International Perspectives on Old Age Psychiatry Training.

Psychiatry of old age is a psychiatric subspecialty that has been developed in many countries since the 1950s as an attempt to improve the care of older adults with mental health disorders. Psychiatry of old age specialist training programs were subsequently established to develop a medical workforce that has the required competencies to work in this subspecialty. This article describes the psychiatry of old age specialist training programs in Australia, New Zealand, the United Kingdom, and Mexico. These training programs have varying durations, ranging from 1 to 3 years. Although it may not be a mandatory requirement to complete a psychiatry of old age clinical rotation, psychiatry of old age experience and competencies are expected during general psychiatry training. There is generally a lack of opportunity to learn about other clinical specialties relevant to older adults, such as geriatric medicine and neurology. Finally, much work is needed to better coordinate psychiatry of old age specialist training positions, workforce development, and service delivery to ensure there is a sufficient supply of psychiatry of old age specialists to meet the mental health needs of older adults in different countries in the coming years.

The effect of exercise on behavioural and psychological symptoms of dementia: the EVIDEM-E randomised controlled clinical trial.

OBJECTIVE: The objective of this study is to evaluate the effectiveness of a simple dyadic (person with dementia and their main carer) exercise regimen as a therapy for the behavioural and psychological symptoms of dementia. METHOD: A two arm, pragmatic, randomised, controlled, single-blind, parallel-group trial of a dyadic exercise regimen (individually tailored walking regimen designed to become progressively intensive and last between 20-30 min, at least five times per week).Community-dwelling individuals with ICD-10 confirmed dementia with the following: clinically significant behavioural and psychological symptoms, a carer willing and able to co-participate in the exercise regimen, and no physical conditions or symptoms that would preclude exercise participation were invited by mental health or primary care services into the study. RESULTS: One hundred and thirty-one dyads were recruited to this study. There was no significant difference in Behavioural and Psychological Symptoms as measured by the Neuropsychiatric Inventory at week 12 between the group receiving the dyadic exercise regimen and those that did not (adjusted difference in means (intervention minus control) = -1.53, p = 0.6, 95% CI [-7.37, 4.32]). There was a significant between-group difference in caregiver's burden as measured by the Zarit Caregiver Burden Inventory at week 12 (OR = 0.18, p = 0.01, CI [0.05, 0.69]) favouring the exercise group. CONCLUSIONS: This study found that regular simple exercise does not appear to improve the behavioural and psychological symptoms of dementia, but did seem to attenuate caregiver burden. Further study to improve exercise uptake are needed.