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Background: There is a high prevalence of mental illness in nursing home residents compared to older adults living in the community. This was highlighted in the most recent comprehensive systematic review on the topic, published in 2010. In the context of a rapidly aging population and increased numbers of older adults requiring residential care, this study aims to provide a contemporary account of the prevalence of mental illness among nursing home residents. Methods: This protocol was prepared in line with the PRISMA-P 2015 Statement. Systematic searches will be undertaken across six electronic databases: PubMed, Embase, Web of Science, PsycNET, CINAHL, and Abstracts in Social Gerontology. Peer-reviewed studies published from 2009 onwards which report the prevalence of mental illness within nursing home populations will be included. Database searches will be supplemented by forward and backward citation searching. Titles and abstracts of records will be screened using a semi-automated process. The full text of selected records will be assessed to confirm inclusion criteria are met. Study selection will be recorded in a PRISMA flowchart. A pilot-tested form will be used to extract data from included studies, alongside the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data. A study characteristics and results table will be prepared to present key details from each included study, supported by a narrative synthesis. Random-effects restricted maximum likelihood meta-analyses will be performed to compute pooled prevalence estimates for mental illnesses represented in the identified studies. Heterogeneity will be assessed using Cochran's Q and Higgins' I2 statistics. A Funnel plot and Egger's test will be used to assess publication bias. The GRADE approach will be used to assess the quality of the body of evidence identified. Discussion: The study will provide a comprehensive and contemporary account of the prevalence of mental illness among nursing home residents. Meta-analyses will provide robust prevalence estimates across a range of presentations. Key insights will be highlighted, including potential sources of heterogeneity. Implications for residents, researchers, care providers, and policymakers will be noted. Systematic review registration: PROSPERO: CRD42023456226. [ABSTRACT FROM AUTHOR]

There will be an increased need for psychologists to provide mental health services in residential aged care facilities. Experience while training is invaluable to improving both confidence and interest in working in this area. Awareness of potential barriers and ethical situations that may impede good mental health care is necessary when providing supervision. This paper reviews issues that supervisors need to be aware of when working with students in this clinical space. Barriers and enablers of clinical placements in residential aged care settings are discussed. Models of care, ethical considerations relating to risk, consent and working systemically, multiple clients, practical difficulties of being off-site and clinical aspects of adapting therapy to residential care settings are identified as key issues related to supervising students. Potential solutions, resources and practical approaches to these issues are also highlighted. A positive approach to the complexities of working in residential aged care settings can lead to quality supervision and clinical care in this much needed area. What is already known about this topic: There is a high degree of mental health issues amongst older adults living in residential aged care. Concerns have been raised about how clinical psychologists will meet future workforce demands. There is a lack of supervisors with experience in providing clinical guidance in this area. What this topic adds: Supervising in residential aged care has been enabled by an increased level of funded psychological services available to aged care residents in Australia. Several unique ethical issues can arise within supervision in residential aged care contexts that need to be discussed with students to improve their competence. There are practical approaches to adapting clinical interventions and working systemically that serve to facilitate a student's placement journey in residential aged care. [ABSTRACT FROM AUTHOR]

Background: This protocol describes a study of the effectiveness of cognitive behaviour therapy (CBT) for reducing depressive symptoms in older adults living in residential aged care (RAC) facilities in Australia. Depressive symptoms are highly prevalent in this population, yet the benefits of CBT for reducing such symptoms in RAC facilities have not been widely investigated. Elders at Ease (ELATE) is a 16-session CBT intervention designed for implementation in RAC facilities. The intervention includes cognitive, behavioural and reminiscence strategies and is delivered by mental health trainees (MHTs) in collaboration with RAC facility staff and residents' family. Methods and analysis: ELATE will be evaluated using a cluster randomised trial comparing outcomes for residents who participate in the intervention with those living in usual care control facilities. The participants are RAC residents aged 65 years or above, with depressive symptoms (Patient Health Questionnaire-2 ≥ 3) and normal cognition or mild cognitive impairment (Standardised Mini Mental Status Examination ≥ 21). They are assessed at four time points: baseline prior to randomisation (T1), mid-treatment (T2; 2.5 months post randomisation), post-treatment (T3; 5 months post-randomisation) and 3-month follow-up (T4; 8 months post randomisation). The primary outcome is change in depressive symptoms between T1 and T3. Secondary outcomes are depressive symptoms at T4, anxiety, suicide ideation, sleep problems, quality of life, staff and family knowledge of late-life depression, stress levels and efficacy in caring for residents, and MHT levels of geropsychology competencies. Residents receiving the intervention are hypothesised to report a greater decrease in depressive symptoms between T1 and T3 compared to residents receiving usual care. The primary analysis is a regression, clustered over site to account for correlated readings, and independent variables are condition and depressive symptoms at T1. A cost-utility analysis is also undertaken. Discussion: ELATE is a comprehensive CBT intervention for reducing depressive symptoms in RAC residents. It is designed to be implemented in collaboration with facility staff and residents' families, individually tailored to residents with normal cognition to mild cognitive impairment and delivered by trainee therapists. ELATE offers a model that may be widely applicable across the RAC sector. Trial registration: Trial registered with the Australian and New Zealand Clinical Trial Registry (ANZCTR) Number ACTRN12619001037190, prospectively registered on 22 July 2019. [ABSTRACT FROM AUTHOR]

