Elderly Mentally Ill Research Articles

Prevalence and Predictors of Suicide Ideation among Elderly Mentally Ill Population in a Tertiary Psychiatric Hospital

BACKGROUND
 Suicide attempts in elderly people has higher risk of mortality. The elderly are more vulnerable to depression and other psychological and social factors that may contribute to higher risk of suicide. Studies have suggested that suicide in elderly is strongly associated with depression and lack of social support. Factors that increase risk of suicide are also found to increase the risk for suicide ideation. Suicide ideation is an important predictor of suicide attempts and completed suicide.
 Aims: Our study aims at estimating the prevalence of suicide ideation among mentally ill geriatric population and identifying potential predictors of suicide ideation among elderly.
 METHODS
 A cross-sectional study involving 50 persons with mental illness aged above 60 years and 50 persons with no previous psychiatric history. The was conducted at a tertiary psychiatric hospital. Geriatric Suicide Ideation Scale, Geriatric Depression scale and other psychopathology assessment tools were used.
 RESULTS
 The GSIS scores were significantly higher among those elderly persons with mental illness and the scores were higher in our study when compared to the community-dwelling elderly persons without psychiatric illness. It was observed that geriatric depression was an important predictor of suicide ideation followed by previous suicide attempt. The study also finds significant difference in the subscales of GSIS and we constructed an ROC for optimal cut-off point for the Indian population.
 CONCLUSIONS
 Geriatric suicide ideation is a less studied area with suicide ideation in elderly person with mental illness having various determinants and risk factors. It is for further research to identify feasible means of assessing suicide ideation among the elderly person receiving care from primary care physicians.

A Study of Criminal Manifestation and Characteristics of Elderly Mental Illness

Objective: As the population of the elderly increases, the prevalence of dementia and other mental diseases of the elderly is also increasing. Dementia is a typical elderly mental illness. Some people with dementia may cause a crime due to symptoms of mental behavior. The purpose of this study is to examine the characteristics of criminal behavior of various elderly mental patients. Methods: From January 1, 2010 to December 31, 2019, the court selected 65 years of age or older from among the criminal psychiatric appraisal cases commissioned by the court. A total of 205 medical records and mental assessments were reviewed retrospectively. All records were prepared through psychiatric interviews, clinical psychological examinations, and other examinations, and the information compiled was viewed in several aspects, including demographic factors, crime characteristics, and psychiatric opinions, at the level of technical analysis. Results: There was a statistically significant difference in the judgment of criminal liability according to the degree of cognitive impairment (p<0.001) in the elderly mentally ill, and a significant difference in criminal behavior depending on the type of mental illness (p<0.001). Conclusion: Not only dementia but also other elderly mental illnesses are related to violent crime. In particular, paranoid symptoms and alcohol abuse in older adults’ mental illness are related to the type of criminal behavior. In an aging society, appropriate therapeutic intervention is needed to prevent criminal behavior of the elderly mentally ill.

Impact of the demand for ‘proxy assent’ on recruitment to a randomised controlled trial of vaccination testing in care homes

Legal frameworks are in place to protect those who lack the capacity to consent to research, such as the Mental Capacity Act in the UK. Assent is sought instead from...

Mental capacity assessments among general hospital inpatients referred to a specialist liaison psychiatry service for older people

Mental capacity has been little studied among older general hospital inpatients. A retrospective analysis was undertaken of routinely collected data (age, gender, ethnicity, admission diagnosis, psychiatric diagnosis, Mini-mental State Examination score, whether capacity was assessed, the outcome of that assessment, and discharge destination) on referrals to a liaison psychiatry service for older people (2003-2006) from medical and surgical teams at a large London teaching hospital. 1267 patients were referred to the service, of whom 379 (30%) were assessed for capacity. The most common mental capacity issues were placement (303 assessed of whom 54% lacked capacity), treatment (86 assessed, 59% lacking capacity) and finances (70 assessed, 79% lacking capacity). Cognitive impairment, dementia and delirium, rather than mental disorders were associated with incapacity. Those assessed and deemed to lack capacity for placement decisions were twice as likely to be placed in a care home, and four times as likely to be placed in an elderly mentally ill (EMI) facility, independent of dementia diagnosis and cognitive functioning. Referrals to a liaison psychiatry service for older people for assessment of mental capacity are common. The main mental capacity issues in older people were those linked to discharge planning. The relatively high proportion of those found to have capacity when capacity had been queried by referring clinicians attests to the important role of specialist liaison teams, particularly in complex cases, in protecting the autonomy of vulnerable older people, and avoiding institutionalization.

