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Background: Negative attitudes towards people living with mental illness (PLWMI), defined here as mentalism, are a major contribution to health care inequity, which may extend into end‐of‐life care. There is a clear need for investigation of the attitudes of doctors towards PLWMI at the end of life as doctors may lead processes of care that contribute to this inequity. Aims: The aim of this pilot study is to examine the perspectives of hospital‐based doctors regarding end‐of‐life care and medical decision‐making in PLWMI. Methods: A survey was created to explore whether mentalism is present in the perspectives of hospital doctors regarding end‐of‐life care for PLWMI. The survey included demographic characteristics of participants and questions comprising statements and vignettes that required agree/disagree responses. Descriptive statistics were used to summarise responses, and chi‐square tests examined associations with demographic variables. Results: The survey was commenced by 48 hospital‐based doctors and completed by 45. Descriptive statistics indicated that mentalism is present in the attitudes of hospital doctors regarding end‐of‐life care of PWLMI, with 47 of 48 participants (98%) endorsing at least one mentalist response. One significant association found that psychiatrists and psychiatry trainees were less likely to endorse a stereotype response in one vignette. Conclusions: This preliminary study addresses a gap within the literature on the potential contribution of mentalist attitudes in doctors to the poorer end‐of‐life care outcomes for PLWMI. The findings highlight the need for further study of this topic and suggest a role for targeted medical education in the pursuit of health care equality for PLWMI. [ABSTRACT FROM AUTHOR]

Introduction: People living with dementia experience poor mental health and high rates of self‐harm. We investigated risk factors for self‐harm in people aged > 40 years living with dementia and risk factors for dementia after self‐harm. Methods: Using linked hospital data from New South Wales, Australia, we defined a dementia cohort (n = 154,811) and a self‐harm cohort (n = 28,972). Using survival analyses, we investigated predictors of self‐harm for the dementia cohort, and predictors of dementia for the self‐harm cohort. Results: We found self‐harm or dementia diagnoses occurred most often within 24 months of a dementia diagnosis or initial self‐harm presentation, respectively. Men living with dementia, and people with complex psychiatric profiles, had the greatest risk of self‐harm. Men who had self‐harmed had the greatest risk of dementia diagnoses. Discussion: Men and people with complex psychiatric profiles and dementia may particularly benefit from post‐diagnosis mental and behavioral support to reduce risk of self‐harm. [ABSTRACT FROM AUTHOR]

Background: Delirium is costly for patients, carers, and healthcare systems. In addition, non‐pharmacological and pharmacological management of delirium is challenging. Electroconvulsive therapy (ECT) has been proposed and used as an anecdotal treatment of delirium in clinical practice. However, the efficacy and safety of this approach are not well understood. Objective: To synthesise and review the evidence relating to the safety and efficacy of ECT as a treatment for delirium. Methods: A systematic review was completed according to PRISMA guidelines using the PubMed, CINAHL, Cochrane Library, and PsycINFO databases. Studies were eligible for inclusion if modified ECT was used to treat delirium symptoms. ECT for delirium in people with neuroleptic malignant syndrome, catatonia, or confusional states associated with acute primary psychiatric conditions were excluded. All included records were first ranked using the hierarchy of evidence‐based medicine; quality was then assessed using the Joanna Briggs critical appraisal checklists. Pooled data across the cases identified were analysed using descriptive statistics. Results: Of 1226 records screened, 10 studies met inclusion criteria: six case reports, three case series, and one quasi‐experimental study. The literature base was of mixed quality. A single quasi‐experimental study was assessed to be of 'fair' quality, the remainder of the case series and case reports were rated as 'poor' to 'fair' quality. A total of only 40 individual people with delirium who were treated with ECT were identified. In 33/40 cases, the aetiology of delirium was substance withdrawal. The number of ECT treatments administered ranged from 1 to 13. ECT was reported to positively contribute towards treatment of delirium in all cases, although objective measures of improvement were reported in only 6/13 patient cases from case reports and case series (46%). The singular quasi‐experimental study reported a statistically significant decrease in duration of delirium, time spent in physical restraint, and in benzodiazepine requirement when ECT was used as an adjunct in benzodiazepine withdrawal delirium. When adverse events were described these included mild confusion and memory deficits; all were reported as time limited and reversible. Considerable limitations in the quality of the evidence base were identified, including the risk of selection, publication and reporting bias. Much data reporting on safety and efficacy of ECT in delirium was missing. Conclusion: There is insufficient literature to support modified ECT as a clinical treatment for delirium. The few studies identified were generally of weak evidence lacking important data on safety and objective outcome measures, and not including populations with broad delirium aetiologies. Further research using more robust methodologies and broader populations (age, aetiology) of people with delirium treated with ECT is needed. [ABSTRACT FROM AUTHOR]

