Tag: Older Adults

What is Geriatric Psychiatry?

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Introduction

Geriatric psychiatry, also known as geropsychiatry, psychogeriatrics or psychiatry of old age, is a subspecialty of psychiatry dealing with the study, prevention, and treatment of mental disorders in humans with old age.

As the population ages, particularly in developing countries, this field is becoming more needed. The diagnosis, treatment and management of dementia and depression are two areas of this field. Geriatric psychiatry is an official subspecialty in psychiatry with a defined curriculum of study and core competencies.

International

The International Psychogeriatric Association is an international community of scientists and healthcare geriatric professionals working for mental health in aging. International Psychogeriatrics is the official journal of the International Psychogeriatric Association.

United Kingdom

The Royal College of Psychiatrists is responsible for training and certifying psychiatrists in the United Kingdom. Within the Royal College of Psychiatrists, the Faculty of Old Age Psychiatry is responsible for training in Old Age Psychiatry. Doctors who have membership of the Royal College of Psychiatrists can undertake a three or four year training programme to become a specialist in Old Age Psychiatry. There is currently a shortage of old age psychiatrists in the United Kingdom.

United States

The American Association for Geriatric Psychiatry (AAGP) is the national organisation representing health care providers specialising in late life mental disorders. The American Journal of Geriatric Psychiatry is the official journal of the AAGP. The American Board of Psychiatry and Neurology and the American Osteopathic Board of Neurology and Psychiatry both issue a board certification in geriatric psychiatry.

After a 4-year residency in psychiatry, a psychiatrist can complete a one-year fellowship in geriatric psychiatry. Many fellowships in geriatric psychiatry exist.

Name

The geropsychiatric unit, the term for a hospital-based geriatric psychiatry programme, was introduced in 1984 by Norman White MD, when he opened New England’s first specialised programme at a community hospital in Rochester, New Hampshire. White is a pioneer in geriatric psychiatry, being among the first psychiatrists nationally to achieve board certification in the field. The prefix psycho- had been proposed for the geriatric programme, but White, knowing New Englanders’ aversion to anything psycho- lobbied successfully for the name geropsychiatric rather than psychogeriatrics.

What is the Geriatric Depression Scale?

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Introduction

The Geriatric Depression Scale (GDS) is a 30-item self-report assessment used to identify depression in the elderly.

The scale was first developed in 1982 by J.A. Yesavage and colleagues.

Outline

In the Geriatric Depression Scale, questions are answered “yes” or “no.” A five-category response set is not utilised in order to ensure that the scale is simple enough to be used when testing ill or moderately cognitively impaired individuals, for whom a more complex set of answers may be confusing, or lead to inaccurate recording of responses.

The GDS is commonly used as a routine part of a Comprehensive Geriatric Assessment. One point is assigned to each answer and the cumulative score is rated on a scoring grid. The grid sets a range of 0-9 as “normal”, 10-19 as “mildly depressed”, and 20-30 as “severely depressed”.

A diagnosis of clinical depression should not be based on GDS results alone. Although the test has well-established reliability and validity evaluated against other diagnostic criteria, responses should be considered along with results from a comprehensive diagnostic work-up. A short version of the GDS (GDS-SF) containing 15 questions has been developed, and the scale is available in languages other than English. The conducted research found the GDS-SF to be an adequate substitute for the original 30-item scale.

The GDS was validated against Hamilton Rating Scale for Depression (HRS-D) and the Zung Self-Rating Depression Scale (SDS). It was found to have a 92% sensitivity and an 89% specificity when evaluated against diagnostic criteria.

Scale Questions and Scoring

The scale consists of 30 yes/no questions. Each question is scored as either 0 or 1 points. The following general cutoff may be used to qualify the severity:

  • Normal 0-9.
  • Mild depressives 10-19.
  • Severe depressives 20-30.

Reference

Yesavage, J.A., Brink, T.L., Rose, T.L., et al. (1982) Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research. 17(1), pp.37-49.

Book: Psychotherapy in Later Life

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Book Title:

Psychotherapy in Later Life.

Author(s): Rajesh R. Tampi, Brandon Yarns, Kristina F. Zdanys, and Deena J. Tampi (Editors).

Year: 2020.

Edition: First (1st).

Publisher: Cambridge University Press.

Type(s): Paperback and Kindle.

Synopsis:

Psychotherapy in Later Life is a practical how-to-guide for psychiatrists, psychologists and mental health workers on choosing and delivering evidence-based psychological therapies to older adults.