Fifteen year comparison of antipsychotic use in people with dementia within hospital and nursing home settings: sequential cross‐sectional study

The use of antipsychotics to treat people with behavioural and psychological symptoms associated with dementia is controversial, especially in long-stay settings. We assessed the relationship between behaviour, function and antipsychotic use in people with dementia in a long-stay psychiatric unit and designated elderly mentally ill (EMI) nursing homes over a 15-year period. Sequential cross-sectional studies assessing twelve behaviours and seven measures of function for each patient. Antipsychotic and antidepressant use was obtained from current prescription records. Regular antipsychotic use in hospital fell between 1990 and 1998. In 1998 use in nursing homes was significantly greater than in hospital, and increased between 1998 and 2005. Noisiness/verbal aggression (NVA) was the only behaviour more commonly associated with regular antipsychotic use over that timescale. Those with low levels of core symptoms (p = 0.021) and high dependency patients (p = 0.001) were more likely to be receiving regular antipsychotics in nursing homes than in hospital. Depression was not treated well even when identified. Compared to a long-stay hospital setting, antipsychotic drug use for people with dementia in nursing homes has risen and become less systematic. This cannot be explained by increasing core behaviour symptoms or differences in physical dependency.

The Camberwell Elderly Mentally Ill and Their Needs for Services

Previous studies on the elderly mentally ill (graduates) have been undertaken in mental hospital settings and on populations being resettled from hospitals. This paper aims to assess the characteristics and service needs of an epidemiological sample of elderly mentally ill. The aim of this study was to identify the characteristics, problems, service utilization and needs of a sample of elderly patients with functional psychosis in a defined epidemiological area. Data collected by PRiSM on psychotic patients who lived in two districts of Maudsley Hospital's catchment area were analyzed using the characteristics, problems and the needs for mental health services of those patients who were over the age of 64. These patients were compared with younger patients using the same data. The elderly patients differed significantly in their characteristics and problems from the younger mentally ill persons. The needs assessment procedure (Camberwell Assessment of Needs, CAN) was less sensitive to physical and psychiatric needs of the elderly as it did not reflect the differences between the two age groups. The lower rate of schizophrenia in the elderly mentally ill compared to the younger community patients and asylum mentally ill is discussed. The explanation may lie in the natural history of the disorder or more plausibly in the implementation of ;community care policy'. The paper concluded that a needs assessment procedure specifically designed to assess the needs of the elderly is required.

Doll use in care homes for people with dementia

Dolls and teddy bears were introduced into an Elderly Mentally Ill (EMI) home as part of a non-pharmacological intervention. Thirteen residents from a population of 33 chose to use a doll and one chose a teddy bear. The impact of the toys was assessed on five domains over a 12-week period and the findings were generally positive, which was consistent with previous observations (Mackenzie et al., in press). The investigation also attempted to determine whether staff were able to predict which residents would chose a toy. In terms of the dolls, out of the 16 residents predicted to use a doll, nine did so (56% accuracy). Despite the benefits outlined in this largely descriptive study, a number of problems were observed and some of these difficulties are outlined below.

Staff nurse who had an alcohol problem and made nursing errors

Nurse Black had worked as a staff nurse on a small ward devoted to the care of elderly mentally ill (EMI) patients for nearly 10 years when it was decided to close the ward and amalgamate it with a new one. It was felt appropriate by Nurse Black's clinical managers to place her on a more acute assessment ward so that her skills and knowledge would be updated and improved.

Deputy matron who physically and verbally abused patients in her care.

Jean, the nurse in this particular case, was a registered mental nurse (RMN) who worked at a large 50-bedded elderly mentally ill (EMI) nursing and residential care home. She often acted as the named person in charge of the home, but always refused to take the post permanently. Jean did, however, accept a post as deputy matron, but she still preferred to see herself as ‘one of the workers’ and liked to fraternize with the untrained staff.

Community integration of elderly mentally ill persons in psychiatric hospitals and two types of residences.

