Antipsychotic use in the elderly: what doctors say they do, and what they do.

OBJECTIVE: To review psychiatrists' attitudes and actual practice on the use of typical and atypical antipsychotics in the elderly. METHODS: Audit data were collected from 18-old-age psychiatry units across Australia. The attitudes of old age psychiatrists and their perceptions of the efficacy, tolerability and clinical usefulness of antipsychotics were examined. RESULTS: The medications used for 321 patients were audited, and the attitudes of the 57 prescribing doctors were assessed. All available atypicals were prescribed and reported as more efficacious and clinically useful than typicals. Adverse events perceived by doctors as an obstacle to prescribing were more frequent than reported adverse event rates in product information. All diagnostic groups improved. Off-label use comprised almost 22% in this sample. CONCLUSIONS: Adverse events are impediments to prescribing, more so with typical than atypical antipsychotics. All available atypicals were used and appeared effective in this elderly population.

Job satisfaction and burnout in mental health services for older people.

OBJECTIVE: The objective of the present paper was to identify factors associated with job satisfaction and burnout among staff working in mental health services for older people. METHODS: A postal survey was distributed to staff members from eight mental health services for older people in Western Australia. Staff focus groups identified causes of work stress. RESULTS: The response rate was 33% (116/349). Teamwork, social support and clear roles had a positive effect on job satisfaction. Community staff members had higher job satisfaction than ward staff. Nurses reported higher burnout and lower job satisfaction than other mental health professionals. Staff members working in newer models of service delivery had higher job satisfaction than those working in more traditional models. CONCLUSION: Surveys and focus groups were an effective means of identifying factors associated with job satisfaction in mental health staff members. Newer models of service delivery with team building and supportive management may improve the workplace for staff.

Does the HoNOS 65+ meet the criteria for a clinical outcome indicator for mental health services for older people?

BACKGROUND: A clinical indicator should demonstrate clinically meaningful change, be relevant, allow comparisons between services, be acceptable to clinicians, and have acceptable validity, reliability and sensitivity to change. The HoNOS 65+ has been suggested as a clinical outcome indicator. The sensitivity to change of the HoNOS 65+ is not known. METHODS: This is a prospective study using routine clinical data. A pilot cohort (n = 42) was used to measure the concurrent validity of the HoNOS 65+ with the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15) and Brief Agitation Rating Scale (BARS). The main cohort of 245 consecutive referrals to a community mental health service for older adults was used to assess sensitivity to change against the CIBIC+. RESULTS: The HoNOS 65+ was acceptable to case managers, most HoNOS 65+ items had excellent interrater reliability and the HoNOS 65+ had good concurrent validity. Changes in the HoNOS 65+ scores between assessment and discharge had a moderate, but significant correlation with CIBIC+ scores. CONCLUSION: The HoNOS 65+ meets the criteria for a clinical outcome indicator for community mental health services for older people. The HoNOS 65+ is sensitive to change.