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Objective: To review studies reporting on the effectiveness of psychiatry service delivery for older people and people with dementia in hospital and residential aged care. Methods: A systematic search of four databases was conducted to obtain peer-reviewed literature reporting original research published since June 2004 evaluating a psychiatry service for older people (aged 60 years and over) or people with dementia in inpatient or residential aged care settings. Results: From the 38 included studies, there was consistent low-to-moderate quality evidence supporting the effectiveness of inpatient older persons’ mental health wards (n = 14) on neuropsychiatric symptoms, mood, anxiety and quality of life. Inpatient consultation/liaison old age psychiatry services (n = 9) were not associated with improved depression, quality of life or mortality in high-quality randomised studies. However, low-quality evidence demonstrated improved patient satisfaction with care and reduced carer stress. The highest quality studies demonstrated no effect of psychiatric in-reach services to residential aged care (n = 9) on neuropsychiatric symptoms but a significant reduction in depressive symptoms among people with dementia. There was low-quality evidence that long-stay intermediate care wards (n = 6) were associated with reduced risk for dangerous behavioural incidents and reduced costs compared to residential aged care facilities. There was no effect of these units on neuropsychiatric symptoms or carer stress. Conclusions and implications: The scarcity of high-quality studies examining the effectiveness of old age psychiatry services leaves providers and policy-makers to rely on low-quality evidence when designing services. Future research should consider carefully which outcomes to include, given that staff skill and confidence, length of stay, recommendation uptake, patient- and family-reported experiences, and negative outcomes (i.e. injuries, property damage) are as important as clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective: While there is considerable current emphasis on youth and early psychosis, relatively little is known about the lives of people who live with psychotic disorders into middle age and beyond. We investigated social functioning, physical health status, substance use and psychiatric symptom profile in people with psychotic disorders aged between 50 and 65 years. Methods: Data were collected as part of the Survey of High Impact Psychosis, a population-based survey of Australians aged 18–65 years with a psychotic disorder. We compared those aged 50–65 years (N = 347) with those aged 18–49 years (N = 1478) across a range of measures. Results: The older group contained more women and more people with affective psychoses compared to the younger group. They were also more likely to have had a later onset and a chronic course of illness. The older group were more likely to have negative symptoms but less likely to exhibit positive symptoms; they also had lower current cognition, compared to the younger group. Compared to the younger group, the older group were more likely to be divorced/separated, to be living alone and to be unemployed. They had substantially lower lifetime use of alcohol and illicit substances, but rates of obesity, metabolic syndrome and diabetes mellitus were higher. Conclusion: Our findings suggest that the characteristics of people with psychosis change significantly as they progress into the middle age and beyond. A better understanding of these differences is important in informing targeted treatment strategies for older people living with psychosis. [ABSTRACT FROM AUTHOR]

Objectives:Old age psychiatrists work with end-of-life (EOL) issues and encounter patient deaths, but death and dying have received limited focus in old age psychiatry training and research. This qualitative study explores old age psychiatrists’ experience of and approach to working with patients at the EOL. Method:Australian old age psychiatrists were purposively sampled and interviewed in-depth. Data saturation was achieved after nine participant interviews. Verbatim transcripts were analysed for themes, which were independently verified. Results:Two dichotomous overarching themes were identified. Death is not our business reflected participants’ experience of working in a mental health framework and incorporated four themes: death should not occur in psychiatry; working in a psychiatric treatment model; keeping a distance from death and unexpected death is a negative experience. Death is our business reflected participants’ experience of working in an aged care context and incorporated four themes: death is part of life; encountering the EOL through dementia care; doing EOL work and expected death is a positive experience. Conclusion:Participants reported conflict because of the contradictory domains in which they work. They were comfortable working with patients at the EOL when death was expected, particularly in dementia. By contrast, they struggled with death as an adverse outcome in circumstances influenced by mental health culture, which was characterised by risk management, suicide prevention and a focus on recovery. This study has implications for models of care underpinning old age psychiatry. An integrated person-centred model of care may provide a contextually appropriate approach for practice. [ABSTRACT FROM AUTHOR]

The article discusses the management and use of high-dose haloperidol for severe aggression in a man with early onset frontotemporal dementia (FTD). It cites the case of a 60 year old man with a history of rapidly progressive FTD complicated by extreme aggression and the perpetrator of domestic violence before diagnosis. It notes that the risk of mortality in elderly nursing home residents increased with higher doses of antipsyhotic medications and was greatest for haloperidol.

Background: Whilst there is considerable focus on early intervention for young people with psychotic disorders, there is little research looking at older people. Although some of these individuals have a recent onset, most will have been living with psychosis for many years. The older population has increased risks of cardiometabolic complications and this is likely to be complicated by psychosis. Methods: The Australian Survey of People Living with Psychosis included 1478 participants aged 18–49 years, and 346 participants aged 50–64 years. The two groups were compared across a range of demographic, diagnostic, physical health, substance abuse and lifestyle factors. Results: The older group contained significantly more women (48.3% vs 38.6%, p<0.0001). There was a smaller proportion of people with ICD- 10 schizophrenia (36.1% vs 45.4% p<0.012), and higher proportions with schizoaffective disorder and affective psychoses. Significantly fewer of the older participants were prescribed clozapine (11.0% vs 16.8%, p < 0.0001). The mean age of onset was later in the older group (30.05 vs 22.23 years, p < 0.0001). There was a striking difference in rates of drug and alcohol abuse. The older group had lower rates of hazardous, harmful or dependent drinking (15.3% vs 35.9%, p < 0.0001), lifetime cannabis use (35.6% vs 74.1%, p < 0.0001), past year cannabis use (11.1% vs 38.1%, p < 0.0001), lifetime amphetamine use (12.8% vs 47.0%, p < 0.0001), and past year amphetamine use (2.9% vs 14.9%, p < 0.0001). The older group were also less likely to currently smoke tobacco (56.9% vs 68.9%, p < 0.0001). Older people were more likely to live alone (45.1% vs 28.6%, p < 0.000). They were less likely to experience food poverty; in the last year 19.5% of older people and 30.7% of younger people had run out of food and did not have money to buy more. Cognitive function was poorer with slower processing speed in the older group, with the NART error score indicating premorbid intelligence was lower in the older group. Older people were more likely to be overweight or obese (80.6% vs 74.3%, p < 0.0001), as well as being more likely to have metabolic syndrome (56.1% vs 48.5%, p = 0.034). There was a greater proportion with very low exercise in the older group (41.6% vs 31.7% p = 0.003). Discussion: Older people with psychosis are more likely to be female and more likely to be diagnosed with an affective psychosis. The poorer cognitive function and higher rates of obesity and metabolic syndrome are consistent with changes seen in aging in the normal population. The older group have much lower rates of both lifetime and current drug and alcohol abuse, and smoking. Whilst there is considerable attention to cardiovascular health as a determinant of premature mortality, our results suggest that lifetime alcohol, cannabis and amphetamine use may also be associated with failure to survive into older age. [ABSTRACT FROM AUTHOR]