Post on 05-Jan-2016
OLD AGE PSYCHIATRY FOR PRIMARY CARE VOCATIONAL
TRAINEES
Dr Nick PearsonConsultant in the Psychiatry of Old Age Reading
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Older Person’s Mental Disorders in Primary Care
• The Dynamic Duo
• Depression
• Dementia
Older Persons’ Depressive Disorders in Primary Care
• Depression in older age is not an inevitable consequence it is a pathological state
• 10-15% over 65yrs
• GP list of 1700 20% > 65 yrs (340)
• Depressed patients= 42
• Treatment Resistant= 14
Older Person’s Depression in Primary Care
• 15-30% seek help
• Prevalence Care homes 30-40%
• Nursing homes 70%
• General hospitals 15-20%
Older Persons’ Dementia in Primary Care
• Prevalence >65 yrs= 5%
• Patients with dementia average GP caseload-17
• 1in 10 receive a diagnosis
• >75yrs=10%
• >85 yrs= 20%
• >90yrs= 30%
Older Persons’ Dementia in Primary Care
• Significant Behavioural and Psychological Symptoms in Dementia BPSD (30%)= 5
• Mild to moderate (2/3) = 11
• May benefit from treatment (3/4)= 8
Older Person’s Mental Disorders in Primary Care
• Younger onset dementia
• 1in 1000 < 65yrs
• 0.3 of a person
Older Persons’ Delirium in Primary Care
• Prevalence in primary care unknown
• 40% of>65yrs in hospital
Older Persons’ Psychotic Disorders in Primary Care
• Psychotic Disorders
• Prevalence in community >65yrs of 1%
• Schizophrenia
• Persistent delusional disorders
• Mania
• Psychotic depression
Older Persons’ Psychotic Disorders in Primary Care
• Severe
• Lethal
• for 65-86 yr olds over a 6 yr period mortality men 30% women 20%
• Psychotic depression men 75 % women 40%
Older Persons’ Neurosis in Primary Care
• Prevalence anxiety disorders>65yrs= 4%
• Phobias= 10%
Older Persons’ Psychoactive Substance Use in Primary Care
• 4% of older males had drunk> 8 units of alcohol on at least 1 day in the previous week.
• 16-24yr olds?
• Alcohol more commonly a complicating factor
Older Persons’ Mental Disorders in Primary Care: Factors
• Physical disorders
• Medication
• Social Context
• Environmental Context
• Individual’s meaning