similar caseloads. Commissioners must ensure that the network of services provided can meet the needs of all eligible patients, whilst more research is required on who such teams should target. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The Equality Act 2010 made it unlawful to discriminate in the provision of services on the grounds of age. This legislation is open to interpretation, but it is affecting the way older people's services are defined and provided. Historical evidence indicates that, since the 1940s, apart from psychiatrists working in dedicated old age services, most were unenthusiastic about working with mentally unwell older people and unsupportive of those who chose to do so. A historical analysis might shed light on current dilemmas about 'all age' or 'old age' services and inform decision-making on future mental health services. [ABSTRACT FROM AUTHOR]

Background: Ageing in the new millennium will be greatly influenced by both global and region specific factors, although increasing numbers as well as significant changes in the socio-cultural milieu are responsible for the recent emphasis on studies pertaining to older adults in India. This has resulted in the caregiver issue becoming a growing concern for national policy makers. The family as a single unit is undergoing changes leading to significant adjustments in accommodating and caring for older adults in the family, making them more vulnerable to illness and psychosocial strains in the absence of familial support network. Aim: To assess and compare quality of life (QOL) between elderly people living in old age home and within the family setup. Methods and materials: A cross sectional research design was adopted for the study. The study was conducted at two old age homes and two areas of Ranchi - Kantatoli and Kanke. The sample comprised of 80 participants who were further divided into 40 participants from old age homes and 40 participants from family. Tools such as socio-demographic data sheet and QOL scale were administered to obtain the data. Result and conclusion: Findings of this study indicate that QOL was better of those elderly people who were living in old age home in comparison of those elderly people who were living within family setup. [ABSTRACT FROM AUTHOR]

Dialectical behaviour therapy skills are increasingly popular clinical interventions. This paper describes a weekly group intervention adapting mindfulness and distress tolerance skills for an older adult in-patient population in the South West. Client feedback on the group is presented. [ABSTRACT FROM AUTHOR]

Background: Rural and remote residents have been identified as a group with limited access to mental health services. Older rural people may experience additional problems due to lack of access to transport, limited opportunities for social engagement and the stigma attached to mental illness. Aim: To explore the extent to which service providers, carers and consumers view the Older Persons' Mental Health Service (OPMHS) as meeting the needs of older people with mental health problems in rural South Australia. Methods: Semi-structured interviews were conducted at 3 case study sites with 22 key informants from mental health teams and organisations providing care to older people and with 4 consumers and 5 carers. Results: The establishment of OPMHS clinicians at the sites studied led to increased access to specialist services for older people leading to earlier assessment and treatment of consumers. It has also led to greater service integration and knowledge sharing about older persons' mental health. Participants identify ongoing service needs particularly for remote, CALD and Aboriginal populations and for after-hours crisis care. Conclusion: The localisation of services and attachment of specialist older persons' clinicians to rural mental health teams has enhanced service delivery for older people through enabling case management within rural communities. There are however, ongoing service needs which need to be resolved. [ABSTRACT FROM AUTHOR]

We present a report on the recent symposium on dementia and depression in older adults, held in Ohrid, Macedonia and discuss the urgent need for development of psychogeriatric and affiliated services in the Southeast European region. The limited epidemiological data from nine countries in this region suggest high variability of prevalence rates for mental health problems in older adults (>65 years of age). At the moment, there are over 520,000 older adults in the region living with dementia alone. The prevalence rates for dementia (%) are either similar to those of the developed countries (9-9.6% in build-up northern Greece and Albania, respectively) or substantially lower (3.6-4% in rural northern Greece and Montenegro, respectively). The latter may be due to either cultural diversity or lack of adequate medical health service provision and expertise to recognize and diagnose dementia. Indeed, there is a lack of organized specialized services for older adults with mental health problem in the region. The symposium raised the awareness of this problem in the region and called for networking between isolated individuals working in this field to improve the current situation and facilitate further development of adequate clinical services to meet the growing needs of the older adults in the countries of the Southeast Europe. [ABSTRACT FROM AUTHOR]

The author reviews the development of welfare services and policies on the elderly in the past forty years. She identifies three eras, the budding period before 1980, the blossoming golden period, from 1981 to 1996 and the consolidation period, from 1997 to 2012. The author discusses salient features and provides critique on each of the three periods. She traces and analyses the characteristics of each period, and critiques on their trials, outcome achievements and challenges. She focuses on community care and restrains from other major educational, health and housing policies. With regard to future development, the author shares the thoughts of Dr. Butler and ideas from the IFA 2012 Prague Conference so as to stimulate collective thinking for future possible formulation of policy direction. The author also wishes to acknowledge support and advice from many geriatricians and psychiatric geriatricians of the Hospital Authority and Health Development who also played important part in the development of policy and services in the three periods. [ABSTRACT FROM AUTHOR]

