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Background: Within the mental health care services for older persons there is a growing need for insight into and evaluation of the results of clinical treatment. The Health of the Nations Outcome Scales 65+ (honos65+) is a promising instrument for the assessment of mental, social and physical health in older persons, but it is not yet known whether it is valid for older persons in the Netherlands., Aim: To assess the reliability, validity and sensibility to change of the honos65+ when applied to older persons with psychiatric disorders., Method: The bio-psycho-social level of functioning of clients aged 60 and over (n=168) receiving mental health care was assessed by means of existing and validated measuring instruments and the results were compared with those obtained with the honos65+. Three months later the population sample was re-assessed in order to test the extent to which the honos65+ was sensitive to change., Results: The reliability and validity of the honos65+ could be ascertained for 168 clients aged 60 and over. After three months 116 clients were re-assessed so that the sensitivity of the honos65+ to change could be noted., Conclusion: The honos65+ is a reliable and valid instrument for assessing clients with affective disorders such as depression and anxiety and for detecting changes in clients’ problems and functioning. No conclusions could be reached regarding the reliability and validity of the honos65+ when used for clients with other psychiatric disorders because the clinical subgroups were too small for patterns to be detected.

Background: In psychiatry for older adults (> 60 years) personality disorders play an important part in diagnosis and treatment and in the advice given to health professionals and carers on how to deal with this age group. So far, however, research in this area has been inadequate., Aim: To investigate age-related diagnostic and therapeutic aspects of personality disorders occurring in adults over the age of 60., Method: A Delphi-study was conducted among 35 Dutch and Belgian experts in the field of personality disorders in older adults. This multidisciplinary panel consisted of psychiatrists, psychologists, psychotherapists, geriatricians and psychiatric nurses. In four rounds 21 gerontological statements to be assessed on a 5-point Likert scale were presented to the panel of experts. Agreement was said to be reached when at least two thirds of the experts agreed or fully agreed with a statement.RESULTS Satisfactory agreement was reached in the case of 20 of the 21 diagnostic and/or therapeutic statements about older adults with personality disorders. CONCLUSION There seem to be various age-specific aspects in the diagnosis and treatment of personality disorders in older adults. Therefore, it is advisable to pay more attention to this highly complex group of older adults when guidelines and protocols are being drawn up and scientific research is being planned or conducted.

This article deals with the question of whether the recently published Multidisciplinary guideline on Personality disorders is unreservedly applicable to older persons. It is concluded that the guideline is on the whole of clinical relevance with regard to older persons, but for such persons certain aspects of the guideline concerning for instance the course of the disorder, diagnosis and treatment, need to be modified. Since the Netherlands has a steadily ageing population, greater concern for older persons with personality disorders is not only of clinical relevance, but is also essential for scientific research in the future.

Background: In the last few years mental healthcare has had to become increasingly accountable to health insurance companies, the government and patient groups with regard to the efficacy, appropriateness and patient-friendliness of the care provided. Routine outcome assessment, based on various measuring instruments, is likely to become more and more frequent in the years to come., Aim: To assess whether the Health of the Nation Outcome Scales for elderly people (HoNOS65+) can be successfully implemented within a psychiatric unit for older persons, whether the instrument is suitable for use in clinical practice and whether it provides an adequate picture of the older population in general., Method: The implementation phase consisted of training 51 social workers within the various sections of the unit. The trained social workers used the HoNOS65+ with 387 patients from various units for older persons within Lentis., Results: The social workers found the HoNOS65+ to be a useful instrument and for each treatment setting and diagnosis it differentiated significantly between types of behaviour problems, symptoms and social problems., Conclusion: The HoNOS65+ can be used profitably with individual patients and patient groups and it highlights the problems in relevant areas of psychiatry for older persons.