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Objectives: This study aimed to describe existing knowledge of crisis supporters (volunteers responding to crisis calls/texts/messages) regarding self-harm and suicide in older adults and investigate knowledge translation through use of a novel online adaptive learning tool.Methods: The online educational tool was tested in an Australian national sample of crisis supporters (trained volunteers) aged 18+. Knowledge Transfer was evaluated utilizing a pre/post intervention methodology for data collection. The collaboratively developed online educational tool comprised a pre-test (10 questions), middle learning module (individualised for participant's incorrect pre-test responses) and post-test (10 questions) on suicidal behaviours in older adults. Data analysed included the demographic characteristics of the participants, individual question scores, and summed pre- and post-tests scores. Group differences in change scores were assessed with either one-way between subjects ANOVA or independent samples t-test, depending on the number of groups within each variable. Pre-post education comparisons on individual change in scores were made using a paired samples t-test. Statistical significance was defined as p <0.05.Results: 104 crisis supporters completed the tool (pre-test, middle lesson and post-test). There was significant improvement in knowledge of crisis supporters after the intervention (pre-test scores Mean (M) = 4.56, SD = 1.62 and post-test scores M = 7.61, SD = 1.60; t (103) = 17.242, p <0.001.).Conclusion: Dedicated training about suicidal behaviors in older adults is needed given their high rates of suicide and differing underlying reasons and needs compared to younger adults. [ABSTRACT FROM AUTHOR]

The human right to a good death and dying well is as important as the right to life. At stake at the end of life are human rights to dignity, autonomy, self-determination and respect for will and preferences, equitable access to quality health care that is needs-based, and respect for family and relationships. Older people with dementia, those with serious mental illness, and those with intellectual disability are vulnerable to "bad deaths" due to violations of these rights. In this paper we explore why this is so and examine existing and potential solutions. A human rights-approach to end-of-life care and policy for older persons with mental health conditions and psychosocial disability is one that is needs-based, encompassing physical and mental health, palliative care, social, and spiritual support services provided in the context of inclusive living. Most importantly, end of life care must be self-determined, and not "one size fits all." An important remedy to existing violations is to strengthen human rights frameworks to cater specifically to older persons' needs with a UN convention on the rights of older persons. Finally, as health professionals we have important contributions to make at the coalface by accepting our responsibilities in the area of death and dying. With the concept of the palliative psychiatrist gaining traction and recognition that death is our business, we add that human rights is also our business. [ABSTRACT FROM AUTHOR]

Ageism and human rights violations may pervade each of the potential factors underlying suicidal ideation or behavior in older persons, including physical and mental health, disability, relationships, and social factors. We outline how infringements of human rights and ageism may create or exacerbate risk factors associated with suicide in older persons. Strategies to address these issues are discussed, including tackling ageism, psychosocial interventions and education. A United Nations convention on the rights of older persons would create a uniform standard of accountability across health and social systems. Future studies are needed to evaluate the effects of alleviating ageism and human rights violations on suicide. [ABSTRACT FROM AUTHOR]

Objectives: To examine the perspectives of people aged 80 years or older who self-harmed regarding their reasons for self-harm and its consequences, and their perceptions of care.Design: A qualitative study using in-depth interviews.Setting: Participants were recruited from two teaching hospitals and associated community services.Participants: People aged 80 years or older who had self-harmed within the previous month.Methods: Structured psychiatric assessment including cognitive testing, DSM-5 diagnosis, and an in-depth qualitative interview focusing upon the reasons for and consequences of self-harm. Narrative enquiry was used to guide the discussion. All interviews were undertaken by a geriatric psychiatrist, audio recorded, transcribed verbatim, and subjected to thematic analysis using N-VIVO.Results: Themes that emerged for the reasons for self-harm included "enough is enough"; "loneliness"; "disintegration of self"; "being a burden"; "cumulative adversity"; "hopelessness and endless suffering"; "helplessness with rejection"; and "the untenable situation". Themes for the consequences of self-harm were "becoming engaged with or distanced from family"; "the problem was solved"; "gaining control"; "I"m worse off now"; "rejection by health professionals"; and "tension in the role of the inpatient clinical environment".Conclusions: Self-harm may communicate a need that cannot otherwise be expressed. An individualized person-centered approach is required to respond to self-harm, including a combination of practical, medical, and psychological approaches as indicated. Involvement of families in the process of understanding the meaning of and responding to self-harm through education and family therapy, as well as education of healthcare professionals beyond risk factor notation may be indicated. [ABSTRACT FROM AUTHOR]

