Attitudes to ageing amongst health care professionals: a qualitative systematic review.

OBJECTIVES: Older adults utilising healthcare may be vulnerable to systemic bias regarding ageing potentially affecting care. Primary aim is to systematically review the qualitative literature examining attitudes to ageing amongst health care professionals (HCPs). Secondary aim is to describe and compare attitudes to ageing between different professional groups. METHODS: Studies examining attitudes to ageing of HCPs were identified using four databases. Original qualitative research with HCPs was included, excluding studies examining students alone, reviews, and grey literature. Three authors undertook standardised data extraction and quality rating for each study and thematic synthesis, with a fourth senior author reviewing. Quality appraisal followed the Attree and Milton guidelines (2006), including studies rated A-C. RESULTS: Of 5869 citations, 13 met initial inclusion criteria. Synthesis of the 12 studies graded A-C followed (excluding one study rated-D). Nurses, doctors, and social workers were most frequently investigated. Identified themes included Attitudes towards older persons, The role of the older persons' family, Behaviour of HCPs towards older persons, Behaviour of older persons towards HCPs, and Definitions of an older person. An overarching theme emerged of the systemic context of attitudes to ageing. Common attitudes were found across disciplines, with doctors emphasising complexity and dependency and nurses the burden of care. CONCLUSIONS: HCP's attitudes to ageing vary and are shaped by professional experiences and systemic factors. HCP attitudes may affect responses to and care of the older person. Therefore, interprofessional research, and systemic and service changes across disciplines are required to foster real and sustainable attitudinal change to support older peoples' care.

A narrative literature review: the application of video games as therapeutic tools for psychological therapy.

OBJECTIVES: Video games (games played by electronically manipulating images produced by a computer programme on a screen) are being developed with a specific focus on treating mental health. This narrative review briefly discusses the history of video games and mental health. It then provides a critical discussion on the application of video games as therapeutic tools, then discusses the notion of 'serious games' (games designed for a primary purpose other than entertainment) and their applicability. CONCLUSIONS: Serious games have preliminary evidence to support their use practically in the clinical treatment of mental illness. Future randomised control trials are necessary to further explore their efficacy and potential areas of application.

Carer Appraisal Scale: Second Edition of a Novel Carer-Based Outcome Measure.

Carers are known to have valuable information regarding patient functioning. It has been repeatedly cited that failure of communication between mental health services and the carers of patients is related to critical incidents and failures in patient care. Despite this, there are no structured interventions for carers to participate in patient care, let alone assist with measuring patient progress. This study builds upon and expands on a previous pilot study of a similar measure that was developed for a specific old-age population to create one suitable for general adult use. Development of the Carer Appraisal Scale was based on a grounded theory approach, beginning with semi-structured interviews with staff members working in the mental health service of a major tertiary referral center, with intent on refinement by focus groups, carer feedback, and eventual reduction in total number of items via factor analysis in order to create an accessible and brief measure suitable for regular clinical use. It is proposed that this measure provides additional value for services in engaging the carers of patients in a clinically meaningful way that will greatly impact on patient care.

Attitudes to ageing: an overview of Australian perspectives of health support systems for the older person.

OBJECTIVES: Older adults utilise health care systems to a higher frequency than younger groups, and are more vulnerable to system bias regarding ageing and expectations of old age. This narrative review attempts to outline the available literature regarding how various health support systems perceive the older adult, with an Australian focus. CONCLUSIONS: Perspectives on ageing are generally negative regardless of health industry. Possible contributors to this include elements of death anxiety, inadequate education and inadequate occupational exposure during training.

The role of psychodynamic psychotherapy for the older adult - two contrasting cases.

OBJECTIVE: To outline the successful psychotherapeutic intervention of two older patients. CONCLUSION: Psychodynamic principles should be considered more readily in the treatment of older people.

Short-term psychodynamic psychotherapy: a brief history.

OBJECTIVE: To discuss the development and rationale for different models of short-term psychodynamic psychotherapy. CONCLUSION: There are a variety of historical reasons for the current climate of short-term dynamic therapies that can help inform upon their application and future directions.

Carer Appraisal Scale: A Pilot Study of a Novel Carer-Based Assessment of Patient Functioning.

Measurement of patient outcomes is an integral part of mental health service evaluation, as well as guiding clinical practice to ensure best outcomes for patients. Moreover, carers have long held a need for a voice in care outcomes. Despite there existing numerous tools for quantifying patient functioning based on clinician assessments or self-reports, there is a serious paucity of tools available for the carers of patients to appraise their functioning. This tool, developed for use in a community aged care psychiatric service, involves 4 sections-a global impression of patient progress, a scorable checklist of patient functioning in multiple domains, a qualitative section for identifying the most pressing concerns from the carer's perspective, and an open-ended feedback on treatment to date. In this pilot study, the Carer Appraisal Scale was found to have a fair correlation with the Health of Nation Outcomes Scale for over 65. This tool has potential for use in community aged care psychiatric services, as it provides a framework for communication of concerns, assists in prioritizing care, and adds value to clinician treatment plans, as well as providing another dimension to assessment of the patient while empowering carers in care participation. Practical implications of its use, limitations, and potential for modifications are also discussed.

Out, out, damned blind spot! The problem of anxiety with dynamic psychotherapy.

OBJECTIVES: This article discusses Lady Macbeth's famous sleepwalking scene from the Shakespearean tragedy, and how it became used as a template for the formulation of obsessive-compulsive disorder. CONCLUSIONS: Psychoanalysis maintained its role in understanding the condition, despite the lack of evidence base and the repeated finding from many therapists of a failure to control symptomatology. It is suggested that psychodynamic psychotherapy suffered from a failure to recognise what components of its practice were aesthetically attractive concepts rather than evidence-based medicine and outcome measures, and is an important issue in considering its future directions.

Psychotherapy and the older person.

OBJECTIVE: This article aims to provide a brief overview of the current evidence for psychotherapeutic approaches in older adults, together with clinical practice notes for interventions. CONCLUSION: There are a range of appropriate psychotherapeutic options for the older adult that merit further study, and further opportunities for enhancing clinical practice.

Personality disorders in geriatric inpatients in a tertiary hospital.

OBJECTIVE: To assess the prevalence of personality disorders in general medical geriatric admissions. METHODS: Forty of 508 general medical geriatric admissions screened at a large tertiary hospital, who were eligible as defined by a Mini-Mental State Examination score of over 23 and capable of informed consent, were assessed by direct interview and discussion with the patient's family or close contact to determine personality traits. RESULTS: Eight (20%) of these patients were found to satisfy DSM-IV criteria for a personality disorder. They were found to have significantly lower global assessments of functioning, impaired overall functioning and lower quality of life compared with non-personality disordered patients. None of their personality disorders had been recognised by their treating teams. CONCLUSIONS: This study supports the need for systematic research into the area and the need for increased clinical awareness of the issues.