Objective The objective of this study is to identify the extent of outreach activity community mental health teams (CMHTs) for older people provide to mainstream services in light of the recommendations of the National Dementia Strategy. In particular, to determine the range of settings in receipt of support; to specify the form of this activity; to identify the professionals involved; and to explore the factors associated with the provision of such support. Methods A self-administered postal questionnaire was sent to all CMHTs in England. The reported arrangements were categorised and reviewed according to a taxonomy of outreach developed from the literature. Results Three hundred and seventy six (88%) of the CMHTs responded. Although nearly all teams undertook some outreach work, much of this was informal in nature. Nevertheless, the vast majority of teams had some formal outreach arrangements in at least one mainstream setting. Just less than three-quarters provided support (most typically education) to care homes, approaching half centres to day centres, and over a third to primary care practices, social services teams, home care providers and general hospitals, respectively. Link workers were the favoured means of supporting general hospital staff. Community mental health nurses were most commonly involved in providing outreach, and larger teams were more likely than smaller teams to have formalised arrangements. A significant minority of teams expressed concerns about their capacity to provide effective services. Conclusions The findings suggest that both more resources and more evidence will be needed to meet the National Dementia Strategy's aim of improving care for older people with mental health problems in mainstream settings. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article discusses the underdiagnosed depression in older people. Topics include are ways to assess patients, management options and referral of patients. Also mentioned are the diagnostic criteria for depression, side effects of selective serotonin reuptake inhibitors (SSRIs), and vascular diseases including stroke, myocardial infarction and diabetes.

Objectives: Self-management is promoted as a strategy for improving outcomes for serious mental illness as well as for chronic general medical conditions. This study evaluated the feasibility and effectiveness of an eight-month program combining training in self-management for both psychiatric and general medical illness, including embedded nurse care management. Methods: Participants were 71 middle-aged and older adults (mean age=60.3±6.5) with serious mental illness and chronic general medical conditions who were randomly assigned to receive integrated Illness Management and Recovery (I-IMR) (N=36) or usual care (N=35). Feasibility was determined by attendance at I-IMR and nurse sessions. Effectiveness outcomes were measured two and six months after the intervention (ten- and 14-month follow-ups) and included self-management of psychiatric and general medical illness, participation in psychiatric and general medical encounters, and self-reported acute health care utilization. Results: I-IMR participants attended 15.8±9.5 I-IMR and 8.2±5.9 nurse sessions, with 75% attending at least ten I-IMR and five nurse sessions. Compared with usual care, I-IMR was associated with greater improvements in participant and clinician ratings for psychiatric illness self-management, greater diabetes self-management, and an increased preference for detailed diagnosis and treatment information during primary care encounters. The proportion of I-IMR participants with at least one psychiatric or general medical hospitalization decreased significantly between baseline and ten- and 14-month follow-ups. Conclusions: I-IMR is a feasible intervention for this at-risk group and demonstrated potential effectiveness by improving self-management of psychiatric illness and diabetes and by reducing the proportion of participants requiring psychiatric or general medical hospitalizations. [ABSTRACT FROM AUTHOR]

