Age Psychiatrists Research Articles

Development of an innovative computerized assessment of instrumental activities of daily living

AbstractBackgroundFunctional impairment is a diagnostic criterion for dementia and distinguishes mild cognitive impairment (MCI) from dementia. Self‐ or informant reports are most commonly used but can be biased and may not reflect actual functional ability. Alternatives include performance‐based assessments, such as the Sydney Test of Activities of daily living in Memory disorders (STAM). The aim of this study is to develop, and validate, a new computerised diagnostic tool (C‐STAM) to assess functional ability that can be administered remotely to increase accessibility. The C‐STAM will realistically simulate everyday activities to assess functional performance.MethodThe C‐STAM is being developed by a multidisciplinary team of psychologists, old age psychiatrists, occupational therapists, and computer scientists. A Delphi study with 31 international experts was conducted to select and refine suitable tasks. An additional step is consultation with consumers (i.e., older people with and without cognitive impairment) and caregivers who have an active role in shaping the C‐STAM. A pilot study with 30 people aged 60+ with normal cognition, MCI, and dementia plus their informants will assess feasibility and user‐experience. After adjustments based on the pilot study, we will conduct a validation study with 180 participants and their informants.ResultThe Delphi study resulted in nine C‐STAM tasks, addressing the domains of communication, shopping, dressing, community mobility, handling finances, managing medications, and memory. Feasibility and acceptability of these tasks will be confirmed through pilot testing and the validation study. We will develop an automated scoring and interpretation guide, age‐ and sex‐specific norms, and clinical cut‐offs to differentiate the three diagnostic groups. Automated data exporting and reporting will be useful for clinical referrals and in research and will facilitate interpretation and communication of results across different clinical settings.ConclusionThe C‐STAM will facilitate early diagnosis of dementia and MCI and will enable a better understanding of disease progression by monitoring functional ability in a time‐ and resource‐efficient way. Results will be used to inform service development to better meet the needs of people with dementia for access to appropriate assessments of functional performance. The C‐STAM will be freely available for use by clinicians and in research.

S18: Newcomers to euthanasia and assisted suicide: challenges for Psychogeriatrics with a focus on Spain and Portugal

Euthanasia or assisted suicide are now legal in several European countries. Spain has approved related legislation in 2022, and in Portugal the subject is currently under debate after preliminary ratification. This remains a controversial topic, raising passionate discussions that sometimes hamper the need to consider, in depth, the ethical, clinical, and operational difficulties of processes of this type. Older age people do not necessarily lose their autonomy with age, nor should they lose their right to decide on euthanasia or assisted suicide whenever the jurisdiction allows it. However, there is a growing concern of older people being coerced into decisions about ending their lives, not least due to their own fears of becoming a burden both for their families and the society. Manuel Martín-Carrasco will analyze how ageism can influence or model a wish to die in elderly people, especially those living with greater physical and/or mental disability. The so-called rational suicide focuses on the possibility that a healthy subject eventually decides to end his own life as a reflex of a free decision, and not within the context of a mental illness. Manuel Sánchez-Perez will discuss how difficulties in assessing the rationality of suicidal ideation include its dimensional character, together with the evidence that rationality is not always absent in depression and that the absence of depression does not imply rationality. Next, Lia Fernandes will provide an overview of years of public and parliamentary debates on euthanasia and physician-assisted suicide in Portugal. She will focus on issues regarding the exact role of psychiatrists (old age psychiatrists in particular) in the decision process, as proposed by the recently approved legislation. Finally, Javier Olivera will provide a brief overview of the recent implementation of legal access to euthanasia in Spain. A discussion of several controversial aspects of the operationalization of such a complex process will follow, including those related with conscientious objection.

