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Background: Depression is a leading cause of disability, with older people particularly susceptible to poor outcomes.Aims: To investigate whether the prevalence of depression and antidepressant use have changed across two decades in older people.Method: The Cognitive Function and Ageing Studies (CFAS I and CFAS II) are two English population-based cohort studies of older people aged ≥65 years, with baseline measurements for each cohort conducted two decades apart (between 1990 and 1993 and between 2008 and 2011). Depression was assessed by the Geriatric Mental State examination and diagnosed with the Automated Geriatric Examination for Computer-Assisted Taxonomy algorithm.Results: In CFAS I, 7635 people aged ≥65 years were interviewed, of whom 1457 were diagnostically assessed. In CFAS II, 7762 people were interviewed and diagnostically assessed. Age-standardised depression prevalence in CFAS II was 6.8% (95% CI 6.3-7.5%), representing a non-significant decline from CFAS I (risk ratio 0.82, 95% CI 0.64-1.07, P = 0.14). At the time of CFAS II, 10.7% of the population (95% CI 10.0-11.5%) were taking antidepressant medication, more than twice that of CFAS I (risk ratio 2.79, 95% CI 1.96-3.97, P < 0.0001). Among care home residents, depression prevalence was unchanged, but the use of antidepressants increased from 7.4% (95% CI 3.8-13.8%) to 29.2% (95% CI 22.6-36.7%).Conclusions: A substantial increase in the proportion of the population reporting taking antidepressant medication is seen across two decades for people aged ≥65 years. However there was no evidence for a change in age-specific prevalence of depression. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to establish the feasibility and initial effectiveness of training and support intervention for care staff to improve pain management in people with dementia living in care homes (PAIN-Dem).Methods: PAIN-Dem training was delivered to care staff from three care homes in South London, followed by intervention support and resources to encourage improved pain management by staff over 4 weeks. Feasibility was assessed through fidelity to intervention materials and qualitative approaches. Focus group discussions with staff explored the use of the PAIN-Dem intervention, and interviews were held with six residents and family carers. Pain was assessed in all residents at baseline, 3 and 4 weeks, and goal attainment scaling was assessed at 4 weeks.Results: Delivery of training was a key driver for success and feasibility of the PAIN-Dem intervention. Improvements in pain management behaviour and staff confidence were seen in homes where training was delivered in a care home setting across the care team with good manager buy-in. Family involvement in pain management was highlighted as an area for improvement. Goal attainment in residents was significantly improved across the cohort, although no significant change in pain was seen.Conclusions: This study shows good initial feasibility of the PAIN-Dem intervention and provides valuable insight into training and support paradigms that deliver successful learning and behaviour change. There is a need for a larger trial of PAIN-Dem to establish its impact on resident pain and quantifiable staff behaviour measures. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective A wide range of behavioural and psychological symptoms (BPSD) are common in dementia, and it has been suggested that groups of correlated symptoms should be studied together. Here, we describe the groups of BPSD that have been identified in the literature and how they have been used to study associations, burden, treatment and underlying biology. Methods The literature database PubMed was searched for articles that identified clusters or factors of BPSD or used previously defined symptom groups. Results Sixty-two studies were included. Generally, the following symptom groups were suggested: affective symptoms, including depression and anxiety; psychosis, including delusions and hallucinations; hyperactivity, including irritability and aggression; and euphoria. Symptoms that did not show consistent results include apathy, eating disturbances, night-time behaviour disturbances, disinhibition and aberrant motor behaviour. Symptom groups differed in their associations, treatment and biology. Conclusions Studies investigating symptom groups show relatively consistent results. Studying symptom groups allows similar symptoms to be studied together, which might strengthen results and may point to differences in their aetiology and treatment. However, a large amount of the individual variability of the symptoms could not be explained by the factors, and authors should carefully address their research question and hypotheses to decide if symptoms should be studied in groups or individually. Clinicians need to consider each symptom in its own right and also to be aware of the interrelations between them when assessing patients and developing strategies for treatment. © 2013 The Authors. International Journal of Geriatric Psychiatry by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives . To examine, using the published literature and local service experience, the contributions that carers can make to the development and evaluation of specialist mental health services for the elderly. Methods . MEDLINE search for relevant papers about carers and the elderly, especially with mental disorders; review of recent experience of service planning, implementation and evaluation in the Cambridge area. Results . Increased emphasis on the role of carers in recent literature, extending into acknowledgement of the carer perspective in official publications; few papers on the role of carers specifically in evaluating services, with only one study looking solely at an old age psychiatry service. Conclusions . There is considerable scope for involving carers in the development and evaluation of services, though there are also some potential concerns, not least that carers and users may have different perspectives. These issues are discussed, along with possible future developments, such as the need for a standardized assessment of carer satisfaction. Copyright © 1998 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

