[Interest of extrahospital multidisciplinary unit of neuro-psycho-geriatric intervened in nursing home: Analysis of 288 interventions]. / Intérêt d'une unité mobile multidisciplinaire extra-hospitalière de neuro-psychogériatrie intervenant en EHPAD : analyse de 288 interventions.

INTRODUCTION: Geriatrics Mobile Units are a new organisation operating in nursing homes. Their mission is to propose globally oriented neuro-psychiatric and geriatric care. The purpose of the study is to assess their activity and impact over a 21-month period. METHOD: A prospective single center study of UMNPG's data including intervention characteristics, patient characteristics, recommendations and reassessment after intervention. The Neuropsychiatric Inventory Nursing Home version (NPI-NH) was measured during intervention and reassessed after 30 days (Student's t-test). RESULTS: From March 2014 to December 2015, UMNPG conducted 288 interventions mainly for medical advices (81%), clinical assessments (54%) and health care team support (46%). The average age was 84.6±7.3years, 73.3% of whom were women. The patients were dependent (62% of GIR 1 or 2) with dementia (60%) and under several medications (83.7%). The symptoms were mainly agitation/aggression (76.4%), anxiety (75%), depression (66.7%), irritability (60.4%), aberrant motor behaviour (55.9%) and delusions (48.6%). The main proposals of UMNPG were a change in treatment (79.5%), a health care team support (85.4%) and hospitalization (8.4%). The rate of follow-up on recommendation was 83% on the 15th day and 80% on the 30th day. The rate of avoided hospitalizations was 16%. The average NPI-NH decreased (on day 0 NPI=50±19.2; on day 30 NPI=33.9±19.6, p<0.001). CONCLUSION: UMNPG-EHPAD intervenes for frail elderly residents with multiple disorders in crisis situations. Medical recommendations help to support people in nursing homes and decrease NPI-NH. UMNPG-EHPAD is part of geriatric network strengthening the city/hospital connection.

[Elderly's suicide attempt]. / Tentative de suicide de la personne âgée.

Suicide attempts among the elderly (more than 65 years old) is a topic that is scarcely studied despite its prevalence. In recent years, researchers from all over the world started to study and publishing about this phenomenon. Several research studies tried to single out elderly people's suicide risk factors, focusing particularly on neurobiological alterations linked to the aging process. Some prevention techniques have already been developed and produced convincing results. Through this literature review, we set out to give both a general and summarized view on suicide and suicide attempts among the elderly.

La tentative de suicide des personnes âgées de 65 ans et plus est un sujet encore peu étudié. Ce n'est pourtant pas un fait rare. Depuis plusieurs années, divers groupes de chercheurs à travers le monde ont commencé à étudier et à publier sur le sujet. Plusieurs études tentent de cibler les facteurs de risque du suicide du senior, notamment au niveau d'altérations neurobiologiques liées à l'âge. Des techniques de préventions ont déjà été développées et montrent des résultats probants. Au travers de cette revue de littérature, nous avons voulu donner une vision globale et résumée du suicide et de la tentative de suicide des seniors.

[Geriatric psychiatry and dementia]. / Gérontopsychiatrie et démence.

Behavioural disorders linked to dementia are common. The intertwining of psychiatric and neurodegenerative pathologies means caregivers are faced with complex situations on a daily basis. The expertise of the geriatric psychiatry teams helps to guide the clinical reasoning and to find the best nursing approach in order to understand the symptom and support the patient.

[Trialogical Evaluation of a Gerontological Psychiatric Consulting and Liaison Service]. / Trialogische Evaluierung eines gerontopsychiatrischen Konsiliar- und Liaisondienstes.

Objective: The presented project shows the effects of a gerontological psychiatric consulting and liaison service (C&L) on nursing home residents and the care team. Methods: The implementation of the C&L was evaluated using a quasi-experimental design in longitudinal section of residents', nursing, medical and family perspective using quantitative and qualitative methods. Results/Conclusion: The results provide evidence for the positive effects of C&L especially in relation to the "common action" within the care team.