OLD AGE LIAISON MENTAL HEALTH SERVICEIN QATAR INTERVENTIONS AND OUTCOMES

Background: There is wide variation in the degree of provision of liaison mental health services across many countries (3) Qatar is no exception, in a general hospital in southern part of Qatar, Liaison Old Age Mental health is provided by Adult Psychiatrists with a phone advise from an Old Age Psychiatrist when requested. A general Hospital in the Northern division of the country is provided by Adult Psychiatrists with one day input from an old age Psychiatrist. Older adults Patients with mental health problems using acute and general hospital inpatient services should have access to a liaison service that specializes in the diagnosis and management of older peoples mental health (5) The research represents a newold age liaison psychiatry service intervention and outcomes in the state of Qatar. Methods: We audited the number referrals to Old Age Mental Health Liaison one year before a new service intervention in a central General hospital and one year after the service intervention. All referrals are received by the Liaison coordination office in the General hospital and data was collected electronically from the office to ensure accuracy. We also audited the educational interventions done for both staff and patients/Families.Our study included all the number of referrals for patients aged 65 plus and under 65 with Dementia to ensure the maximum statistical power possible for the service intervention. Results: The total number of referrals for patients aged 65 and above or below 65 with Dementia from June 2021 to May 2022 were 125 (n=125). The total number of Old Age Liaison Similar referrals after the service intervention from June 2022 to May 2023 were 95 referrals (n=95, p 0.01, 24% reduction in referrals rates)The Chi squared test was used to calculate the p value. Expected average of referrals to a general hospital was estimated from several inner cities general hospitals (8,21) Conclusion: The authors believe that is the first service to focus on Old Age Mental Health Liaison in the state Qatar. The study was statistically significant and qualitatively included educational outcomes provided for both staff and Patients/families. In addition, it showed an overall reduction in the number of referrals following our intervention. We believe that our outcomes are evidence based and although our outcomes are limited, they are specific, measurable, attainable, and time linked.

The 2023 New Zealand psychiatry of old age services and workforce survey.

The primary objective was to survey the Psychiatry of Old Age (POA) service resources in New Zealand: number of psychiatrists, inpatient beds, and community psychogeriatric beds. A secondary objective was to compare the POA service resources reported by frontline clinicians with official government data. The New Zealand Branch of Faculty of POA collected information from a POA representative in each of the 20 districts, along with official government data. Information from 17 services were obtained. POA service resources varied greatly between districts. There were discrepancies between the New Zealand Branch of Faculty of POA and official government data. The number of old age psychiatrist FTEs per 10,000 older adults ranged from 0.3 to 1.1 (mean = 0.7). The number of inpatient beds per 10,000 older adults ranged from 0.0 to 4.1 (mean = 1.6); and the number of psychogeriatric beds per 10,000 older adults ranged from 0.0 to 22.7 (mean = 12.6). There is an urgent need to address the official government data discrepancies and POA service resource inequalities. This can ensure the "postcode" system that determines psychiatric care for older adults can be effectively eliminated. We also found the number of POA inpatient beds is below the internationally recommended level.

1058 ESTABLISHING A VIRTUAL MULTIDISCIPLINARY TEAM MEETING FOR CARE HOME RESIDENTS IN NEWCASTLE-UPON-TYNE

Abstract Introduction Care home (CH) residents are frail with complex physical and mental health needs. Healthcare provided is often by different organisations and fragmented. Optimising quality of life and reducing avoidable hospital attendance is crucial. The Newcastle Specialist Care Home Support Team (SCHST) provides care for 2,482 residents across 55 Newcastle CHs. Between April 2019–2020, there were 2,428 unplanned hospital attendances in this cohort. SCHST looked to establish multidisciplinary team (MDT) meetings to streamline care by collaboration and integrating pre-existing services. We aimed to establish weekly virtual MDT meetings to facilitate coordinated care for CH residents, reduce unplanned hospital attendances and improve communications between services, reducing need for additional referrals. Method Members identified to comprise the MDT included SCHST staff, Geriatricians, Old Age Psychiatrists, Pharmacists and GPs. Weekly meetings via Microsoft Teams were established, with the SCHST undertaking initial assessments of those referred. Management plans were formulated and actioned with feedback to GPs, CH staff and relatives. Residents were either discharged, planned for MDT re-review, or planned for in-person CH review. Interventions include medications optimisation, CH staff education, psychiatric and comprehensive geriatric assessments. Results From April-Nov 2021, 77 residents were referred to MDT. The number of reviews ranged from 1–6 (median = 2). All residents received an initial assessment by SCHST, with only 18 requiring in-person geriatrician input. Analysis of 22 residents showed fewer unplanned admissions in the 6 months following MDT review, compared to 6 months before. (Pre-MDT median 2 (range 0–6); post-MDT 0 (0–9); p < 0.05). Conclusion Preliminary data suggest that the virtual Care Home MDT may reduce the number of unplanned hospital admissions of care home residents, with less than one quarter requiring face-to-face geriatrician reviews. The CH MDT has shown to provide effective delivery of care, whilst reducing workload and improving efficiency, through collaborative interdisciplinary working.