Background: Dementia is often associated with poorer mental health and higher rates of self‐harm compared to older people without dementia. This study investigated risk factors for self‐harm in dementia and risk factors for developing dementia following self‐harm. A further aim was to elucidate the health profiles and healthcare pathways of individuals with dementia who self‐harm as a critical step to develop effective prevention strategies. Method: Using linked health data from hospital admissions, emergency department presentations and ambulatory mental health visits, we established a population‐based cohort of individuals with dementia and self‐harm in New South Wales, Australia spanning 13 years. The project was guided by an advocate advisory group, including people with dementia and care‐partners who inform all stages of the project. Result: The cohort included 154,811 people with dementia, of which 652 (0.4%) had a subsequent diagnosis of self‐harm. People with dementia who self‐harmed were younger at the time of their dementia diagnosis (median age 69.6 (IQR 52.7‐80.1) versus 83.5 (IQR 78.0‐88.1)) and had a lower proportion of females (39.4% versus 59.6%) compared to people with dementia without self‐harm. A diagnosis of self‐harm most often occured within 24 months after a dementia diagnosis. Men living with dementia, and people with complex psychiatric profiles had the greatest risk of self‐harm. People with dementia and self‐harm had more comorbidities compared to those without self‐harm. The most frequent comorbidities in people with dementia and self‐harm were drug/alcohol use (19.9%), depression (13.5%), anxiety (11.8%), and psychotic disorder (10.9%); these comorbidities were observed in 2.7%, 2.7%, 2.2% and 2.1% of people with dementia without self‐harm, respectively. People with dementia and self‐harm had more ambulatory mental health visits, ED presentations and involuntary admissions in the year before a dementia diagnosis compared to those without self‐harm. Conclusion: The health profiles and healthcare pathways are significantly different for people with dementia who self‐harm versus those who do not. Poor mental health, dementia, and self‐harm are substantially intertwined in older adults. Post‐diagnostic counselling and support should be provided following a dementia diagnosis. This project will inform strategies for health services to better meet the needs of people with dementia who self‐harm. [ABSTRACT FROM AUTHOR]

The article offers information on use of opioids for chronic non-cancer pain in older Australians. Topics discussed include information on rising prevalence of prescription opioid use; information on guidelines on the treatment of opioid dependence which aims to improve access to opioid treatment by expanding programs to the primary care setting; and need for clinical pain management guidelines including the use of opioids that are relevant to older people.

Objective: To examine the insights of carers to better understand self-harm in their older relatives.Methods: An in-depth interview was conducted with the nominated relative/friend (carer) of a person over 80 who had self-harmed within the last month. Carer interpretation and experience of the self-harm and clinical care were explored qualitatively. Audio recordings were transcribed and the content thematically analyzed using N-VIVO.Results: Thirty-two carers of 30 older people who self-harmed were interviewed. Physical, social, and psychological issues were identified as contributory to self-harm. Themes relating to the perceived barriers to seeking help included "they can't communicate," "suicide and secrets," and "invalidation." Themes for the intent of self-harm were "attention seeking" and "wanting to die." Themes which emerged for consequences of self-harm for carers were "anger," "guilt and self-blame," and "it made us ill." Themes for solutions to address the underlying factors leading to self-harm were "more practical support and structure," "improving communication," "removing means of self-harm," "advance care directives as a solution for suffering," and "ignoring self-harm." Clinical care themes were "shared shame and stigma," "safety and supervision vs being locked up," "clinicians dismissing the carer," and "relief and support."Conclusions: Validation of carer perspectives and understanding family dynamics may improve communication at various system levels and inform interventions for older persons, concurrently support families, and potentially reduce risk of repeat self-harm. Good care must be holistic, be person-centred, and relieve carer burden. A shared understanding and psychotherapeutic approaches to management of self-harm in late life should be considered. [ABSTRACT FROM AUTHOR]

An editorial is presented on the mobility of the older population with migration between and within countries, plus refugees and asylum seekers, has resulted in a growing number of older migrants in many countries such as Australia. It expresses the view that migrants bring their own culture, language, health beliefs and life experiences, and health services must be sensitive and responsive to all these factors.