A questionnaire regarding the teaching of old age psychiatry was sent to psychiatrists at teaching hospitals in England. A 53% response was received. Old age psychiatry is usually taught within general psychiatry, though there is frequent collaboration with geriatric medicine. Large numbers of students provide a challenge to this small speciality. More resources including time for teaching appear to be needed. Old age psychiatrists were keen to convey their enthusiasm and highlight the positive aspects of working with the elderly. [ABSTRACT FROM AUTHOR]

This article is based on the examination of seven old age psychiatry services in England in 1991, and it addresses the main issues in the organization of community-oriented clinical services for elderly people with mental disorders. The current practice of old age psychiatry places much emphasis, but there were marked differences in emphasis. The most controversial issue was whether all patients should initially be seen by a psychiatrist or whether assessments by non-medical professional were acceptable. Several areas of recent development in old age psychiatry are also discussed. [ABSTRACT FROM AUTHOR]

Objective: To monitor key processes and outcomes in joint health and social services community psychogeriatric teams, from the perspective of principal caters of people with dementia. Design: Interview with carets six months after referral of the 39 community based people with dementia. Overall 34 (87%) principal carers volunteered but 5 refused follow-up. Setting: Two rural and two urban health and social services teams. All were routine service teams, rather than run for research purposes. District had relatively large long stay inpatient facility but low independent sector provision. Main outcome measures: Measures included avoidable admissions, crises or untoward events, unmet needs, proportion of carets experiencing severe stress assessed on the General Health Questionnaire, the cater satisfaction with service elements. Also comparison of cater and keyworker assessments of carer stress. Results: The majority of patients were female and few were under 75 years old. 93% were severely or totally impaired on the Activities of Daily Living problem score. The principal carets were mostly spouses or children, 56% being female. During the six month period from referral, keyworkers considered that there were 2 avoidable admissions and crisis or untoward events in 18 cases, the largest group being accidents (7). Caters considered needs to be met in 44% of cases. Lack of patient stimulation and cater respite, together with needs for appropriate institutional care, formed the major areas of unmet need. Fifteen of 26 (58%) caters completing the General Health Questionnaire had scores indicating the probable or definite presence of psychological distress. However, keyworker assessments of cater stress showed no correlation with GHQ scores. Fourteen of 32 (43%) considered the services received as of poor or moderate quality. Accounts of problems in arranging and using services highlighted a series of issues requiring management of policy attention. Conclusions: Carer inclusion in the monitoring of joint agency teams is feasible and leads to the identification of a range of practical problems in service configuration and delivery. Keyworker assessments of caret stress may not be valid and direct measurement may be necessary. [ABSTRACT FROM AUTHOR]

Objective: To monitor key processes and outcomes in joint health and social services community psychogeriatric teams. Design: Six month follow-up of new referrals to 4 teams in Cambridge. Data collected from structured clinical assessment forms at baseline and interviews with keyworkers at follow-up. Data for groups with and without dementia were compared. Setting: Two rural and two urban teams in area with relatively large long stay inpatient facility but low independent sector provision. All were routine service teams, rather than run for research purposes. Main outcome measures: The main outcome measures were survival, institutionalisation, key worker assessments of avoidable admissions, appropriateness of placement, unmet needs, carer stress and global outcome for patient and carers. Results: Rates of referral to urban teams were double rural rates. Around forty percent of the dementia group had a social worker as assessor and keyworker. The dementia group was significantly more dependent and received more informal and formal care. After six months, only 54% of the dementia group were alive and living outside institutional care, compared to 79% in the functionally ill group. Unplanned admissions to hospitals or homes were rarely judged avoidable by key workers. Outcomes for carets were judged poor in 15% of both groups, and 13% and 11 % of carers respectively were judged to be under severe stress. Unmet needs were more common in the dementia group, and related principally to residential care and cater respite. A number of measures, including evidence of geographical inequity and identification of unmet needs, provided an important contribution to local policy development. Further work is needed on the validity of keyworker assessments of carer stress, given the findings of the cater interview sub-study. [ABSTRACT FROM AUTHOR]

The article discusses geriatric psychiatry as of April 2013, with a focus on the instruments used in measuring behavioural and psychological symptoms of dementia (BPSD). Topics include the Neuropsychiatric Inventory (NPI) questionnaire which measures BPSD, cognitive impairment assessments, and the Behavioral Pathology in Alzheimer’s Disease Scale (BEHAVE-AD).

The article presents an obituary for professor Robert George Jones.

Presents an obituary for Charles Peter Beynon Brook, former consultant in old age psychiatry in Cambridge. Career highlights; Family information; Dates of his birth and death.