Objective: Consultation-liaison psychiatry (CLP) services vary in terms of structure, function and responsiveness. It is not known whether evaluation measurements can be meaningfully compared across different CLP services to assess value and efficiency. The aim was to develop and test a common tool for measuring process and outcome measures in CLP.Methods: A data collection tool was developed using the literature and consultation with CLP clinicians. The tool was used to prospectively gather referral data, response times, health utilisation data and functional outcomes for individuals referred over seven months to three different CLP teams, servicing inner city, district and regional areas.Results: The structure, staffing, liaison attachments and scope of practice varied between the services. The regional CLP service attended seven hospitals and had the highest referral rate and largest inpatient population pool. The three services received referrals for similar reasons and made similar diagnoses. Multimodal management was the norm, and CLP facilitated follow-up arrangements upon discharge. Only the district CLP service saw all emergency referrals within an hour. Age and need for an interpreter did not affect response times.Conclusion: Despite local differences in geography, CLP roles, hospital and community mental health service pathways and patient populations, the CLP data collection tool was applicable across sites. Staff resourcing and referral demand are key determinants of CLP response times. [ABSTRACT FROM AUTHOR]

Background: Systematically targeting modifiable risk factors for delirium may reduce its incidence. However, research interventions have not become part of routine clinical practice. Particular approaches to the education of clinical staff may improve their practice and patient outcomes. Objectives: To evaluate the effectiveness of a multifaceted educational program in preventing delirium in hospitalised older patients and improving staff practice, knowledge and confidence. Design: A before and after study. Setting: A 22-bed general medical ward of a district hospital in Sydney, Australia. Participants: Patients were aged 65 years and over and not delirious upon admission. Of 568 eligible patients, 129 were recruited pre-intervention (3 withdrew initial consent) and 129 patients post-intervention. Methods: Prior to the intervention, in order to establish a baseline, patients were assessed early after admission and again at discharge. The intervention was a one-hour lecture on delirium focusing on prevention for medical and nursing staff followed by weekly interactive tutorials with delirium resource staff and ward modifications. Following the initial education session, data were gathered in a second group of medical ward patients at the same time-points to ascertain the effectiveness of the intervention. Pre and postintervention data were analysed to determine change in staff objective knowledge and self-ratings of confidence and clinical practice in relation to delirium. The main outcome measures were incident delirium and change in staff practice, confidence and knowledge. Results: The mean age of patients was 81. The pre and post-intervention groups were comparable, aside from greater co morbidity in the pre-intervention group (F(1, 253) = 9.20, p = 0.003). Post-intervention there was a significant reduction in incident delirium (19% vs. 10.1%, X2 = 4.14, p = 0.042), and improved function on discharge (mean improvement 5.3 points, p < 0.001, SD 13.31, 95% CI -7.61 to -2.97). Staff objective knowledge of delirium improved post-intervention and their confidence assessing and managing delirious patients. Staff addressed more risk factors for delirium postintervention (8.1 vs. 9.8, F(1, 253) = 73.44, p < 0.001). Conclusions: A low-cost educational intervention reduced the incidence of delirium and improved function in older medical patients and staff knowledge and practice addressing risk factors for delirium. The program is readily transferable to other settings, but requires replication due to limitations of the before and after design. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this study was to review how the effectiveness of consultation liaison psychiatry (CLP) services has been measured and to evaluate the strength of the evidence for effectiveness. Methods: Systematic review of medical databases using broad search terms as well as expert opinion was sought. The literature search was restricted to studies of general, whole-of-hospital inpatient CLP services. Results: Forty articles were found and grouped into five measurements of effectiveness: cost effectiveness including length of stay, concordance, staff and patient feedback, and follow-up outcome studies. All measurements contributed to the evaluation of CLP services, but no one measure in isolation could adequately cover the multifaceted roles of CLP. Concordance was the only measurement with an established, consistent approach for evaluation. Cost effectiveness and follow-up outcome studies were the only measures with levels of evidence above four, however the three follow-up outcome studies reported conflicting results. Subjective evidence derived from patient and staff feedback is important but presently lacking due to methodological problems. The effectiveness of CLP services was demonstrated by cost-effectiveness, earlier referrals to CLP predicting shorter length of stay, and concordance with some management recommendations. Conclusion: There is evidence that some CLP services are cost-effective and reduce length of stay when involved early and that referrers follow certain recommendations. However, many studies had disparate results and were methodologically flawed. Future research should focus on standardising patient and staff feedback, and short-term patient outcomes. [Copyright &y& Elsevier]

A linguistically diverse cohort of 126 medical inpatients 65 y and over was recruited to determine rates of delirium after admission, associated outcomes, and staff detection of delirium. A clinical interview and cognitive and functional questionnaires were completed with the patient and their carer, and files were reviewed. The incidence of delirium at comprehensive assessment early after admission was 10.3% and the overall incidence 19.1% over the whole admission. Cognitive impairment was common (n = 80, 63.5%), including 61 patients (48.4%) who had dementia. Most patients (83%) with delirium had dementia. Staff recognized less than 21% of patients with delirium, 33% of patients with dementia, and 36% of cognitively impaired patients. There was no difference in outcomes between English and non- English speaking patients. Given the high prevalence and poor recognition of cognitive disorders in older people, routine cognitive screening should occur. Staff education should focus upon improving delirium detection and addressing the needs of cognitively impaired older inpatients. [ABSTRACT FROM AUTHOR]

