A survey of psychiatric services for elderly people in Australia

Training in Aging as a Diversity Factor: Education, Knowledge, and Attitudes Amongst Psychology Doctoral Students

The population of older adults is growing rapidly and there will be an increased need for psychological services for this population. Current estimates indicate a significant workforce gap such that all psychologists, regardless of specialty area, will likely be called upon to work with older adults. Education and experience in the care of older adults has been consistently connected with improved competence and interest in working with this population. Further, the APA requires that training programmes adequately cover aspects of individual diversity, though age-related education and training may be largely lacking and/or minimally addressed. The present study explores age-related training within a sample of psychology doctoral students. Participants (n = 85) consisted of doctoral trainees recruited via email (listserv) to complete an anonymous online survey as part of a larger study. Results indicate that (1) training in aging varies and is inadequate in some programmes; (2) knowledge in aging varies and is associated with training opportunities; (3) training in aging is less than training in race/ ethnic diversity; and (4) attitudes toward older clients are most strongly predicted by extent of training in aging. The authors offer suggestions for expanding age-related aspects into generalist training.

The clinical utility of the Cornell Scale for Depression in Dementia as a routine assessment in nursing homes

OBJECTIVE

To examine the clinical utility of the Cornell Scale for Depression in Dementia (CSDD) in nursing homes.

SETTING

14 nursing homes in Sydney and Brisbane, Australia.

PARTICIPANTS

92 residents with a mean age of 85 years.

MEASUREMENTS

Consenting residents were assessed by care staff for depression using the CSDD as part of their routine assessment. Specialist clinicians conducted assessment of depression using the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders for residents without dementia or the Provisional Diagnostic Criteria for Depression in Alzheimer Disease for residents with dementia to establish expert clinical diagnoses of depression. The diagnostic performance of the staff completed CSDD was analyzed against expert diagnosis using receiver operating characteristic (ROC) curves.

RESULTS

The CSDD showed low diagnostic accuracy, with areas under the ROC curve being 0.69, 0.68 and 0.70 for the total sample, residents with dementia and residents without dementia, respectively. At the standard CSDD cutoff score, the sensitivity and specificity were 71% and 59% for the total sample, 69% and 57% for residents with dementia, and 75% and 61% for residents without dementia. The Youden index (for optimizing cut-points) suggested different depression cutoff scores for residents with and without dementia.

CONCLUSION

When administered by nursing home staff the clinical utility of the CSDD is highly questionable in identifying depression. The complexity of the scale, the time required for collecting relevant information, and staff skills and knowledge of assessing depression in older people must be considered when using the CSDD in nursing homes.

Geropsychology content in clinical training programs: a comparison of Australian, Canadian and U.S. data

BACKGROUND

There is a worldwide shortage of mental health professionals trained in the provision of mental health services to older adults. This shortage in many countries is most acutely felt in the discipline of psychology. Examining training programs in clinical psychology with respect to training content may shed light on ways to increase interest among students and improve practical experiences in working with older adults.

METHODS

A large multinational survey of geropsychology content in university-based clinical and counselling psychology training programs was conducted in 2007 in the U.S.A., Australia, and Canada. Both clinical/counseling programs and internship/practicum placements were surveyed as to staffing, didactic content and training opportunities with respect to geropsychology.

RESULTS

Survey response rates varied from 15% in the U.S.A. (n = 46), 70% in Australia (n = 25) to 91.5% in Canada (n = 22). The U.S.A. and Australia reported specialist concentrations in geropsychology within graduate clinical psychology training programs. More assessment and psychopathology courses in the three countries were cited as having ageing content than psychotherapy courses. Many non-specialist programs in all three countries offered course work in geropsychology, and many had staff who specialized in working clinically with an older population. Interest in expanding aging courses and placements was cited by several training sites. Recruiting staff and finding appropriate placement opportunities with older adult populations were cited as barriers to expanding geropsychology offerings.

CONCLUSIONS

In light of our results, we conclude with a discussion of innovative means of engaging students with ageing content/populations, and suggestions for overcoming staffing and placement shortcomings.

Development of a tool to evaluate geropsychology knowledge and skill competencies

BACKGROUND

Workforce shortages to meet the mental health needs of the world's aging population are well documented. Within the field of professional geropsychology in the U.S.A., a national conference was convened in 2006 to delineate competencies for psychological practice with older adults and a training model for the field. The conference produced the Pikes Peak Model of Geropsychology Training. The Council of Professional Geropsychology Training Programs (CoPGTP) aimed to produce a competency evaluation tool to help individuals define training needs for and evaluate progress in development of the Pikes Peak professional geropsychology competencies.

METHODS

A CoPGTP task force worked for one year to adapt the Pikes Peak Model geropsychology attitude, knowledge, and skill competencies into an evaluation tool for use by supervisors, students and professional psychologists at all levels of geropsychology training. The task force developed a competency rating tool, which included delineation of behavioral anchors for each of the Pikes Peak geropsychology knowledge and skill competencies and use of a developmental rating scale. Pilot testing was conducted, with 13 individuals providing feedback on the clarity and feasibility of the tool for evaluation of oneself or students.

RESULTS

The Geropsychology Knowledge and Skills Assessment Tool, Version 1.1, is now posted on the CoPGTP website and is being used by geropsychology training programs in the U.S.A.

CONCLUSIONS

The evaluation tool has both strengths and limitations. We discuss future directions for its ongoing validation and professional use.

Psychogeriatrics and general practice in Australia

We describe the interface between general practice and psychogeriatrics in Australia. While aged care services are complex and there are serious deficiencies in the management of the elderly, several initiatives appear set to improve the level of care. Economic considerations, mutual education of general practitioners and psychogeriatricians, and social factors are strong determinants of good primary care of the mental health needs of older people.