Cognitive behavioral therapy (CBT) for depression and anxiety for older adults living in residential aged care facilities (RACFs) needs to accommodate the care needs of residents and the circumstances of RACFs. This systematic review examines the delivery and content characteristics of these interventions, in relation to participant satisfaction, staff appraisal, uptake rate, attrition rate, and treatment effectiveness. Such a review could provide important information for the development of future CBT-based interventions. Studies that examined the application of CBT for depression or anxiety in RACFs were identified by systematically searching a number of relevant databases. Reference lists of all included studies were examined, and citation searches on the Web of Science were conducted. Two independent reviewers were involved in screening articles and in extracting data and assessing methodological quality of the selected studies. Across the 18 studies included in this review, the most common therapeutic strategy was pleasant activities scheduling. Studies varied on treatment duration (2–24 weeks), number of sessions (6–24), and length of sessions (10–120 min). Residents and staff members were satisfied with the CBT interventions. The average uptake rate was 72.9%. The average attrition rate was 19.9%. Statistically significant results were reported in 8 of the 12 randomized controlled trials (RCTs). In these eight RCTs, CBT was characterized by psychoeducation, behavioral activation, and problem-solving techniques; further, the therapists in six of these studies had training in psychology. CBT interventions for depression and anxiety are acceptable to RACF residents and judged positively by staff members. Effective studies differed from non-effective studies on content and training characteristics, but not on other delivery features. [ABSTRACT FROM AUTHOR]

Psychosocial approaches to the management of behavioural and psychological symptoms of dementia have received much support in the scientific literature. The following paper focuses on cognitive behaviour therapy as a valid framework in assessing and treating people with behavioural and psychological symptoms of dementia. The importance of identifying symptoms of depression and anxiety is emphasized, as cognitive behaviour therapy has been shown to be an effective intervention for these conditions in older adults. Modifications of cognitive behaviour therapy for those with dementia are discussed based on available evidence, with emphasis on incorporating nursing home staff in treatment programs and focusing on behavioural elements of cognitive behaviour therapy such as activity scheduling. The paper concludes with suggestions regarding how to incorporate and promote the use of cognitive behaviour therapy in dementia care settings. [ABSTRACT FROM AUTHOR]

Objective Rates of depression and anxiety are high among older adults in residential aged care facilities (RACFs). This study examined the extent to which psychological services are made available to facility residents in Australia, and investigated barriers to accessing such services. Method The sample consisted of 90 senior staff from a random sample of RACFs. Participants completed self-report questionnaires regarding their perspectives on the availability of psychological services and potential barriers to access psychological services. Results Access to psychological services was poor. Psychologists were employed at a rate only one third that of other providers of mental health services. Residents were rarely referred to psychologists or to psychological treatments. The most important barriers to access, as perceived by participants, were the low availability of psychologists specialising in treating older adults, lack of government funding for such access, and limited staff training in detecting depression and anxiety. Conclusion Access to psychologists and psychological services remains poor in Australian residential aged care settings. Such access may be improved by developing a workforce of clinical geropsychologists, improving funding mechanisms for residents to access psychological services, and addressing staff knowledge about depression and anxiety. [ABSTRACT FROM AUTHOR]

Objective This brief examines the evidence that is currently available to inform the provision of psychological services within aged care services, considering both residential care and home care settings. Method A narrative literature review of the literature evaluating psychological approaches for common conditions in aged care settings was conducted, focusing on the assessment and treatment of common mental health disorders and dementia. Information on the current employment and training of Australian psychologists in geropsychology was also summarised. Results While further research is required, existing literature provides a clear rationale for the benefit of psychological approaches to address a range of conditions, including the management of dementia. There is only limited research focusing specifically on the home care setting, despite the increasing number of older adults who receive aged care services in their own homes. The current provision of psychological services in Australia is critically low, driven in part by funding limitations. Meanwhile, substantial gaps remain in the training provided to provisional psychologists. Conclusion A number of key recommendations are made to address the growing need for age-specific psychological assessments and interventions to be included as part of the delivery of aged care services in this country. Given the continued high prevalence of mental health disorders and dementia within aged care settings, as well as even higher rates of subthreshold conditions, improved access to psychological services for older Australians must become a priority. [ABSTRACT FROM AUTHOR]