[Innovative healthcare strategies in geriatric psychiatry and psychotherapy]. / Innovative Versorgungsstrategien in der Gerontopsychiatrie und -psychotherapie.

BACKGROUND: The development of efficacious treatment strategies in older adults with mental illnesses is necessary. The growing number of homebound patients and the incidence of physical comorbidities and impairment of activities of daily living are important factors for interdisciplinary treatment strategies in old age and there is a need for home-based services providing medical and psychosocial interventions. OBJECTIVE: Recent studies have provided information on home-based and collaborative treatment strategies in mentally ill elderly patients. METHODS: This article provides an overview on selected randomized controlled trials (RCT) conducted with mentally ill older adults. RESULTS: Studies have shown promising effects when applying stepped care interventions, collaborative care and assertive community treatment in old patients suffering from mental diseases when compared to usual care. Long-standing home-based mental health programs have been designed and successfully implemented showing improved identification, treatment and ongoing care of mental health problems. In-home tele-psychotherapy has been shown to be efficacious in homebound older adults with limited access to evidence-based psychotherapy and showed a sustained effect in one study. CONCLUSION: Collaborative care models, stepped care interventions in primary care settings and an enhanced inter-professional approach to patient care in old age psychiatry is necessary to improve detection, treatment and ongoing care. Tele-mental health services may become important parts of the provision of mental health services and the effectiveness revealed for in-home tele-health problem solving therapy in old age depression may be an approach to make psychotherapy available to a large number of underserved elderly patients with mental illness.

The Role of Psychogeriatrics in Healthy Living and Active Ageing.

A healthy and active life is a key issue for elderly citizens, above all when psychological complications such as depression and anxiety disorders, late delusion or loneliness can be observed. Moreover, medical pathologies in elderly patients often have a multi-factorial etiology and many psychopathological dimensions and psychosocial risk factors are underestimated. From the perspective of clinical health psychology, psychogeriatrics could play an important role in promoting active ageing and a healthy lifestyle in elderly persons through tailored clinical approaches based on specific research and advanced professional training in this area. More research is needed in order to study which determinants affect the process of an active and functional ageing. Possible research ageing areas are: 1) evaluation of psychosocial risk-protective factors related to the individual's biography and personality. 2) Evaluation of enrichment programs and clinical protocols focused on the management of different topics such as health system areas, behavioral areas, social and physical environment areas, psychological factors and economic determinants. The goal of Psychogeriatrics endeavors to develop and evaluate interventions designed to stimulate improvement in friendship, self-esteem and subjective well-being, as well as to reduce loneliness among older citizens. 3) Evaluation of self-management programs in chronic disease conditions (such as obesity, diabetes, hypertension, poor nutrition, physical inactivity, alcohol abuse and tobacco smoking), that could enhance risk factors for health in elderly citizens. Typical key elements of self-management, such as decision making, problem solving, motivation, self-efficacy, resource utilization, and citizen's empowerment have to be studied.

Program evaluation of a telepsychiatry service for older adults connecting a university-affiliated geriatric center to a rural psychogeriatric outreach service in Northwest Ontario, Canada.

BACKGROUND: Weekly telepsychiatry consultations have been provided since 2002 to six communities in Northwest Ontario. Staff from a single community psychogeriatric outreach service who work within these communities facilitate the referrals. METHODS: The program evaluation included (a) a chart review of the last 100 referrals, (b) analysis of patient and staff evaluations, (c) a survey mailed to all physicians in referring communities, and (d) three focus groups of staff working in local community agencies. RESULTS: The mean age at the time of consultation was 76.7 years. Sixty-eight percent of patients were females. The most frequent diagnoses were dementia (54%), depression (28%), and mild cognitive impairment (19%). The most frequent medication recommendations were antidepressants or cholinesterase inhibitors. Two hundred ninety-four patient assessments and case consultations were carried out between 2002 and 2009. Post-session evaluation surveys rated the provision of information, whether objectives were met, and overall usefulness of recommendations. The mean scores for these questions on a 5-point scale were between 4.6 and 4.85. Referring physicians were confident and satisfied with the recommendations made for their patients. All planned to continue to use telepsychiatry as a care option for the future. The focus groups added useful information about challenges and potential barriers to utilizing the program. CONCLUSIONS: The program was rated as being highly valued across all modalities of evaluation. Members of the referring team believe that access to a geriatric psychiatrist has broadened the team's knowledge base, its use of assessment tools, and increased their ability to better construct their patients' treatment plans.