Assessing and disclosing test results for \u2018mild cognitive impairment\u2019: the perspective of old age psychiatrists in Scotland

BackgroundMild cognitive impairment (MCI) is a condition that exists between normal healthy ageing and dementia with an uncertain aetiology and prognosis. This uncertainty creates a complex dynamic between the clinicians’ conception of MCI, what is communicated to the individual about their condition, and how the individual responds to the information conveyed to them. The aim of this study was to explore clinicians’ views around the assessment and communication of MCI in memory clinics.MethodAs part of a larger longitudinal study looking at patients’ adjustment to MCI disclosure, we interviewed Old Age Psychiatrists at the five participating sites across Scotland. The study obtained ethics approvals and the interviews (carried out between Nov 2020–Jan 2021) followed a semi-structured schedule focusing on [1] how likely clinicians are to use the term MCI with patients; [2] what tests clinicians rely on and how much utility they see in them; and [3] how clinicians communicate risk of progression to dementia. The interviews were voice recorded and were analysed using reflective thematic analysis.ResultsInitial results show that most clinicians interviewed (Total N = 19) considered MCI to have significant limitations as a diagnostic term. Nevertheless, most clinicians reported using the term MCI (n = 15/19). Clinical history was commonly described as the primary aid in the diagnostic process and also to rule out functional impairment (which was sometimes corroborated by Occupational Therapy assessment). All clinicians reported using the Addenbrooke’s Cognitive Examination-III as a primary assessment tool. Neuroimaging was frequently found to have minimal usefulness due to the neuroradiological reports being non-specific.ConclusionOur study revealed a mixture of approaches to assessing and disclosing test results for MCI. Some clinicians consider the condition as a separate entity among neurodegenerative disorders whereas others find the term unhelpful due to its uncertain prognosis. Clinicians report a lack of specific and sensitive assessment methods for identifying the aetiology of MCI in clinical practice. Our study demonstrates a broad range of views and therefore variability in MCI risk disclosure in memory assessment services which may impact the management of individuals with MCI.

Symposium

Dementias or major neurocognitive disorders (NCD) are a group of neuro-degenerative disorders characterized by progressive impairment in cognition, behavior, judgement and functioning. As the illness progresses and overall cognitive abilities deteriorate, the moderate and severe stages are often fraught with challenges of palliative and end-of-life care (ELC). ELC support encompasses multiple domains of living, including physical, medical, emotional, social and spiritual. In fact, ELC may extend to the caregivers even after the demise of the patient.ELC in dementia assumes an added importance with relation to dignified care of the individual with compromised cognitive abilities as well as protection from coercion, involuntary decisions and legal hassles. Physician-assisted death (PAD) has also emerged as a controversial yet important area in ELC. This involves several medical, social, ethical and legal connotations with no “one right path” to choose. The last few decades have noticed several legal moves in this direction globally, from the Oregon declaration to legalization of euthanasia in several European nations to passive euthanasia being supported in India. Several factors complicate ELC in dementia including do-not-resuscitate orders, ability to comprehend, communicate and execute an informed choice, contextualizing the suffering of the affected, and finally right to live (versus right to die). This is even more pertinent in the light of advance directives being implemented through the Indian Mental Healthcare Act, 2017. In a rapidly ageing country like India with a rising dementia burden, it is thus imperative to start a collaborative dialogue regarding ELC and PAD in dementia through a multi-disciplinary approach. In a rights and dignity-based mental health era, social justice in dementia care can only be achieved if ELC is based on a patient-centric approach respecting the individual’s choices and autonomy.With this background, this symposium generates an East (India) – West (UK) dialogue related to ELC in dementia management, discusses the legal provisions of PAD in the two nations, focuses on dignity-based dementia care and finally highlights the stand of the Indian Psychiatric Society (IPS) with relation to this matter.The individual sessions are as follows: 1.Dignity in dementia care: Focus on human rights and autonomy(Dr DEBANJAN BANERJEE, Consultant geriatric psychiatrist, Kolkata, India)2.End-of-life care in neurocognitive disorders: The Indian caveats(Dr Neelanjana Paul, Associate Professor & Head, Dept of Psychiatry, ICare Institute of Medical Sciences & Research, Haldia, India)3.End-of-life care in dementia management: Perspectives from the UK(Dr Sujoy Mukherjee, Consultant Old Age Psychiatrist, West London NHS Trust, U.K.)4.Physician-assisted-death and end-of-life care in dementia: The Indian Psychiatric Society (IPS) stand(Dr Gautam Saha, Director, Clinic Brain Neuropsychiatric Institute and Research Center, Kolkata & President, Indian Psychiatric Society)