Deinstitutionalization policy in the Netherlands has given rise to two new living arrangements for elderly long-term psychiatric patients. Both involve accommodation in mainstream residential homes for elderly persons, either concentrated in a specialized care unit or dispersed throughout the facility. The authors studied the effectiveness of these two housing models for the community integration of such residents compared with accommodation in a psychiatric hospital. Three subsamples were selected: 49 residents in six units of concentrated housing, 47 residents in 12 units of dispersed housing, and 78 patients in 24 psychiatric hospital units, for a total sample of 174 participants. These samples were compared in a quasi-experimental, posttest-only design that used four measures of community integration: amount of perceived influence over one's daily life, involvement in social activities, social network size, and frequency of visits received from members of the network. To adjust for differences in the populations, the hospital patients were matched to the residential home residents, and confounding factors were controlled for. Residential homes afforded more privacy, were closer to public services, and had a more diversified population than psychiatric hospitals. Participants in dispersed housing experienced more personal influence over their lives than did hospital patients. Concentrated-housing participants were less enterprising and had smaller social networks. The three groups did not differ in the frequency of visits received from network members. Community-integrated facilities do not necessarily imply community-integrated residents. Only dispersed-housing residences were an improvement over hospitals, and then solely in terms of residents' influence over their own daily lives. The advantage of the dispersed-housing model is that it resembles independent living while its institutional nature offers structure and protection.

Life story books for the elderly mentally ill.

The use of life story books with people with moderate to severe dementia in continuing care and day hospital settings is examined. The approach involved activity-based carer and relative training and support. A collaborative approach has developed and shifts in staff attitudes are discussed. Consideration is given to generalisation to other aspects of patient care.

Purposeful Activity and Elderly Mentally Ill People: Why?

Purposeful Activity and Elderly Mentally Ill People: Why?

Elderly Mentally Ill People and Quality of Life: Who Wants Activities?

Purposeful activity, accepted as an important constituent of quality living by many people, has not been well researched in relation to elderly mentally Ill people. In a 43-bed nursing home in the north west of England, a small study explored initial patient, relative and staff reactions to a newly introduced part-time activity programme. The results highlighted the importance of a flexible programme of activities, coordinated by an appointed person and providing mental stimulation for the residents. The willingness of staff to become further involved as the programme expands suggests that additional staff training and specific time allocation would be needed.

Therapeutic Foster Homes for Elderly Mentally Ill Persons

Therapeutic Foster Homes for Elderly Mentally Ill Persons

The future of day care in old age psychiatry

In 1961 Shaw &amp; Macmillan claimed that there was no doubt of the value of the day hospital as an “alternative to in-patient care and prophylaxis” for the elderly mentally ill (EMI). Thirty years later the day hospital remains central to many EMI services. During these years little has been done to evaluate this method of service delivery against other models of service provision.

Implications of a Mental Health Intervention for Elderly Mentally Ill Residents of Residential Care Facilities

Unresolved issues of responsibility between mental health and aging systems low priority within the mental health system for serving older RCF residents, and little expectation for the facility to be a treatment environment, all contribute to gaps in service delivery to mentally ill boarding home residents. This article reports the results of a two-year mental health intervention in RCFs. Findings show little intervention impact, but revealed that residents treated were generally socially marginal with weak ego skills, rather than significantly mentally ill. A more intensive program that restructures the facility's milieu to offer planned normal life demands and that models structured programs like milieu treatment, in situ treatment for the younger mentally ill, and programs for developmentally disabled persons is suggested.

Home Health Care??s Unique Role in Serving the Elderly Mentally Ill

Psychiatric home health services are a viable option for providing essential treatment to elderly clients having major mental disorders or acute psychiatric problems secondary to a medical illness. This valuable adjunct to in-home treatment can be provided by psychiatric mental health nurse specialists who work collaboratively with other mental health disciplines. If a home health agency does not have a psychiatric treatment component, it can expand its services by hiring a qualified psychiatric nurse and educating its interdisciplinary staff in the appropriate care of mentally ill clients. Referrals can be obtained from facilities for acute psychiatric disorders, psychiatrists, general hospitals, outpatient clinics, and patients themselves or their families. This important service can benefit acutely ill psychiatric patients by enabling them to be discharged from inpatient settings sooner and treated comfortably in the less restrictive environment of their home while receiving appropriate and adequate follow-up and referral. As such, it is cost-efficient to the client and society and represents the community-based care of the future for the mentally ill.

Private Care for the Elderly Mentally Ill: Report of a Working Party of the Section for the Psychiatry of Old Age

Private Care for the Elderly Mentally Ill: Report of a Working Party of the Section for the Psychiatry of Old Age

Private Care for the Elderly Mentally Ill. Report of a Working Party of the Section for the Psychiatry of Old Age

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Family therapy with the elderly mentally ill. Some strategies and techniques.

Over a six month period, 142 consecutive referrals of patients over 65 to a community-orientated psycho-geriatric service in North London were studied. The psycho-social factors determining referral were quantified and their relationship to diagnosis analysed. Therapeutic strategies are described, devised to deal with the presenting psycho-social problems. It is suggested that a family-centred approach is of some value in the management of the elderly mentally ill.