One day in the life of old age psychiatrists in the United Kingdom.

BACKGROUND: The provision of mental health care for older people will become increasingly important with rising demand related to global demographic changes. This project aimed to identify changes in work patterns of UK consultant old age psychiatrists between 1993 and 2012. METHOD: A link to an online questionnaire was circulated to consultant old age psychiatrists through the Faculty of Old Age Psychiatry, Royal College of Psychiatrists. RESULTS: In all 210 usable responses were received. On the survey day 71% of old age psychiatrists arrived at work before 9 am, and 40% left work after 6 pm. Over one-third (35%) worked for another hour or more at home. The range of activities was broader than previously reported. Administrative activity was undertaken by over 60% and acute ward work by only 26%. Few consultants reported time in long-stay care or day hospitals. Outpatient activity included Memory Clinics and Health Center Clinics. The main stressors reported by consultants were lack of resources and pressures from management-imposed, financially driven service changes. Relationships with people at work (including patients and their families) and outside work were the main identified support. CONCLUSIONS: Consultants' working hours have changed little since 1997, but the range and emphases of activities have changed. Changes in service organization are stressful and consultants are supported by relationships with colleagues and patients. Work patterns are changing in response to demands and constraints on the specialty. Research is needed into service design and work patterns, which can provide humane care in the current economic climate.

Psychogeriatric care: building rural community capacity.

INTRODUCTION: Since the late 1980s, British Columbia (BC) Canada has been undergoing a process of regionalization of health services which includes decentralization and the demand for self-sufficiency with respect to caring for people with mental health issues. In BC, regionalization has meant the continued downsizing of its one large provincial psychiatric hospital Riverview, which has resulted in relocating patients from this hospital to cities and towns throughout BC, and the establishment and/or renovation of psychiatric tertiary-care facilities to treat local community members who experience mental ill health. In the context of the relocation of psychiatric tertiary care, communities in northern BC face the specific challenge of having to provide these specialized services in remote settings, not only for people transferred from Riverview, but also for the increasing number of people 'aging-in-place' in a region that has the fastest growth of older adults in BC. Little is known about the capacity of these remote communities to manage change, develop broader models of care, and integrate people with psychogeriatric mental health issues with residents at existing facilities. METHODS: This study employed a qualitative research design which involved field research in the rural community where people were transferred, and interviews and focus groups with key people involved in the transfer process. In the analysis of the data a gender-based lens was applied to clarify the differing needs and concerns of male and female patients and to attend to possible needs relating to culture and ethnicity. RESULTS: The findings illustrate persistent 'hinterland-metropolis' and 'front-line versus administrative staff' tensions, with respect to resource distribution and top-down governance, and demonstrate the need for more transparent and comprehensive planning by health authorities with respect to instituting mental health reforms in a northern context, as well as improved communication between administrative and front-line staff. The research suggests that it is important to attend to the differing needs of women and men in the context of psychogeriatric care, as well as to other factors such as ethnicity and culture, in order to provide appropriate care. Finally, building community capacity to deal with the complex needs of patients is severely hampered not only by facility and regional health authority staff turnover, but also the stresses inherent to working in northern communities which include geographic, social and economic challenges. CONCLUSION: Increased local engagement is a way to identify and address challenges related to relocating psychogeriatric care to northern and remote settings, and to enhance psychogeriatric care provision in similar locales. While provincial and regional level 'big picture' planning is a necessity, study participants highlighted the critical role of local perspective and expertise.