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Purpose: There is a lack of research informing service requirements for older (aged≥55 years) forensic mental health patients. The aim of this research was to increase knowledge about older forensic mental health patients' quality of life, wellbeing, recovery, and progress, in order to make recommendations of how to facilitate and enhance these factors., Methods: In-depth interviews with patients ( N  = 37) and staff ( N  = 48) were undertaken; data were analysed using thematic analysis., Results: Environmental (e.g., physical, structural and facilities), relational (staff, family and friends) and individual (characteristics, feelings, behaviours) factors were identified as enablers and/or obstacles to wellbeing, recovery, progress and quality of life., Conclusions: The physical and psychological environment of services needs to be adapted to meet the needs of patients. Therapeutic relationships with staff should be encouraged and a person-centred and individual recovery approach adopted. Prosocial relationships with peers, friends and family need to be fostered to enable positive recovery outcomes. Older patients should be empowered to develop a sense of autonomy to enable quality of life, wellbeing, and recovery, and progress.

Background: It is important to investigate the needs, experiences, and outcomes of older forensic mental health inpatients. In this consensus document, we offer practitioners working with older forensic inpatients recommendations to meet the unique older-age-related needs of this group., Method: We report on the findings of a scoping review of service provision and age-responsive interventions for this population. We complement this with a review of qualitative studies investigating staff and patient views on age-responsive inpatient care., Results: The guidance synthesizes this evidence into sections on: epidemiological studies of demographic, clinical, and legal profiles; qualitative studies; investigations of patient need; evidence for interventions tailored to this patient group; future directions for research; and finally, recommendations for practice. Forensic patients over the age of 50 years have a different set of psychological and physical health needs from their peers. There is a dearth of dedicated interventions and support to assist patients through secure services and into the community., Conclusions: We suggest service providers involve older patients in treatment and service organization decisions, adapt interventions to be responsive to this group, train staff to recognize physical vulnerabilities and cognitive decline, and embrace methods of communication developed in other areas of care, such as dementia Care.

Objectives: There is a lack of research informing service delivery for older forensic mental health patients. This study explored service provision in forensic mental health inpatient and community services in England, investigating what is required for progress in terms of quality of life, health, wellbeing, recovery and reduced risk, and the barriers and facilitators associated with this., Methods: Semi-structured interviews were undertaken with 48 members of staff working with older forensic mental health patients in secure inpatient units or the community in England. Data were analysed using thematic analysis., Results: Two global themes 'What works' and 'What doesn't work' were identified comprising themes representing environmental, interpersonal and individual factors. 'What works' included: positive social support and relationships; individualised holistic patient-centred care; hub and spoke approach to patient care; and suitable environments. 'What doesn't work' included: absence of/or maladaptive relationships with family and friends; gaps in service provision; and unsuitable environments., Conclusions: For older patients to progress to improved quality of life, health, wellbeing and reduced risk, multilevel and comprehensive support is required, comprising a range of services, interventions, and multidisciplinary input, and individualised to each patient's needs. The physical environment needs to be adapted for older patients and provide a social environment that seeks to include supportive families, friends and expert professional input. A clear patient progression pathway is required; this must be reflected in policy and provision.

The menopause is a time in a woman's life when it is recognized that biological and social changes can impact upon mental wellbeing. Several studies have investigated the relationship between menopause and psychological symptoms, especially depression, with mixed results. In part, this is due to a considerable overlap between depressive symptoms and those due to declining estrogen levels, causing challenges in assessment. However it appears that vulnerable women are at a higher risk of succumbing to depression during menopausal transition. Antidepressants remain the mainstay of treating depressive symptoms, with little conclusive evidence for hormone replacement therapy. Memory problems during menopause are a common complaint, but there is no demonstrated link to subsequent dementia. This paper also reviews considerations of diagnosis and treatment of postmenopausal depression.

The ageing population of the world presents major challenges for society and for health services. Mental health issues are extremely important, as mental disorders, notably dementia and depression, are common in old age. Mental ill health can profoundly affect the quality of people's old age and has a significant impact upon the use of health and social services. In this paper, we examine these problems from the point of view of older people as consumers, and discuss the role of health promotion, primary care, social services and specialist mental health services for older people. Certain groups within the population, including women, people from minority ethnic backgrounds, very old people, people with learning disabilities, and gay and lesbian older people face some particular issues, which are briefly discussed. Although this paper takes a mainly UK perspective, the mental health of older people is a huge global public health issue. Good epidemiology is central to understanding the needs of ageing populations and responding to them appropriately. Further research is needed in other areas, especially as to which service interventions are effective and efficient.