It covers all the main evidence-based psychological therapies such as cognitive behavioural therapy (CBT) and interpersonal psychotherapy (IPT), as well as specialist topics such as combining psychotherapy with pharmacological treatments, working with diverse populations and individual versus group therapy.

The World Health Organisation estimates that over the next four decades, the proportion of the world’s older adults will nearly double, from 12% to 22%, and that one in five older adults has a diagnosable mental health disorder.

Given the increasing number of older adults requiring mental health treatment, incorporating talking therapies into treatment plans is key to tackling issues related to polypharmacy, medication interactions and side effects. Written by experts in geriatric mental health, this book provides the most authoritative information on the use of psychotherapy in older adults.

Deprescribing & Antidepressant Use in Older Adults

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Research Paper Title

Long term antidepressant use in a cohort of older people.

Background

Depression is the most common mental health problem in older adults and untreated is associated with significant burden of illness for patients. This study aimed to examine longitudinal patterns of antidepressant use in older adults and determine which factors were associated with changes in use.

Methods

Adults aged 50 and over, from the Irish Longitudinal Study on Ageing, who participated at any one of the four TILDA waves (n = 8,175) were included in the analysis. Repeated measures latent class analysis (RMLCA) is the model-based approach we used to identify underlying subgroups in a population.

Results

The researchers found antidepressant use ranged from 6% to 10%, over a 6-year period. RMLCA identified three distinct classes of anti-depressant use. Notably, 6% of older adults were categorised in a ‘long-term antidepressant use’ class, with consistent use across all four waves, and 6% were categorised in an ‘Intermittent/ Developing Use’ class. We found long-term antidepressant use to be a characteristic of older adults with chronic conditions at baseline of study and striking low uptake of psychological and psychiatric services.

Conclusions

These findings provide evidence of the complex presentations of depression with comorbidities in long-term antidepressant users. While prolonged use of antidepressants in an older cohort is often rationalised due to recurrent depression and comorbidities, this study suggests little deprescribing of antidepressants and a need for greater access and provision of psychological services tailored to later life seem necessary to improve management of this condition.

Reference

O’Neill, A., McFarland, J. & Kelly, D. (2021) Long term antidepressant use in a cohort of older people. International Journal of Geriatric Psychiatry. doi: 10.1002/gps.5518. Online ahead of print.

What is the Effect of ECT on Cognitive Functioning?

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Research Paper Title

Transient Cognitive Impairment and White Matter Hyperintensities in Severely Depressed Older Patients Treated With Electroconvulsive Therapy.

Background

Although electroconvulsive therapy (ECT) is a safe and effective treatment for patients with severe late life depression (LLD), transient cognitive impairment can be a reason to discontinue the treatment. The aim of the current study was to evaluate the association between structural brain characteristics and general cognitive function during and after ECT.

Methods

A total of 80 patients with LLD from the prospective naturalistic follow-up Mood Disorders in Elderly treated with Electroconvulsive Therapy study were examined. Magnetic resonance imaging scans were acquired before ECT. Overall brain morphology (white and grey matter) was evaluated using visual rating scales. Cognitive functioning before, during, and after ECT was measured using the Mini Mental State Examination (MMSE). A linear mixed-model analysis was performed to analyse the association between structural brain alterations and cognitive functioning over time.

Results

Patients with moderate to severe white matter hyperintensities (WMH) showed significantly lower MMSE scores than patients without severe WMH (F(1,75.54) = 5.42, p = 0.02) before, during, and post-ECT, however their trajectory of cognitive functioning was similar as no time × WMH interaction effect was observed (F(4,65.85) = 1.9, p = 0.25). Transient cognitive impairment was not associated with medial temporal or global cortical atrophy (MTA, GCA).

Conclusions

All patients showed a significant drop in cognitive functioning during ECT, which however recovered above baseline levels post-ECT and remained stable until at least 6 months post-ECT, independently of severity of WMH, GCA, or MTA. Therefore, clinicians should not be reluctant to start or continue ECT in patients with severe structural brain alterations.

