An integrated model for defining the scope of psychogeriatrics: the five Cs

Prevalence of depression in older adults: A systematic review and meta-analysis

Depression is a prevalent mental disorder in older adults, but the prevalence in older adults varies largely across studies due to differences in regional cultures and screening tools. The objective of this review is to systematically evaluate the global prevalence of depression in older adults. PubMed, Embase, Web of Science and Cochran Library databases were searched independently from 2000 to 2021. Subgroups, sensitivity, and meta-regression analyses were performed to address heterogeneity. Publication bias was evaluated using Egger's test. Forty-eight eligible studies were included in this review. The global prevalence of depression in older adults was 28.4%, with high between-study heterogeneity. The meta-analysis showed that the prevalence of depression in older adults is high although it varied with geographic regions, screening tools, sample sizes and representativeness, and study quality. Therefore, it is necessary to carefully consider appropriate screening tools to estimate the prevalence in different regions of a population.

Cognitive behaviour therapy for generalized anxiety disorder: Is CBT equally efficacious in adults of working age and older adults?

The current meta-analysis compared the efficacy of CBT for GAD between adults of working age and older people. In addition, we conducted a qualitative content analysis of treatment protocols used in studies with older clients to explore potential factors that may enhance treatment outcomes with this particular client group. Applying the inclusion criteria resulted in the identification of 15 studies with 22 comparisons between CBT and control groups (770 patients). When examining overall effect sizes for CBT for GAD between older people and adults of working age there were no statistically significant differences in outcome. However, overall effect size of CBT for GAD was moderate for older people (g=0.55, 95% CI 0.22-0.88) and large for adults of working age (g=0.94, 95% CI 0.52-1.36), suggesting that there is still room for improvement in CBT with older people. The main difference in outcome between CBT for GAD between the two age groups was related to methodological quality in that no older people studies used an intention-to-treat design. The content analysis demonstrated that studies with older clients were conducted according to robust CBT protocols but did not take account of gerontological evidence to make them more age-appropriate.

Age-Appropriate Augmented Cognitive Behavior Therapy to Enhance Treatment Outcome for Late-Life Depression and Anxiety Disorders

We present an explanation of the benefits of using gerontological theory to augment treatment outcome in cognitive behavior therapy (CBT). Traditional formulations/conceptualizations of CBT may not always be the most optimal fit when working with older people, who may be experiencing different developmental life stages compared to adults of working age. In addressing how CBT may be different with older people, it is proposed that one may augment CBT outcome by applying gerontological theory as “vehicles for change.” This evidence-based scientist approach is consistent with standard practice in CBT. This paper outlines some examples of how gerontological theory can be useful to bring about an enhanced treatment outcome.

Medical outcome of patients with dementia in a free-standing psychiatric hospital

BACKGROUND

The hospital outcome of patients with dementia is significantly worse than that of cognitively intact persons of the same age admitted to medical or surgical units but has not been investigated in psychiatric settings.

AIM OF STUDY

To determine the medical outcome of patients with dementia admitted for behavioral disturbance to a free-standing psychiatric hospital.

METHODS

Emergency transfers from the psychiatric setting to a general hospital were used as proxies for medical deteriorations occurring among the 71 patients with dementia (age 78.4 ± 10.4 years; 40.1% males) and 71 age- and gender-matched nondementia control patients. The patients were identified in a cohort of 1000 patients consecutively admitted to a free-standing mental health institution. Logistic regression was used to determine the clinical and laboratory variables independently associated with medical deteriorations.

RESULTS

A total of 30 patients with dementia and 25 nondementia patients were transferred to a general hospital after an acute medical deterioration (42.3% vs 35.2%, P = .38). Febrile illnesses and falls with head trauma were the most common reasons for transfers in the dementia group, in which they constituted more than half of medical deteriorations, a proportion significantly higher than in the control group (P = .011). Admission hemoglobin levels were the only independent predictor of medical deterioration in this geriatric sample.

CONCLUSIONS

Although nearly 50% of patients with dementia admitted for behavioral disturbance to a free-standing psychiatric institution required transfer to a general hospital, their rate of medical deteriorations was similar to age-matched nondementia control patients.

Sixteen-month evaluation of depressive symptomatology in older adults

We examined the prevalence of depressive symptoms over time in a sample of community-residing older adults at baseline, 2 months, 6 months, and 14 months. The nonprobability sample (N = 222) was 90% female, 87% Caucasian, 15% Hispanic, and 12% African American with an average age of 75 years. If depressive symptoms had been measured at only one time, 19% of the sample would have scored above the cutoff versus 39% scoring above the cutoff when measured at all 4 periods. The findings provide evidence that depressive symptoms in older adults are variable and fluctuate over time. The significance of this research was the longitudinal evaluation of depressive symptoms in community-residing elders.

Medical comorbidity in psychogeriatric patients

PURPOSE OF REVIEW

To undertake a systematic review of articles published in the years 2008-2010 related to medical comorbidities in psychogeriatric patients. This paper addresses selected research findings on the prevalence and causes of medical comorbidity in elderly patients with psychiatric illnesses. MEDLINE, EMBASE and PsychINFO databases were used to identify potential studies. Specific medical comorbidities which were studied included osteoporosis and diabetes. Several studies investigated general medical comorbidities.

RECENT FINDINGS

Elderly patients with psychiatric illness generally had the presence of at least one medical comorbidity compared with elderly patients without a psychiatric illness. Depression in elderly patients was the most commonly studied psychiatric illness.

SUMMARY

Elderly patients with psychiatric illness commonly have comorbid medical conditions. The presence, appropriate investigations and management of these are often suboptimal and can affect quality of life and increase mortality.

Peculiarities of geriatric psychiatry: a focus on aging and depression

There is a debate on whether Geriatric Psychiatry stands for itself as a discrete specialty or whether it is an extension of clinical Geriatrics, Neurology, and Psychiatry. This review aims to outline some recent data and possible approaches to define peculiarities of Geriatric Psychiatry, focusing on certain characteristics that define the aging brain. Geriatric depression is discussed taking into consideration some data from translational research. The brain aging process is not uniform. Frontal areas show marked impairment in inhibiting irrelevant information in working memory as they age, and the recruitment of these areas occur differently than in young subjects. Executive functions also change in normal elderly. Geriatric depression is a general definition of a multidimensional disorder with multiple risk factors. Dysexecutive syndrome is considered as a key to the neuropsychology of geriatric depression, correlated with functional impairment in late life. Late-onset depression has a higher load of comordibity, of cerebrovascular disease, and of some genetic factors that may be different from early onset depression. Also, there are at least four clusters of treatment outcomes that are common in geriatric depression, which mirror the neuropsychological and clinical profiles. Research and practice in Geriatric Psychiatry should focus on the interaction of various dimensions and risk factors rather than on attempting to find a single cause to the disorders. Some answers may be found in comorbidity issues, in white matter lesions, which are more common in the elderly, and in genetic factors that impact on the aging process.