Dementia and hearing loss are both common among older people. The co-occurrence of the two conditions increases complexities in all aspects of an individual's care and management plan. There has been increasing research interest in the relationship between dementia and hearing loss in recent years. In this review we discuss the relationship between hearing loss and dementia, including hearing loss as a risk factor for dementia; the effects of dementia with hearing loss on affected persons' quality of life and the care they receive; screening and available interventions; and opportunities for prevention. We also discuss dementia and hearing loss in the care home setting, as the majority of residents have either, or indeed both, dementia and/or hearing loss. Several mechanisms have been suggested for how hearing loss and dementia may be related but the evidence for how these may operate together is still unclear. Similarly, although it is to be hoped that the active identification and management of hearing problems may help to reduce the future development of cognitive impairment, evidence for this is still lacking. [ABSTRACT FROM AUTHOR]

Older patients account for around 20% of the population in secure forensic psychiatric services in the UK. However, little qualitative research has investigated the experience of ageing in secure settings. This study aimed to gather the individual views of a sample of patients over 50 years old in three services within the region of one NHS Trust in England providing different levels of security: high, medium and low. A total of 15 participants were selected and underwent one-on-one qualitative interviews. The interviews were analysed through thematic analysis, which generated seven themes: Self-agency, activities, social life, practical matters, recovery, physical health and service improvement. Study findings highlighted the complexity of ageing in secure settings. Despite the positive feedback reported in aspects such as physical health care, education opportunities, staff and support of religious practices, participants experienced added barriers to recovery, caused by social isolation/withdrawal and activities/treatment that did not respond to their complex age-related needs, generating poor motivation to engage, thus increasing length of stay in the institution. Our findings call for the development/implementation of programmes tailored to the unique needs of older patients. This process requires an active involvement of the primary stakeholders and further patient-centred research. [ABSTRACT FROM AUTHOR]

Objective: More understanding is needed about the emotional experiences of dementia from the perspective of the individual. This understanding can then inform the provision of health care to meet individual needs. This systematic review aimed to present all available descriptions of emotional distress and explanations for emotional distress experienced by individuals with dementia, articulated personally and by others.Methods: A systematic mixed-method review identified literature that was screened and quality appraised. Data were analysed quantitatively and qualitatively using corpus-based methods and meta-ethnography.Results: The 121 included studies showed that individuals with dementia have expressed emotional distress comprehensibly. Family, professional caregivers, clinicians, and academic writers have also observed and described extreme emotional experiences. Feeling fearful and lonely were predominant and show the importance of anxiety in dementia. Explanations for emotional distress included threats to universal, human needs for identity, belonging, hope, and predictability.Conclusions: The variable and personal emotional experiences of individuals with dementia are well described and should not continue to be overlooked. Limitations, future research, and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

Objective: The existing literature on ageing prisoners tends to focus on such aspects as diagnosis and physical ill-health. In contrast, the experience of imprisonment from the perspective of ageing prisoners has received less attention. Grounded in a Good Lives Model theoretical framework, we reviewed and meta-synthesised literature around their experience of life in prison, its impact on their wellbeing and how prison services are currently addressing their complex needs. We further identify potential areas of improvement.Methods: 1. Systematic search on Assia, PsycInfo, MedLine, Embase, Web of Science, Google and Gov.uk. 2. Extraction and categorisation of data on NVivo. 3. Development of themes through thematic analysis and meta-synthesis. 4. Identification of potential areas of improvement.Results: We selected 25 studies for our review, of which 13 were from the USA, seven from the UK, two from Australia and one each from Ireland, Switzerland and Israel. We identified three themes: The hardship of imprisonment, addressing health and social care needs, and the route out of prison.Conclusions: Ageing prisoners have unique and complex health and social care needs which, to varying degree across different countries, are mostly unmet. Promising initiatives to address their needs are emerging, but, at present time, the overall experience of incarceration for the ageing prisoner is quite poor, given the inconsistent physical, emotional and social care support offered from prison intake to release and beyond. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