Reference

Wagenmakers, M.J., Vansteelandt, K., van Exel, E., Postuma, R., Schouws, S.N.T.M., Obbels, J., Rhebergen, D., Bouckaert, F., Stek., M.L., Barkhof, F., Beekman, A.T.F., Veltman, D.J., Sienaert, P., Dols, A. & Oudega, M.L. (2021) Transient Cognitive Impairment and White Matter Hyperintensities in Severely Depressed Older Patients Treated With Electroconvulsive Therapy. The American Journal of Geriatric Psychiatry. S1064-7481(20)30597-2. doi: 10.1016/j.jagp.2020.12.028. Online ahead of print.

Aromatherapy & Mental Health

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Research Paper Title

The effects of Lavender and Chamomile essential oil inhalation aromatherapy on depression, anxiety and stress in older community-dwelling people: A randomised controlled trial.

Background

Considering the prevalence of mental health problems in older adults, this study aims to investigate the effect of inhalation aromatherapy using lavender and chamomile essential oils on depression, anxiety, and stress of community-dwelling older people.

Methods

A three-armed, parallel, randomised, and controlled trial design was used in this study. 183 participants were enrolled and randomly assigned to three groups (n = 61): the lavender, chamomile, and control groups. The participants in the experimental groups inhaled three drops of 1.5% lavender and chamomile essential oils for 30 nights. The participants in the control group inhaled only distilled water in a similar fashion. Data were collected using the Depression, Anxiety, and Stress-Scale (DASS) at baseline, immediately after the intervention, and one month after the intervention. Chi-square, Fisher’s exact, one-way ANOVA, and repeated measures ANOVA were used for data analysis.

Results

Statistically significant improvement occurred in depression, anxiety, and stress levels immediately and one month after the intervention in lavender and chamomile groups compared to the control group (p < 0.01).

Conclusions

Inhalation aromatherapy with both lavender and chamomile essential oils helped decrease depression, anxiety, and stress levels in community-dwelling older adults.

Reference

Ebrahimi, H., Mardani, A., Basirinezhad, M.H., Hamidzadeh, A. & Eskandari, F. (2021) The effects of Lavender and Chamomile essential oil inhalation aromatherapy on depression, anxiety and stress in older community-dwelling people: A randomized controlled trial. Explore (New York, N.Y.). doi: 10.1016/j.explore.2020.12.012. Online ahead of print.

Older People: Physical Health, Check; Mental Health, Overlooked

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Research Paper Title

Promoting active ageing in older people with mental disorders living in the community: An integrative review.

Background

Approximately 15% of older people aged 60 and above are experiencing a mental disorder. However, they are commonly unrecognised from health care providers.

Therefore the purpose of this research was to critically synthesise the evidence in relation to the promotion of active ageing in older people, including those with mental disorders.

Methods

This study is an integrative review. Articles published between January 2002 and March 2017 in English and in Thai were identified through searches of the databases CINAHL, MEDLINE, EMBASE, PsycINFO, and Thai LIS, as well as through manual searching.

Methodologically high-quality research articles were included if they addressed the promotion of active ageing and related concepts, the impact of mental disorders on active ageing and related concepts, the perspective of older people regarding active ageing, and issues related to working with older people with mental health problems living in the community.

Results

A total of 18 articles were included. The findings show that there is little evidence regarding the promotion of active ageing in older people with mental disorders.

Older people with mental disorders were less likely to achieve successful ageing compared with those without mental disorders, suggesting they need support from health care providers. However, there are several barriers to care and working with older people with mental disorders at the community level.

Conclusions

Of concern is that health professionals focus on the physical health of older people while mental health issues are overlooked.

Reference

Kenbubpha, K., Higgins, I., Chan, S.W-C. & Wilson, A. (2020) Promoting active ageing in older people with mental disorders living in the community: An integrative review. International Journal of Nursing Practice. 24(3):e12624. doi: 10.1111/ijn.12624. Epub 2018 Mar 30.

Pre-Clinical Dementia & Depression

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Research Paper Title

A cross-national study of depression in preclinical dementia: A COSMIC collaboration study.

Background

Depression commonly accompanies Alzheimer’s disease, but the nature of this association remains uncertain.

Methods

Longitudinal data from the COSMIC consortium were harmonized for eight population-based cohorts from four continents.

Incident dementia was diagnosed in 646 participants, with a median follow-up time of 5.6 years to diagnosis.

The association between years to dementia diagnosis and successive depressive states was assessed using a mixed effect logistic regression model.

A generic inverse variance method was used to group study results, construct forest plots, and generate heterogeneity statistics.

Results

A common trajectory was observed showing an increase in the incidence of depression as the time to dementia diagnosis decreased despite cross-national variability in depression rates.

