Care-seeking as a proxy indicator of the mental health of elderly Brazilians

Objective: To assess a large set of metadata made public by the Brazilian Ministry of Health on older subjects who visited outpatient mental health services in Brazil from 2008 to 2012. Methods: We extracted data from the Brazilian Unified Health System Information Technology Department (Departamento de Informática do Sistema Único de Saúde, DATASUS), then calculated rates of visits per population in each of the five regions of Brazil, using census data for each year. Finally, logistic regressions were performed with depressive disorders or dementias as dependent variables, controlled by age and year of visit, stratified by region. Results: Mood disorders were the leading reason for visits to outpatient mental health services by older adults, followed by delusional disorders. The calculated rates were lower than the known prevalence of depressive disorders and dementias, but the regressions revealed typical patterns. Males were less likely to present with a depressive disorder, while older subjects were more likely to present with depression and dementia. Conclusions: Publicly available data from DATASUS may not enable inferences about the prevalence of mental disorders in elders, but inferential analyses match what is known about these conditions. This approach is supplemental to other more common ones and is of special importance for policymakers and health system managers.

Contemporary issues in liaison psychiatry and growing older adult population in India: experiences from UK initiatives

Background: Most tertiary hospitals in India carry out liaison work with various departments like neurology, organ transplant, intensive care units and cosmetic surgery. Mental disorders affecting older people admitted to general hospitals is poorly detected and managed in many general hospitals in India and elsewhere. Aim: To evaluate the service of an old age psychiatric liaison team working in a general hospital and reviewing the parallels which could be drawn with respect to Indian perspective. Method: The study model is based on the cross sectional assessment and service evaluation of a psychiatric liaison team (PLT) for older adults working in conjunction with general hospital. Parallels are drawn to compare and contrast the liaison service model in India and the United Kingdom (UK). Results: A total of 143 patients out of 174 were screened by the PLT; 29.3% were males and 70.6% were females and just more than 60% were above the age of 80 years. Around 32.2% of patients were between the age group of 66-80 years. Most referrals (71.3%) to the PLT were from nursing staff of general hospital belonging to varying seniority. Around 30.8% of the patients referred to PLT have a previous diagnosis of psychiatric illness. Diagnosis of dementia was the commonest (17.4%), followed by depression which was 4.2%, Mild Cognitive Impairment (MCI) was present in 2.8% of patients, 2% have diagnosis of vascular dementia. A survey of non-psychiatry clinicians showed a substantial proportion of doctors underestimate the psychiatric morbidity especially about unexplained physical symptoms and specific depressive symptoms. Conclusion: Psychiatry as a specialty has been neglected at all levels in India and service development has been scanty. The inception of the concept of liaison psychiatry in India has been almost an ancient one but it has not raised the standards of care to any significant level.

Declaração de consenso da seção de psiquiatria geriátrica da Associação Mundial de Psiquiatria sobre ética e capacidade em pessoas idosas com doença mental / World Psychiatric Association section of old age psychiatry consensus statement on ethics and capacity in older people with mental disorders

CONTEXTO: A Seção de Psiquiatria Geriátrica da Associação Mundial de Psiquiatria (AMP), desde 1997, vem desenvolvendo Declarações de Consenso relevantespara a prática da Psiquiatria Geriátrica. Desde 2006, a Seção vem trabalhando para desenvolver uma Declaração de Consenso sobre Ética e Capacidade em pessoas idosas com transtornos mentais. MÉTODO: Uma Conferência de Consenso foi realizada em Praga em setembro de 2008. Organizada pela Seção de Psiquiatria da Pessoa Idosa da AMP, ela contou com a participação do International Council of Nurses, Alzheimer Europe e Alzheimer Disease International. Os participantes foram reconhecidos pela sua perícia nesse domínio e vieram de 11 países. Incluíam psiquiatras, uma neurologista, um enfermeiro e representantes de cuidadores familiares. RESULTADOS: Após dois dias de reuniões e debate, redigiu-se um rascunho da declaração que foi submetida para análise nas diversas organizações/associações que participaram da reunião. Após as sugestões finais recolhidas, um texto definitivo foi preparado em inglês e publicado. A presente versão em português é da responsabilidade de dois participantes lusófonos da reunião, que são também coautores da declaração de consenso final. CONCLUSÕES: Essa Declaração de Consenso oferece aos clínicos em saúde mental que cuidam de pessoas idosas com transtornos mentais, cuidadores, outros profissionais da saúde e o público em geral as definições e o debate sobre os princípios éticos que podem frequentemente ser complexos e desafiadores, apoiados em orientações práticas para satisfazer tais necessidades e padrões éticos e encorajar a boa prática clínica.

BACKGROUND: The World Psychiatric Association (WPA) Section of Old Age Psychiatry, since 1997, has developed Consensus Statements relevant to the practice of Old Age Psychiatry. Since 2006 the Section has worked to develop a Consensus Statement on Ethics and Capacity in older people with mental disorders. METHOD: A Consensus Conference was realized in Prague, September 2008. The meeting was organized by the WPA Section of Old Age Psychiatry, with the participation of International Council of Nurses, Alzheimer Europe and Alzheimer Disease International. Participants who are recognised for their expertise in this area came from 11 countries and include psychiatrists, a neurologist, a nurse and family caregiving representatives. RESULTS: After two days of debate a draft was prepared and submitted to the organizations/associations represented at the meeting. When their respective comments were collected, a final text was prepared and published originally in English. This Portuguese version was prepared by two members of the meeting who came from Portuguese spoken countries. DISCUSSION: This Consensus Statement offers to mental health clinicians caring for older people with mental disorders, caregivers, other health professionals and the general public the setting out of and discourse in ethical principles which can often be complex and challenging, supported by practical guidance in meeting such ethical needs and standards, and to encouraged good clinical practice.

Old Age Psychiatry: Overview / 신경정신의학

"Old Age Psychiatry" is a branch of psychiatry. WHO, WPA and IPA strongly suggest that the Old Age Psychiatry is directed to "Lead(Guide) best possible care of geriatric patients and their families, Education and training for all health and social care workers, Development of appropriate training manuals with culturally appropriate material, Encourage the direction of geriatric psychiatry health policy. To the development of Old Age Psychiatry, Integrated approach and paradigm, Prevention, diagnosis and rehabilitation and Multidisciplinary approaches is essential. And strategies for mental health services, "Systemic care services and Delivery care services" is needed. When we review of past 10 year of Old Age Psychiatry in Korea, we have problems such as Inadequate human resources, Training issues, Multi-disciplinary infrastructure, Economic issues. But we hope that Old Age Psychiatry in Korea has a potential to develop and it should be overcome with enthusiasm and patience. In conclusion, for the future development of Old Age Psychiatry, Old Age Psychiatry must be based on the disorders in elderly can be treated successfully and improving quality of life and creating of life.