It is well-documented that the population of much of the developed world is aging. On the one hand, this represents a success story in terms of reducing deaths from infectious and a number of systemic diseases, most notably cardiovascular disease. On the other hand, it also presents a challenge to provide adequate health services to a population with rapidly increasing longevity, as well as an opportunity to develop policies that can assist in promoting good physical and mental health. A number of authors have asked whether we are ready to meet the challenges of an aging population (Doyle et al., 2009; Connolly, 2012). Over the years, prominent psychologists have suggested that clinical psychology could play a greater role in the provision of services for older adults, and lamented the apparent lack of enthusiasm on the part of psychologists to work with this group (e.g. Karel et al., 2012). In this paper, we examine a range of questions pertinent to this theme: where are the psychologists in the provision of mental health services to older adults? What contribution can psychologists make to improve the mental health of this growing sector of the population? How can we encourage more psychologists to specialize in working with older adults? [ABSTRACT FROM PUBLISHER]

Aim: To identify the most common and distressing behavioural and psychological symptoms of dementia (BPSD) in nursing homes and to identify staff preferences regarding its behavioural management. Method: A descriptive cross-sectional survey was completed by a self-selected sample of 247 staff working in 21 nursing homes in a defined catchment area. The survey contained items relating to experience in aged care work, attitudes towards BPSD, ratings of the importance of certain behavioural strategies for managing BPSD, and the Challenging Behaviour Scale. Results: Shouting, wandering and restlessness had the highest incidence, frequency and difficulty ratings. Frequency of BPSD and level of satisfaction with how they were managed had the greatest effect on overall level of difficulty in managing behaviours. Staff rated discussing behavioural concerns at a group level and with senior nursing staff as the most important behavioural strategies. Conclusion: A strong relationship was found between frequency and difficulty of BPSD. Therefore, interventions targeted at lowering frequency of BPSD are recommended. Communication across a number of levels may enhance the implementation of behavioural interventions. [ABSTRACT FROM AUTHOR]

The Mini-Mental State Examination (MMSE) is one of the most commonly used instruments to screen for cognitive deficits within the hospital setting. However training in how to administer this widely used tool is scarce with little, if any, formal training for nursing staff. Scores are also often misused with over reliance on results and cut-offs to support a diagnosis of dementia within the acute and sub-acute aged care context. The present study assessed the level of training and accuracy in administering the MMSE within a geriatric in-patient rehabilitation ward. Ratings of the level of knowledge, training and confidence in administering the MMSE were obtained from 16 registered nurses and two medical officers before and after an education session on the uses of the MMSE and correct administration. Objective assessment of competencies in administration was also obtained with interrater reliability scores demonstrating high accuracy in the use of this screening instrument. Knowledge improved following the training session, but confidence scores remained unchanged. Results also indicated limited knowledge regarding the necessity for cognitive screening in an aged care setting. Inconsistency in administration of certain items was also identified as a concern. Strategies for improving the quality of administration are identified and discussed. [ABSTRACT FROM AUTHOR]

Despite the growing number of older adults that implies an increasing need for psychological services, few psychologists choose to specialize in working with older clients. The present cross-sectional research examined predictors of student interest in working with older clients in an effort to understand factors that may influence future psychologists to work in this area. The targeted sample consisted of Australian postgraduate psychology students whose course coordinators responded to a request to participate in this national survey. Four hundred and thirty-one postgraduate trainee psychology students completed the survey that examined training, contact, and attitudinal variables. This represents a 45.3% response rate from surveys being distributed by course coordinators. Having undergone or intending to do a placement within an aged care setting was the most powerful predictor of interest, with confidence in working with the elderly, and positively anticipating old age being attitudinal factors related to increased interest. Amount or quality of contact with older adults and normal education through aging-related coursework failed to predict interest, based on hierarchical regression analysis. Implications for future training of psychologists highlight the importance of quality clinical experiences with older clients during training as opposed to pure coursework. [ABSTRACT FROM AUTHOR]

Little recent objective evidence exists to qualify past concerns regarding the low numbers of psychologists working with older adults in Australia. The present study reports on figures from two surveys of Australian psychologists, finding that of the 1,699 psychologists surveyed, only 6% specialise in treating older adults. This figure is comparable to those from studies conducted overseas, where more training and employment opportunities are available. Reasons for such low figures are explored together with recommendations to meet the future demand for psychological services as the proportion of elderly adults within the Australian population increases. [ABSTRACT FROM AUTHOR]

The article presents clinician's quick guide of evidence-based approaches on psychological treatments for depression and anxiety with older adults living in residential aged care facilities. Topics include individuals are among the most vulnerable in our society, with high rates of depressive and anxiety symptoms; and psychological interventions that have been validated for residential aged care populations include cognitive-behavioral and reminiscence therapies.