Assessing and disclosing test results for MCI: The perspective of UK old age psychiatrists

AbstractBackgroundMild cognitive impairment (MCI) is a state between normal healthy ageing and dementia with an uncertain prognosis. This uncertainty creates a complex dynamic between the clinicians’ conception of MCI, what is communicated to the individual about their condition, and how the individual perceives the information conveyed to them. The aim of this study was to explore clinicians’ views around the assessment and communication of MCI in memory clinics.MethodAs part of a larger longitudinal study looking at patients’ adjustment to being told they have MCI, we interviewed Old Age Psychiatrists at the five participating sites across South‐East Scotland. The study obtained ethics approvals and the interviews (carried out between Nov 2020–Jan 2021) followed a semi‐structured schedule focusing on [1] how likely clinicians are to use the term MCI with patients; [2] what tests clinicians rely on and how much utility they see in them; and [3] how clinicians communicate risk of conversion to dementia. The interviews were voice recorded and will be analysed using reflective thematic analysis (Clarke and Braun, 2019).ResultInitial results show that most clinicians interviewed (Total N=19) felt MCI had significant limitations as a diagnostic label. Nevertheless, more clinicians reported using the term MCI (n=15) with patients than not (n=4). Clinical history was commonly described as the primary aid in the diagnostic process and also to rule out functional impairment (which was sometimes corroborated by Occupational Therapy assessment). All clinicians reported using the Addenbrooke's Cognitive Examination‐Revised as a primary assessment tool; neuroimaging (e.g., CT) was frequently found to have minimal usefulness due to the reports being non‐specific.ConclusionOur study revealed a mixture of approaches to assessing and disclosing test results for MCI. Some clinicians consider the condition as a separate entity among neurodegenerative disorders whereas others find the term unhelpful due to its poor prognosis. Clinicians report a lack of specific and sensitive assessment methods for identifying MCI in clinical practice. Our study demonstrates a broad range of views and therefore variability in MCI risk disclosure in memory assessment services which may impact on the management of individuals with MCI.

G Vernon Davies: unsung pioneer of old age psychiatry in Victoria.

To provide a biography of G Vernon Davies who took up a career in old age psychiatry in 1955 at the age of 67 at Mont Park Hospital in an era when there few psychiatrists working in the field. In the 1950s and 1960s, Vernon Davies worked as an old age psychiatrist and published papers containing sensible practical advice informed by contemporary research and experience, broadly applicable to both primary and secondary care, presented in a compassionate and empathetic manner. His clinical research in old age psychiatry resulted in the first doctoral degree in psychiatry awarded at the University of Melbourne at the age of 79. Before commencing old age psychiatry, he served in the Australian Army Medical Corps as a Regimental Medical Officer and received the Distinguished Service Order. He spent 3 years as a medical missionary in the New Hebrides before settling at Wangaratta where he worked as a physician for over 30 years. He contributed to his local community in a broad range of activities. Vernon Davies is an Australian pioneer of old age psychiatry.