Introduction In an ageing population, very old men appear most vulnerable to suicide. Most suicide research in late life is quantitative and focuses on determining the risk factors for suicidal behaviour. There is a close relationship between self-harm in older people and suicide; with shared risk factors and greater intent to die and lethality of self-harm in older people. Few studies have explored the experience or meaning of self-harm in older people, the experiences of care and outcomes. This study seeks to understand the outcomes for a cognitively, culturally and linguistically diverse cohort of older people who have harmed themselves, their needs, and perceptions of clinical care. We hypothesise that participants who have not had their needs met following the self-harm will remain distressed, with ongoing thoughts of or actual self-harm, and poorer engagement with clinical services. Methods A cohort of 27 people aged 80 or more and their 29 nominated carers who were interviewed after an episode of self-harm a year earlier, were followed-up. Outcomes including recurrence of self-harm, hospitalisation, contact with mental health services, place of residence, and death were recorded. In addition to information obtained by interview, the medical records of patients were screened for outcomes. Individual qualitative interviews utilised narrative inquiry to facilitate participants' discussion of their reflections upon the self-harm, clinical care and outcomes. Audio recordings were transcribed and N-VIVO used to perform the thematic analysis. Results Eighteen people aged over 80 who had self-harmed and 25 of their carers were available at follow-up. Six of the patients and one carer died of natural causes during the follow-up period. There were no deaths by suicide. Four participants declined to participate and one could not be contacted. In the follow-up period four participants (4/18 = 22%) had repeated self-harm and 16/27 (60%) were living in residential care. Three of the four patients who repeated self-harm were living in a facility, which for two patients was the main contributing factor to repeat self-harm. By contrast, not moving into residential care after the initial self-harm was a key reason underlying repeat self-harm for another patient. Repeat self-harm in the fourth patient related to symptoms of psychotic depression. Themes from the patient interviews were grouped under three headings; reflections on the self-harm (subthemes: denial and avoidance; secrecy; the persistent wish to die); perceptions of alienation from the clinicians (mistrust; ignored and invalidated) and the perceived outcomes of self-harm which were largely negative (persistent suffering and hopelessness; rejection; being a burden; miserable in residential care), but not exclusively (the problem was fixed; eliciting care). Carer themes included reflections on the self-harm (subthemes: denial and avoidance; secrecy; the persistent wish to die); perceptions of alienation from the clinicians (therapeutic nihilism; ignored and invalidated; craving communication; risk management) but also a divergent theme of holistic integrated care; and reflections on perceived outcomes (carer burden; untreated depression and suffering; resigned acceptance; better understanding of the patient). Reactions to residential care were complex and predominantly negative - subthemes included distress at initial adjustment to residential care; grief and guilt at residential care; defeated and waiting to die; desperate to leave; and poor quality care. A divergent subtheme regarding residential care was they are cared for now. Conclusions There was considerable synergism between patient and carer themes, suggesting triangulation of data generation. Specifically, reflections on self-harm were characterised by denial, avoidance, secrecy, and often a persistent wish to die. Such maladaptive responses suggest a role for interventions which enhance insight and promote openness. The considerable reported carer burden identified at baseline and still present a year later was independently identified and appreciated by patients; a key target for ongoing clinical care. Self-harm would ideally be met with a clinical response of better engagement of patients and carers, not alienation and invalidation as was reported. Education for clinical staff should anticipate and actively address such perceptions. Some older people moved into residential care as a consequence of their self-harm. A striking aspect of the perception of outcomes for both patients and carers was the distress associated with living in residential care. Although nursing homes may be seen as a solution to provide a safe environment or ensure routine care, in reality patients and carers experience considerable difficulty adjusting to placement, and associated responses of defeat and misery. Clinicians need to better understand the complex emotional responses to residential care for patients and carers. Anticipating and proactively addressing these responses could better support patients and carers in this situation. Older people and their carers may be affected by the sequelae of self-harm long after the event. The responsiveness of clinical care may wane over time, leaving patients and carers feeling isolated in their distress. For those who enter residential care after self-harm, particular interventions should be developed to facilitate, support and reduce associated negative emotional responses in both patients and carers. This research was funded by Not applicable. [ABSTRACT FROM AUTHOR]

A correction to the article "Why Do the Very Old Self-Harm: A Qualitative Study," which appeared in a 2018 issue, is presented.