Psychiatric consultation to a continuing care retirement community.

Life care communities provide a continuum of residential services to the elderly. This report describes the provision of on-site psychiatric consultations to 82 individuals residing in one such community. Dementia and major depression were the most common diagnoses made.

Diagnosis of illness presentation in the elderly.

In the standard medical model of diagnosis, there is a 1:1 correspondence between clinical symptoms and signs and a pathological disease process. However, it is believed that this model does not accurately define many illness presentations in elderly patients. The frequency with which the medical model is diagnostically accurate, and the other models that might more effectively diagnose geriatric illness, are unknown. This study was designed to ascertain the frequency with which the medical model of diagnosis pertains in a clinical population of older adults and to develop and validate alternative models for diagnosis of illness presentation in this population. Using a retrospective chart review (n = 86) and a prospective validation in a second sample (n = 56) of geriatric assessment clinic patients, it was found that the medical model of illness fit less than half of the patients. To describe the illness presentations of the remaining patients, four new diagnostic models of illness presentation were identified which incorporate comorbidity, functional, and psychosocial factors. Use of these new models along with the medical model of illness diagnosis may assist in more accurate and complete diagnosis in elderly patients and enhance teaching of effective diagnosis in geriatric medicine.

Psychogeriatric assessment and treatment in urban public housing.

A psychogeriatric outreach team provides in-home evaluation and treatment for elderly persons living in high-rise public housing in Baltimore. During the first ten months of the team's operation, housing staff referred 9.5 percent of the elderly residents of four public housing sites for evaluation. Evaluations were completed for 85 residents, 25 percent of whom were age 80 or older. Twenty-one percent of the residents evaluated were unable to perform at least one basic activity of daily living such as eating, bathing, or dressing without assistance, and 54 percent needed help with cooking, cleaning, and other instrumental activities of daily living. Eighty-nine percent of the residents who were evaluated by the team met criteria for at least one DSM-III-R diagnosis; 63 percent of the disorders had not been previously diagnosed. The most prevalent diagnoses were dementia, depressive syndromes, schizophrenic and delusional disorders, and alcohol abuse or dependence.