304 - Mental healthcare services and advocacy for older people amidst the COVID crisis: Voices from South Asia

AbstractAsia has some of the fastest developing economies and largest conglomerations of populations in the world. One such geographically unique region is South Asia, which accounts for nearly 25% of the global population and one-fifth of the psychiatric morbidity worldwide. This region is also ageing rapidly compared to rest of the world due to modifications in healthcare facilities, hygiene, and lifestyle as well as improved sanitation and infection control. Besides, some of the South Asian countries have also been worst-hit by the COVID-19 pandemic which has led to an exaggerated psychosocial crisis among their older people. Many of these nations face issues with community psychiatric care, trained manpower, socio-economic resources, legislation catering to psychological care and health inequalities. However, recent years have also witnessed paradigm shift in mental health policies, infrastructure and technology among these nations. Climate changes, migration, displacement and ecological characteristics further make South Asia unique in mental health needs and challenges.With this background, leaders in the field of psychogeriatric care from some of the South Asian nations come together to discuss and highlight upcoming strategies for mental health advocacy and service delivery among older people in these regions. Mutual collaboration and cross-country research are globally called upon.Panelists:1. Dr. Gautam Saha (President, Indian Psychiatric Society) drgsaha@yahoo.co.in2. Dr. G.Prasad Rao (President, Indian Association of Geriatric Mental Health) prasad40@gmail.com3. Dr. Sudarshan Narsingh (President, Psychiatrists’ Association of Nepal & President, SAARC Psychiatric Federation) drsudar@yahoo.com4. Dr. Wazizul Alam Chowdhury (President, Bangladesh Associa tion of Psychiatrists) bap@agni.com5. Dr. Afzal Javed (President, World Psychiatric Association and Chairman, Pakistan Psychiatric Centre, Fountain House, Lahore) afzalj@gmail.comModerator:Dr. Debanjan Banerjee (Old Age Psychiatrist, NIMHANS, Bangalore; Member, IPA Public Awareness and Advocacy Committee) dr.Djan88@gmail.com

Ajit Kumar Shah

Ajit Kumar Shah was born in Eldoret, Kenya, and came to the UK as a teenager. He undertook medical training at Liverpool University. At the end of his psychiatry training...

To resuscitate or not to resuscitate; a question for old age psychiatrists

AimsThe inpatient population of an older adult psychiatric ward will include people with physical and mental health conditions which affect life span and quality of life. Patients may be frail, acutely unwell, or have terminal illnesses such as dementia. It is therefore essential that clinicians review resuscitation status as part of their routine practice. However, we are aware that advanced decision-making – to resuscitate or not to resuscitate – is not routine practice across older adult psychiatric wards in the UK. Our 2017 audit reflected this, demonstrating a very low rate of resuscitation decisions at NELFT.This re-audit aimed to measure the frequency and quality of resuscitation decisions on an older adult psychiatric ward. We expected improvements in these areas, subsequent to changes implemented from the initial audit. We also sought to identify which patient factors influenced clinicians’ decision-making on resuscitation.Please note, this audit was completed prior to the COVID-19 pandemic.MethodIn June 2017, an audit of 25 patients admitted to two older adult psychiatric acute wards was completed. In December 2019, a retrospective analysis of the last 25 admissions to one older adult ward was undertaken. Electronic patient notes and DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) orders were examined. The audit measured frequency of resuscitation decisions and quality of documentation against current standards. DNACPR orders were analysed and clinicians were interviewed to identify the reasons for such decisions.ResultThere was an increase in the number of patients for which resuscitation decisions were made, from 4% in 2017 to 40% (n = 10) in 2019. The majority of patients with a DNACPR decision (n = 8) had a diagnosis of dementia. Prospective quality of life, with this diagnosis, was the most frequent determinant of DNACPR decisions (n = 7). Qualitative analysis indicated that clinicians were more likely to consider a resuscitation decision for patients with an organic disorder rather than functional disorder.Adequate completion of DNACPR orders was seen in each case. Either the patient, a family member or carer was involved in every decision. The standard for recording decisions on the electronic patient record was not met.ConclusionIt is good practice to consider resuscitation decisions for patients admitted to older adult psychiatric wards. This re-audit found an improvement in frequency of resuscitation decisions and also revealed differences in decision-making for patients with organic and functional disorders. Implementation of further change is indicated; decision-making can be improved through reflection, teaching, changes to practice, and technologies.