Recently, the Australian Digital Health Agency launched MyHealth Record to the public. As of July 2019, 90.1% of Australians hold records with this service, allowing 16 400 health organisations access to >28 million clinical documents. The streamlining of patient data was intended to facilitate sharing of information and improve communication between medical providers, while promoting efficiency in clinical practice. We have identified a hitherto unrecognised application of this infrastructure in the identification and management of factitious disorder, a rare yet highly diagnostically challenging condition involving intentional feigning of illness, which presents a significant resource burden to the Australian health system. [ABSTRACT FROM AUTHOR]

Objective: To measure the diagnostic accuracy of the 4A's test in screening for delirium in geriatric inpatients from culturally diverse backgrounds.Methods: A prospective study was conducted with patients admitted to the geriatric and orthogeriatric services of a tertiary teaching hospital. Consenting participants aged 65 years and over were screened for delirium with the 4AT by nursing staff within 72 h of admission. The diagnosis of delirium was made separately by expert assessors, responsible for the participant's clinical care, blinded to the 4AT score, within 30 min of the 4AT assessment using the DSM 5 criteria and the Confusion Assessment Method. Interpreters were used for non-English speaking patients. The Informant Questionnaire for Cognitive Decline in the Elderly was completed by a carer/relative to assess for probable dementia.Results: A total of 257 participants (mean age 85) were recruited over five months. Delirium was diagnosed in 159 (62%) by the expert assessors and 158 (62%) by the 4AT assessment. A total of 205 participants (80% of total population) had probable dementia. The sensitivity and specificity of the 4AT were 87% and 80%, respectively, in detecting delirium overall, 86% and 71% in people with probable dementia and 91% and 71% for non-English speaking participants. The area under the receiver operating characteristic curve for delirium in the whole population was 0.92, 0.89 in the probable dementia subgroup and 0.90 in non-English speaking participants.Conclusions: The 4AT is a sensitive and specific screening tool for delirium in geriatric inpatients, including those with probable dementia or who are non-English speaking. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article focuses on the relationship of mental illness, dementia and firearm violence and injury, particularly in Australia. Topics discussed include the suicide risks of firearms, relating the high risk of suicide in American homes, the survey conducted to 243 psychiatrists and general practitioners in Queensland which shows that 93% of respondents believe that doctors played role in reporting people at risks of firearm violence, and the role of health professionals on the subject.

The aim of this study was to combine knowledge about how clinicians learn with a review of educational interventions to prevent delirium in hospitalised patients. The primary aim was to evaluate the effectiveness of approaches to delirium education. A detailed search of educational and medical databases was undertaken. The type of intervention used was classified according to the PRECEED model of Green and colleagues, using factors relevant to behaviour change in health promotion. The effectiveness of the intervention was determined by assessing changes in staff performance and patient outcomes. Nineteen studies of variable design and quality were identified. Studies using predisposing, enabling and reinforcing strategies together were more often effective in producing changes in staff behaviour and patient outcomes. Education and guidelines used together or in combination have little effect. When strategies to enable and reinforce changes in clinical practice are used together with education sessions, outcomes for patients are more positive. [ABSTRACT FROM AUTHOR]

There has been considerable debate as to whether dementia with Lewy bodies (DLB) represents a distinct diagnosis or lies on a spectrum with Parkinson's disease dementia (PDD). The objective of this review was to identify whether conceptualising these dementias as distinct diagnostic entities is meaningful, or indeed possible. A literature review was conducted using the databases MEDLINE and PSYCHINFO. DLB and PDD share many clinical features including the pattern of cognitive deficits and Lewy-body pathology. However, they may be usefully distinguished by their clinical course and differential response to treatment. Some patients with DLB have a rapidly progressive dementia and may be particularly sensitive to neuroleptic medication, resulting in considerable morbidity and mortality. [ABSTRACT FROM AUTHOR]

Keywords: Sexual harassment in medicine; Dementia; Geriatric psychiatry EN Sexual harassment in medicine Dementia Geriatric psychiatry 532 532 1 06/23/21 20210615 NES 210615 To the Editor: Sexual incidents involving patients in hospitals are prevalent and are distressing for patients and staff alike, but they are poorly managed.1 Such incidents are frequently perpetrated by people with acute mental illness (eg, mania, psychosis), substance misuse, personality vulnerabilities, and cognitive impairment (eg, delirium, dementia). There is no disclosure of his behaviour to non-ward staff involved in his care (eg, consulting teams), among whom further assaults occur. Sexual incidents span the age range, although lack of staff's understanding of sexuality and sexual behaviour in older adults2 mandates practice improvement. [Extracted from the article]