Evolution of aged persons mental health services in Victoria: the history behind their development.

AIMS: This paper aims to describe the development of psychiatry of old age in Victoria, Australia, from the 1950s to the present. Social and political aspects which contributed to service development are discussed. METHODS: A qualitative, narrative literature review was undertaken. CONCLUSIONS: Today there is a comprehensive statewide aged persons mental health service, comprising of inpatient and residential units and community teams.

A profile of inpatient admissions to an aged psychiatry service in Victoria.

OBJECTIVE: The study aimed to characterize the demographics, diagnostic makeup and aspects of patient management for the inpatient population of a large aged psychiatry service. METHOD: Sociodemographic and clinical variables were retrospectively collated from inpatient files and discharge summaries over a 3-year period. Age, gender, country of birth, diagnostic group, length of stay, involuntary care status and number of admissions were described and analysed. A total of 604 patients were included in the study, with complete data available for 516. RESULTS: Approximately half of the patients were aged 65-75 years and 59.3% were female. More than half had been born outside of Australia. The primary diagnosis was an affective disorder in 39.0% of admissions, dementia in 27.5% and psychotic illnesses in 25.8%. The median length of stay was 28 days; 60.8% had a period of involuntary care and 79.8% had only one admission. CONCLUSION: In the near future, aged psychiatry services will face increased numbers of patients and rising expectations. To best respond to these challenges, we need to have an understanding of current patient and service profiles. The findings of this study illustrate a range of patient, diagnostic and management variables in aged psychiatry practice. This information can be used for comparison with other services and in planning for future development of services.

Mental health care for our ageing Australian population.

OBJECTIVE: In the context of the National Strategy for an Ageing Australia, the aim of this paper was to highlight some of the challenges for aged mental health services as our population ages. CONCLUSIONS: The demand for greater consumer participation in treatment planning and provision, and the increasing complexity of managing medical and psychiatric comorbidity in our 'old-old' population will be major drivers for improving our models of clinical practice and forging stronger partnerships between the public and private sectors.

Access to a community aged psychiatry service by elderly from non-English-speaking backgrounds.

OBJECTIVE: With the ageing of Australia's ethnic communities, aged mental health services need to examine issues pertaining to accessibility and appropriateness in the context of this sociodemographic change. The aim of this review of referrals to a community aged-psychiatry service was to compare for differences between patients from non-English-speaking backgrounds (NESB) and English-speaking backgrounds (ESB). METHOD: Sociodemographic and clinical variables were retrospectively collated for a 12-month period and analysed according to NESB and ESB status. The 1996 Australian Census data were used for comparison of catchment area representation of different ethnic groups. RESULTS: 40.8% of patients referred to the service were from NESB, and 78.8% of these were assessed with an interpreter. Taken as broad ethnic groups, the referral of elderly European migrants was similar to their representation in the local population, while elderly migrants from Asia and other non-European backgrounds were under-represented. Sociodemographic differences were found in that the elderly from NESB were more likely to be poorly educated, have a low proficiency in English, and to have been employed in unskilled occupations. On the other hand, patterns of referral, diagnosis, past psychiatric history and outcome did not differ significantly between the two groups. Clinical variables relating to referral source, past psychiatric history, and outcome did not differ significantly across the two groups. CONCLUSIONS: This 12-month review of referrals to an aged psychiatry community service found that nearly half were of elderly patients from NESB. The lower utilisation of the service by certain ethnic groups may reflect obstacles in their pathway to care. Alternatively, strong family networks, or a lower prevalence of mental illness in these elderly, may explain the findings in this report.

Esquizofrenia e transtornos delirantes com início na terceira idade / Schizophrenia and delusional disorders with onset in later life

Transtornos mentais do espectro da esquizofrenia säo comumente associados a início na primeira fase da vida adulta. Quando sintomas psicóticos näo-afetivos emergem pela primeira vez em fases tardias da vida, a apresentaçäo clínica tem semelhanças e diferenças em relaçäo às síndromes de início precoce. Essa situaçäo resultou em debate contínuo sobre o status nosológico da psicose de início tardio e sobre se há fatores de risco associados a esse pico de incidência na terceira idade. Embora déficits cognitivos precoces sejam freqüentemente identificados entre esses pacientes, ainda näo foi possível estabelecer se problemas cognitivos estäo associados a um quadro demencial dos idosos. Comprometimento sensorial, isolamento social e história familiar de esquizofrenia têm sido associados à psicose de início tardio, mas esses fatores de risco parecem exercer um papel näo-específico sobre a vulnerabilidade. Ainda que as questöes sobre o diagnóstico mais adequado para esses quadros clínicos permaneçam näo resolvidas, os psiquiatras precisam formular estratégias de tratamento que levem em consideraçäo a complexa constelaçäo de sintomas da apresentaçäo clínica de pacientes idosos psicóticos