102 - Dementia and primary care – lessons from Europe: Symposium

Primary care doctors /General Practitioners are sometimes criticised for failing to recognise dementia in its early stages. Old age psychiatrists, neurologists or geriatricians take on the tasks of recognition, diagnosis (subtyping) and post-diagnostic support, and some Primary care doctors /General Practitioners welcome this division of labour as a way of avoiding the demanding tasks of dementia recognition and response. However, the rising prevalence of dementia syndromes in an ageing population is undermining the ability of secondary care specialists to fulfil their tasks of timely recognition, diagnosis and support. Primary care doctors /General Practitioners will be encouraged to take over some secondary care tasks. This will pose problems for Primary care doctors /General Practitioners, who may not have been trained to work with people with dementia, and who may not be able to incorporate such work into their practice even when trained. This symposium will explore the current and future challenges Primary care doctors /General Practitioners face in recognising and responding to dementia, and outline some lessons from four European countries (Ireland, Spain, Portugal and England). Themes to be presented include: Barriers to the recognition of dementia,The dementia-specific educational needs of Primary care doctors/General Practitioners,Interprofessional education of community-based primary care teams,Case management of people with dementia in primary care,IT solutions to problems of support for people with dementia.Effective dementia-care interventions in primary care post-diagnostic care pathways,Systemically-inspired brief interventions in primary care.Chair: Emeritus Professor Steve Iliffe, Centre for Ageing Population Studies, University College London [England]; co-chair: Professor Manuel Gonçalves-Pereira, Professor of Behavioural Medicine and Psychiatry, Nova Medical School, Universidade Nova de Lisboa [Portugal]Speakers:Dr Tony Foley, Lecturer Department of General Practice, University College Cork [Ireland]Professor Manuel A. Franco, Head of Psychiatry and Mental Health Department. University Rio Hortega Hospital (Valladolid) [Spain]Dr Conceição Balsinha, General Practitioner & Assistant professor/PhD student, Nova Medical School, Universidade Nova de Lisboa & Professor Manuel Gonçalves-Pereira, Nova Medical School, Universidade Nova de Lisboa [Portugal]Emeritus Professor Steve Iliffe, Centre for Ageing Population studies, University College London [England]

The role of the old age psychiatrist in a mobile geriatric team: an example in Tours city area (France)

Demographic changes require an adaptation of the geriatric care offer, which is readily oriented towards the community and including the development of out-of-hospital mobile geriatric team (MGT). Although psychiatric disorders of older persons require a comprehensive, integrative and multidisciplinary approach, geriatrics and old age psychiatry mobile units often work in parallel without concertation for the management of complex pathologies. The aim of this paper is to present the organisation and the results of a out-of-hospital MGT with a geriatrician and old age psychiatrists (OAP) in a same unit. Data were collected during the first-year (2018) of the out-of-hospital MGT of Tours University hospital. After initial geriatric assessment and when old age psychiatry (OAP) intervention was needed, referral mode and justification, patient's characteristics and recommendations made by the team were collected. During the study period, 151 patients were assessed, 53% (n=80) had out-of-medical follow-up or difficulties to access to healthcare; 40% (n=60) had behavioural and psychological symptoms of dementia (BPSD), 30% (n=45) falls, 15% (n=23) social problems, 10% (n=15) alteration of overall health status and 5% (n=7) drug conciliation; 40% (n=60) benefited from an OAP evaluation; 100% (n=60) had out of medical follow-up, 83% (n=50) had severe BPSD, 17% (n=10) psychological symptom with psychiatric condition, 10% (n=6) misused psychotropic medications in charge of general comorbidities decompensation; 32% (n=19) had geriatric, OAP consultations and 33% (n=20) were in denial of care; 23% (n=14) with severe BPSD had a second OAP consultation. Relationship between geriatrician and OAP in the same MGT enables to deliver comprehensive care, including organic, psychiatric and cognitive comorbidities and collaborative assessment of iatrogenicity. A strengthened relationship with general practitioners is a possible option for these frail older patients, out-of-medical follow-up allowing their reintegration in the geriatric healthcare system.