Background Depression and anxiety are common in residents of elderly homes. Both disorders have negative effects on functioning, well-being and health-care utilisation. Besides treatment, prevention can be an option to reduce the burden of mental disorders. The objective of this study was to evaluate the cost-effectiveness of a stepped care programme to prevent the onset of depression and anxiety disorders in residents of elderly homes compared with usual care from a societal perspective. Methods Outcomes were incidence of depression and/or anxiety, severity of depressive and anxiety symptoms and quality-adjusted life years. Health-care utilisation was measured during interviews. Multiple imputation was used to impute missing cost and effect data. Uncertainty around cost differences and incremental cost-effectiveness ratios was estimated using bootstrapping. Cost-effectiveness planes and acceptability curves were created. Results The incidence of depression and anxiety combined in the intervention group was not reduced in comparison with the usual care group. There was also no effect on the other outcomes. Mean total costs in the intervention group were €838 higher than in the usual care group, but this difference was not statistically significant (95% confidence interval, −593 to 2420). Cost-effectiveness planes showed that there was considerable uncertainty. Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective in comparison with usual care was 0.46 for reducing the incidence of depression and anxiety combined. Conclusion A stepped care programme to prevent depression and anxiety in older people living in elderly homes was not considered cost-effective in comparison with usual care. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives The objective of this study was to evaluate the 2-year effects of a stepped-care programme to prevent the onset of a major depressive disorder (MDD) in older people living in residential homes. Methods A 2-year follow-up study of a pragmatic randomised controlled trial was conducted in 14 residential homes in the Netherlands. A total of 185 residents (Center for Epidemiologic Studies Depression Scale score >7), who did not meet the diagnostic criteria for MDD, were randomised to a stepped-care programme ( n = 93) or to usual care ( n = 92). Stepped-care participants sequentially underwent watchful waiting, a self-help intervention, life review and a consultation with the general practitioner. The primary outcome measure was the incidence of MDD during a period of 2 years, according to the Mini International Neuropsychiatric Interview. Results After 2 years, the incidence of MDD was not significantly reduced in the intervention group compared with the control group (incidence rate ratio: 0.98; 95% confidence interval (CI) [0.54, 1.81]). However, in the completer analysis, on the basis of 79 residents who completed the 2-year measurements, there was a significant difference in favour of the intervention group (incidence rate ratio: 0.53; 95% CI [0.32, 0.87]). Dropout percentages were high (44%), mostly accounted for by illness and death (68%). Conclusion A minority of residents had benefit from the intervention that sustained after 2 years in the completer group. Yet, these findings cannot be generalised as the majority of the residents did not opt for participation in the project and many dropped out. Ways should be sought to motivate residents with depressive symptoms to engage in preventive interventions. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background. In older individuals, acute medical illnesses and admission to hospital are often associated with a deterioration of cognitive status, also in the absence of dementia and full-blown delirium. We evaluated the prevalence of subsyndromal delirium (SSD) and its correlates in a sample of elderly medical inpatients. Methods. From 763 consecutive inpatients, 325 participants with known dementia or delirium were excluded, whereas 438 (mean age: 80.6 years; female participants: 60.1%) were enrolled. SSD was diagnosed within 48 hour from admission, when at least two DSM-IV delirium criteria including disorientation, attention or memory deficit, altered level of consciousness, or perceptual disturbances were present. Cognitive performance was evaluated by Mini Mental Status Examination (MMSE). General, clinical, and laboratory parameters were also registered. Results. One hundred and sixty-six patients (37%) had SSD. Compared with controls, SSD patients were older individuals, had less formal education, higher comorbidity, lower hemoglobin/lymphocytes counts, and higher creatinine levels. A trend toward higher prevalence of previous stroke and widowhood was observed. A MMSE score of less than 24/30 identified SSD with 88% sensitivity and 78% specificity. In SSD patients, MMSE independently correlated with years of education, high-sensitivity C reactive protein levels, and O2 arterial saturation (model adjusted r2 = 0.30, p = .001); conversely, only years of education were associated with MMSE in controls (adjusted r2 = 0.06, p = .01). Conclusions. Our data suggest that SSD is common in hospitalized older medical inpatients, and low MMSE score might be useful for identification of participants at risk of SSD. Current inflammatory response and reduced O2 arterial saturation were the only independent determinants of cognitive performance in SSD patients. [ABSTRACT FROM PUBLISHER]

The authors address the issue of mental health and substance use (MH/SU) care for older adults in India. They discuss the prevalence of mental health and substance abuse in older adults as well as evidence-based practices and barriers to assessment and treatment. They also offer recommendations for improving MH/SU services for older adults.

A study carried out to study the health problems, available health services, and barriers in accessing the health services to rural elderly in Chittoor District, (AP) revealed that body/joint pains, impaired vision, fatigue, sleep disorders, mental health problems, digestive problems, dental problems, bowel complaints, etc., are the major health problems and PHCs, private hospitals followed by RMPs and mobile medical services are the major sources of health care for rural elderly. Financial barriers, lack of family support, poor care, long waiting time, only one type of tablets for all problems, ill-treatment of staff, issue of drugs only for a few days, poor attention by the doctor, etc., are the major barriers expressed by the respondents in accessing the health care services. Patient hearing and better treatment by doctors, more medicines, elderly friendly behaviour of health staff, preference to elderly patients in OPD, health education, improved facilities in PHCs, MMUs with Doctor and periodical eye camps at PHCs are some of the major expecta- tions/aspirations of the rural elderly for their better health care. [ABSTRACT FROM AUTHOR]