Conclusions

The results support the hypothesis that depression occurring in the preclinical phases of dementia is more likely to be attributable to dementia-related brain changes than environment or reverse causality.

Reference

Carles, S., Carriere, I., Reppermund, S., Davin, A., Guaita, A. et al. (2020) A cross-national study of depression in preclinical dementia: A COSMIC collaboration study. Alzheimer’s & Dementia. doi: 10.1002/alz.12149. Online ahead of print.

International Day of Older Persons

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Introduction

The International Day of Older Persons is observed on 01 October each year.

On 14 December 1990 the United Nations General Assembly voted to establish 01 October as the International Day of Older Persons as recorded in Resolution 45/106.

The holiday was observed for the first time on 01 October 1991.

Purpose

The holiday is celebrated by raising awareness about issues affecting the elderly, such as senescence and elder abuse.

It is also a day to appreciate the contributions that older people make to society.

Similarities to Other Days

This holiday is similar to National Grandparents Day in the United States and Canada as well as Double Ninth Festival in China and Respect for the Aged Day in Japan.

The observance is a focus of ageing organisations and the United Nations Programme on Ageing.

Annual Themes

  • 1998 & 2000: Towards A Society for All Ages.
  • 2004: Older persons in an intergenerational society.
  • 2005: Ageing in the new millennium.
  • 2006: Improving the Quality of Life for Older Persons: Advancing UN Global Strategies.
  • 2007: Addressing the Challenges and Opportunities of Ageing.
  • 2008: Rights of Older Persons.
  • 2009: Celebrating the 10th Anniversary of the International Year of Older Persons: Towards a Society for All Ages.
  • 2010: Older persons and the achievement of the MDGs.
  • 2011: The Growing Opportunities & Challenges of Global Ageing.
  • 2012: Longevity: Shaping the Future.
  • 2013: The future we want: what older persons are saying.
  • 2014: Leaving No One Behind: Promoting a Society for All.
  • 2015: Sustainability and Age Inclusiveness in the Urban Environment.
  • 2016: Take A Stand Against Ageism.
  • 2017: Stepping into the Future: Tapping the Talents, Contributions and Participation of Older Persons in Society.
  • 2018: Celebrating Older Human Rights champions.
  • 2019: The Journey to Age Equality.
  • 2020: Pandemics: Do They Change How We Address Age and Ageing?

How Do People Celebrate International Day of Older Persons?

The celebration of International Day of Older Persons is done to create awareness and empathy regarding the well being of the elderly.

People usually celebrate the day by spending time with their grandparents, visiting old age homes and N.G.O’s and cooking or baking them. Some kids also give greeting cards to their elderly on this day.

Do Older Adults with Parent(s) Alive Experience Higher Psychological Pain and Suicidal Ideation?

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Research Paper Title

Do Older Adults with Parent(s) Alive Experience Higher Psychological Pain and Suicidal Ideation? A Cross-Sectional Study in China.

Background

Elderly mental health promotion is an important task in the current “Healthy China Action”.

This study aims to:

  1. Clarify the psychological pain and suicidal ideation of the Chinese elderly with different parental states;
  2. Examine the associated factors of psychological pain and suicidal ideation; and
  3. Examine the relationship between psychological pain and suicidal ideation.

Methods

A sample of 4622 adults aged 60 years and older were included in this study, from the China’s Health-related Quality of Life Survey for Older Adults 2018.

Results

Participants with both parents alive demonstrated the heaviest psychological pain, and those with one parent alive observed significantly lowest psychological pain and suicidal ideation.

Participants who were single, divorced, or widowed, live in rural areas, had higher education level, had lower family income, suffered from two or more chronic diseases, and had no self-care ability were more likely to experience psychological pain and suicidal ideation.

In addition, higher psychological pain was significantly associated with the occurrence of suicidal ideation.

Conclusions

In China, much more attention should be paid to the mental health condition of the elderly, especially for those with both parents alive.

Moreover, the associated factors above should be considered to develop targeted health interventions.

Reference

Yang, Y., Wang, S., Hu, B., HAo, J., Hu, R., Zhou, Y. & Mao, Zongfu. (2020) Do Older Adults with Parent(s) Alive Experience Higher Psychological Pain and Suicidal Ideation? A Cross-Sectional Study in China. International Journal of Environmental Research and Public Health. 17(17), pp.E6399. doi: 10.3390/ijerph17176399.