184 A National Survey of Clinicians who Assess People with Suspected Dementia: Service Characteristics and Practice

Abstract Background The Irish National Dementia Strategy (2014) identified timely diagnosis and intervention as a priority area. The National Dementia Office established a Dementia Diagnostic Project to develop a framework for diagnostic services nationally. As part of preparatory work, a national survey explored baseline peri-diagnostic practice in geriatric medicine, neurology and psychiatry of old age services. Methods A survey was developed by the project steering group, piloted, and then distributed to all 86 Geriatricians, 39 Neurologists, and 34 Psychiatrists of Old Age Psychiatrists in Ireland. Two reminder e-mails were sent. Results In total, 56 clinicians responded (response rate 35%). The majority (74%) saw 1-20 people with suspected dementia (PwSD) per month. Most referrals came from General Practitioners or other physicians; but rarely from Health and Social Care Professionals. Most people were referred specifically for their memory complaint, rather than a co-morbidity. Waiting times for urgent review varied between 24 hours and 4 years; neurology services had the longest waiting times. Only 30% saw PwSD in a dedicated clinic; about the same proportion saw PwSD in their own home; or in residential care settings. About half reported assessing people with intellectual disability and suspected dementia, mainly the neurologists. The Montreal Cognitive Assessment was the most commonly used cognitive tool (89%), followed by the Addenbrook’s Cognitive Examination (56%). Only 17% commonly used functional brain imaging in diagnosis, mainly neurologists; half of respondents ‘never’ or ‘rarely’ used cerebrospinal fluid analysis. Multidisciplinary input was mainly from Occupational Therapists (61%), Psychology/Neuropsychology (52%), and Nursing disciplines (33%). When asked which discipline would most benefit their diagnostic service, neurologists all chose psychology input; geriatricians selected a range of disciplines. Conclusion The significant variability within current services who see PwSD, in terms of multidisciplinary involvement, waiting times, setting, and supporting investigations, supports the need for a national diagnostic framework.

Assessing driving fitness in dementia: a challenge for old age psychiatrists.

To investigate how old age psychiatrists consider the fitness of dementia patients to drive safely and the challenges they face. Participants were interviewed using a semi-structured approach that explored topics including their approach to driving fitness and cessation, challenges experienced and previous training. Thematic analysis was used to generate main themes. Thirteen participants were recruited. Most felt they were not experts in driving fitness. Many found these assessments challenging for both themselves and their patients, with a negative impact on therapeutic alliance. There was a lack of formal training and variability both in the approach when considering fitness to drive as well as raising the issue of driving with patients. These results highlight the need to increase the availability of training for driving fitness, and to develop a standardised approach to help improve consistency amongst clinicians.

Factors Associated with Psychiatrist Opt-out from US Medicare: an Observational Study.

Concerns exist about availability and access to psychiatric services in the USA. For Medicare beneficiaries, one impediment to psychiatric services is the extent to which psychiatrists have opted out of the Medicare program. This study describes geographic variation in rates that psychiatrists opt out of Medicare, and assesses physician-level and geographic-level predictors of opt-out. Retrospective cross-sectional analysis of data describing psychiatrists' opt-out status as of March 2017 linked to data on psychiatrist location, psychiatrist characteristics (obtained from a comprehensive US physician database), and market area-level characteristics. 27,838 psychiatrists in the USA MAIN MEASURES: Whether a psychiatrist had opted out of Medicare as of March 2017. Overall, 7.0% of psychiatrists (1940/27,838) opted out of Medicare as of March 2017. Opt-out rates varied substantially across states and within states. Physician-level factors independently associated with opt-out included: older age (psychiatrists > 65years were 2.6 percentage points more likely to opt vs. psychiatrists < 35years old, p = 0.03), greater years of experience, female gender (female psychiatrists were 2.6 percentage points more likely to opt out than male psychiatrists, p < 0.001), graduation from a top-20 ranked medical school (1.7 percentage points more likely to opt out of Medicare, p < 0.001), and domestic medical graduate (domestic graduates were 7.3 percentage points more likely to opt out of Medicare vs. foreign graduates, p < 0.001). Adjusting for other individual- and geographic-level factors, psychiatrists who practiced in areas with more psychiatrists per Medicare beneficiary were less likely to opt out (p < 0.001). The overall likelihood that psychiatrists opt out of Medicare is significant and varies considerably across regions and by characteristics of psychiatrists.

Development of a tool for monitoring the prescribing of antipsychotic medications to people with dementia in general practice: a modified eDelphi consensus study.