Despite increasing numbers of older people in the Australian population, few psychologists work with this segment of the population. The prevalence of psychological disorders in this age group is substantial and there is increasing evidence for the effectiveness of psychological treatments for these conditions in older adults. This study explored the reasons for the limited number of psychologists who work with this growing population. A survey of more than 500 Australian psychologists based in Sydney, Australia, used the Reactions to Ageing Questionnaire to assess attitudes, and other questions enquired about training, current practice, and interest in work with older adults. The response rate was 39%, with 17% of the respondents being specialists in work with older adults. Stereotyped attitudes did not differentiate specialists from generalists, but interest in therapy with older adults did, along with age, years of practice and working in an aged care setting. While the limited survey restricts the generalisability of the results, they do suggest that training in itself is not sufficient to overcome a reluctance to work with older adults. Supervised practice settings appear to be effective, but greater efforts are needed to increase both academic training and work settings for work with older adults in Australia. [ABSTRACT FROM AUTHOR]

The practice of psychology covers the range of ages from conception through to the end of life and palliative care. Psychologists practice in a variety of roles, but the majority of these roles involve interactions with nonprofessionals of varying ages. These interactions are governed by codes of ethical practice, whether these are developed by the funding bodies for research activities, professional associations, or regulatory bodies. Ethical codes vary in their format and emphasis, but all have the protection of the public as a major purpose. Often there are special provisions in these codes for particular populations or circumstances. Here we describe the development of ethical guidelines for the practice of psychology with older adults in Australia and report on those guidelines and their supporting literature. [ABSTRACT FROM AUTHOR]

The increase in the proportion of the over-65 population in Australia has not been recognised in the field of psychological research and practise. It is suggested that further research is needed to identify risk factors for psychological problems in this age group. The little research that is available supports the use of psychological interventions in the management of common problems of everyday living amongst elderly clients. It is argued that the wider adoption of such early intervention techniques may help to prevent the occurrence of more serious mental health problems. Australian psychologists are encouraged to play a more active role in devising appropriate treatments and in conducting additional studies of the effectiveness of both new and existing treatments in this age group. In particular, studies on the effectiveness of treatments for problems such as bereavement, chronic pain, and elder abuse are identified as potential growth areas for psychologists. [ABSTRACT FROM AUTHOR]

Australia has fallen behind overseas counterparts in the area of geropsychology, and clinical geropsychology in particular. Older Australians are not getting the level of psychological services needed on the basis of their status as a large and growing proportion of the population, nor in terms of the level of psychological problems they experience. Research showing the efficacy of psychological interventions in this age group is briefly reviewed. Given the established need and demonstrated efficacy of psychological interventions in this age group, reasons for the paucity of psychological services to the Australian aged are then explored. Finally, possible solutions to this problem are presented, with an emphasis on the need for increased attention to geropsychology in clinical psychology training. This includes the need for students to be exposed to older adults in their practical placements, both in order to dispel stereotypes and to generate interest in this neglected and growing segment of the population. [ABSTRACT FROM AUTHOR]

The applicability for older patients of cognitive (CT) and cognitive-behavioural (CBT) therapies for depression, now well established for clinical populations aged less than 65 years, was reviewed. Eighteen English language articles published to the end of 1994 were located using Medline, Psychlit and key reference searches. Outcome data from seven studies indicate that CT is clearly more effective than no therapy or placebo, through prediction of success remains uncertain. Several variables may influence outcome. Outcome in younger and older depressives with CT was comparable. Adaptation of cognitive-behavioural techniques for older depressives is described. While these may enhance CT's efficacy with older people, they as yet lack empirical evidence. The review, though limited, concludes that CT is an effective intervention for depression in older people and recommends strategies for further research to enable more accurate targeting of therapy. [ABSTRACT FROM AUTHOR]

Objective: To assess attitudes towards personal ageing among Australian psychologists. Methods: Six hundred and four practising psychologists were surveyed using the Reactions to Ageing Questionnaire (RAQ). Potential predictors of attitudes to ageing, such as age, gender and number of years in clinical practice were examined, together with the amount and quality of contact with older family members and older friends. Measures related to the training of psychologists were also of interest. Results: The strongest significant predictors of attitudes to ageing were respondents’ age and positive attitudes towards conducting therapy with older clients. Contact and training variables were not associated with scores on the RAQ. Conclusion: These results highlight age as a contributing factor in attitude formation. [ABSTRACT FROM AUTHOR]

Presents a correction to the article "Cognitive Therapy for Depression in the Elderly" which was previously published in the 1996 issue of the "International Journal of Geriatric Psychiatry."