BackgroundThe number of beds in care homes (with and without nurses) in the United Kingdom is three times greater than the number of beds in National Health Service (NHS) hospitals. Care homes are predominantly owned by a range of commercial, not-for-profit or charitable providers and their residents have high levels of disability, frailty and co-morbidity. NHS support for care home residents is very variable, and it is unclear what models of clinical support work and are cost-effective.ObjectivesTo critically evaluate how the NHS works with care homes.MethodsA review of surveys of NHS services provided to care homes that had been completed since 2008. It included published national surveys, local surveys commissioned by Primary Care organisations, studies from charities and academic centres, grey literature identified across the nine government regions, and information from care home, primary care and other research networks. Data extraction captured forms of NHS service provision for care homes in England in terms of frequency, location, focus and purpose.ResultsFive surveys focused primarily on general practitioner services, and 10 on specialist services to care home. Working relationships between the NHS and care homes lack structure and purpose and have generally evolved locally. There are wide variations in provision of both generalist and specialist healthcare services to care homes. Larger care home chains may take a systematic approach to both organising access to NHS generalist and specialist services, and to supplementing gaps with in-house provision. Access to dental care for care home residents appears to be particularly deficient.ConclusionsHistorical differences in innovation and provision of NHS services, the complexities of collaborating across different sectors (private and public, health and social care, general and mental health), and variable levels of organisation of care homes, all lead to persistent and embedded inequity in the distribution of NHS resources to this population. Clinical commissioners seeking to improve the quality of care of care home residents need to consider how best to provide fair access to health care for older people living in a care home, and to establish a specification for service delivery to this vulnerable population. [ABSTRACT FROM PUBLISHER]

Background: Teams working in the community to manage crisis in dementia currently exist, but with widely varying models of practice, it is difficult to determine the effectiveness of such teams. Objective: The aim of this study is to develop a "best practice model" for dementia services managing crisis, as well as a set of resources to help teams implement this model to measure and improve practice delivery. These will be the best practice tool and toolkit to be utilized by teams to improve the effectiveness of crisis teams working with older people with dementia and their caregivers. This paper describes the protocol for a prospective study using qualitative methods to establish an understanding of the current practice to develop a "best practice model." Methods: Participants (people with dementia, caregivers, staff members, and stakeholders) from a variety of geographical areas, with a broad experience of crisis and noncrisis work, will be purposively selected to participate in qualitative approaches including interviews, focus groups, a consensus workshop, and development and field testing of both the best practice tool and toolkit. Results: Data were collected between October 2016 and August 2018. Thematic analysis will be utilized to establish the current working of teams managing crisis in dementia in order to draw together elements of the best practice. Conclusions: This is the first study to systematically explore the requirements needed to fulfill effective and appropriate home management for people with dementia and their caregivers at the time of mental health crisis, as delivered by teams managing crisis in dementia. This systematic approach to development will support greater acceptability and validity of the best practice tool and toolkit and lay the foundation for a large scale trial with teams managing crisis in dementia across England to investigate the effects on practice and impact on service provision, as well as the associated experiences of people with dementia and their caregivers. International Registered Report Identifier (IRRID): RR1-10.2196/14781 JMIR Res Protoc 2021;10(1):e14781 doi:10.2196/14781 We help JMIR researchers to raise funds to pursue their research and development aimed at tackling important health and technology challenges. If you would like to show your support for this author, please donate using the button below. The funds raised will directly benefit the corresponding author of this article (minus 8% admin fees). Your donations will help this author to continue publishing open access papers in JMIR journals. Donations of over $100 may also be acknowledged in future publications. Suggested contribution levels: $20/$50/$100 [ABSTRACT FROM AUTHOR]

Discusses medical and mental health care for older people who are residents in care homes in Great Britain. Profile of care home residents; Estimated depression affliction among residents; Evidence suggesting that residents of care homes receive inferior standards of general medical and mental health care; Drugs and other medical interventions for older people.

Older forensic mental health patients have complex needs and requirements; service provision is required to address mental health, offending risk and issues associated with aging (geriatric care). This study aimed to identify the systems and processes that enable valued progress (in terms of quality of life, health, wellbeing, recovery and reduced risk) for older forensic mental health patients. Interviews were conducted with 48 members of staff working with these patients in secure hospitals or the community. Thematic analysis was used to analyze the data. Four overarching themes were identified regarding what facilitated or acted as a barrier in relation to quality of life, health, wellbeing and recovery. Multidisciplinary input, an individualized approach and implementing holistic and needs-led care was found to facilitate progress. However, lack of resources, excluding the patients in care planning, gaps in expertise and knowledge, and a lack of specialized units that could address mental health, forensic and elderly needs were found to be barriers. Extensive, multilevel and wide-ranging support is required specifically for older forensic mental health patients. Joint working is required between older adult and forensic mental health services incorporating geriatric medicine expertise in order to implement co-produced care and treatment plans. [ABSTRACT FROM AUTHOR]