BackgroundDespite their adverse effects, antipsychotics are frequently used to manage behavioral and psychological symptoms of dementia. Regular monitoring of antipsychotic prescribing has been shown to improve the appropriateness of prescribing. However, there is currently no consensus on what the components of such a monitoring tool would be.AimThe aim of this study was to use an expert consensus process to identify the key components of an antipsychotic repeat prescribing tool for use with people with dementia in a general practice setting.MethodsA modified eDelphi technique was employed. We invited multidisciplinary experts in antipsychotic prescribing to people with dementia to participate. These experts included general practitioners (GPs), geriatricians and old age psychiatrists. The list of statements for round 1 was developed through a review of existing monitoring tools and international best practice guidelines. In the second round of the Delphi, any statement that had not reached consensus in the first round was presented for re-rating, with personalized feedback on the group and the individual’s response to the specific statement. The final round consisted of a face-to-face expert meeting to resolve any uncertainties from round 2.ResultsA total of 23 items were rated over two eDelphi rounds and one face-to-face consensus meeting to yield a total of 18 endorsed items and five rejected items. The endorsed statements informed the development of a structured, repeat prescribing tool for monitoring antipsychotics in people with dementia in primary care.ConclusionThe development of repeat prescribing tool provides GPs with practical advice that is lacking in current guidelines and will help to support GPs by providing a structured format to use when reviewing antipsychotic prescriptions for people with dementia, ultimately improving patient care. The feasibility and acceptability of the tool now need to be evaluated in clinical practice.

How sexuality relates to people with dementia in the hospital setting.

British Journal of NursingVol. 27, No. 8 RegularsHow sexuality relates to people with dementia in the hospital settingAysha MendesAysha MendesSearch for more papers by this authorAysha MendesPublished Online:23 Apr 2018https://doi.org/10.12968/bjon.2018.27.8.462AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Benbow SM, Beeston D. Sexuality, aging and dementia. Int Psychogeriat. 2012; 24(7):1026-1033. https://doi.org/https://doi.org/10.1017/S1041610212000257 Crossref, Medline, Google ScholarDementiaGuide. About Dementia. Alzheimer's Disease: Inhibition. 2018. https://tinyurl.com/yc6n9r7f (accessed 12 April 2018) Google ScholarInternational Longevity Centre. The last taboo. A guide to dementia, sexuality, intimacy and sexual behaviour in care homes. 2011. https://tinyurl.com/o7elazx (accessed 12 April 2018) Google ScholarLightbody E. Sexuality and dementia: for better or for worse? Old Age Psychiatrist. 2014; 59. https://tinyurl.com/yan5gcxy (accessed 12 April 2018) Google ScholarMendes A. Companionship, intimacy and sexual expression in dementia. Nursing and Residential Care. 2015; 17(7): 390–392. https://doi.org/https://doi.org/10.12968/nrec.2015.17.7.390 Link, Google ScholarRoyal College of Nursing. Older people in care homes: sex, sexuality and intimate relationships. An RCN discussion and guidance document for the nursing workforce. London: RCN; 2011. https://tinyurl.com/y87fssuf (accessed 10 April 2018) Google Scholar FiguresReferencesRelatedDetails 26 April 2018Volume 27Issue 8ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 23 April 2018 Published in print 26 April 2018 Information© MA Healthcare LimitedPDF download

Completed audit cycle to explore the use of the STOPP/START toolkit to optimise medication in psychiatric in-patients with dementia.

Benzodiazepines, antipsychotics and opiates were most commonly prescribed inappropriately. The most common unprescribed medication groups were statins, calcium supplements and vitamin D supplements. There was an overall reduction of 7% in comorbidities and 8% in the number of prescriptions. t-test showed a significant drop in average comorbidities between both audits, t(1) = 23.920, P = 0.027, and in average prescriptions per patient, t(1) = 28.808, P = 0.022. There was no difference in the number of patients receiving polypharmacy, t(1) = 7.500, P = 0.084, or receiving medication with a high risk of adverse drug reactions, t(1) = 6.857, P = 0.092. Clinical implications The STOPP/START toolkit highlighted the importance of collaborative working between doctors, clinical pharmacists and nursing staff, and could provide old age psychiatrists with a structured tool to identify inappropriate prescribing of non-psychiatric medications. Declaration of interests None.