Do older people receive equitable private psychiatric service provision under Medicare?

OBJECTIVE: The objective of this study is to determine the 1998 rates, types, regional variation and Medicare expenditure of private psychiatry services for older people in Australia, as compared with younger adults and with 1985-1986 data. METHOD: Medicare Benefits Schedule Item Statistics for the psychiatric item numbers 300-352 and item 14224 were obtained from the Health Insurance Commission for each State and Territory. The items were examined in the age groups 15-64 years, 65 years and over and 75 years and over. Main outcome measures were per capita service provision by age group, State and Territory and Medicare expenditure by age group. RESULTS: During 1998, 6.4% (5765.6 per 100 000) of private psychiatric services were to patients aged > 64 years. Patients aged 15-64 received 2.7 times the number of psychiatric services per capita than patients > 64 and 3.6 times that of patients aged > 74 years. Patients aged > 64 received more hospital and nursing home consultations, home visits and electroconvulsive therapy per capita, while younger adults used more office-based consultations, longer consultations, and group therapy. Victoria had the highest per capita rate (7659.2 per 100 000) and the Northern Territory the lowest (540.4 per 100 000), although the highest proportion of services to older patients was in Western Australia. Per capita the proportion of Medicare expenditure allocated to adults aged less than 65 years was 4.1 times that for adults over 64 years. CONCLUSIONS: Private psychiatric service provision to older people is inequitable when compared with younger adults. The proportion of Medicare private psychiatry expenditure on older adults has declined since 1985-1986.

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.

Prevention of suicide in old age.

The prevention of suicide in old age has received little attention, despite suicide rates being highest in older men. About 90% of older people who attempt or complete suicide have a mental disorder, usually depression, which often has been inadequately treated. Other treatable contributing factors include pain, grief, loneliness, alcoholism and carer stress. Few suicides in older people occur in the context of terminal illness or can be regarded as "rational". Educational programs are required to improve the recognition and treatment of depression in primary care.

A comparison of caregivers for elderly stroke and dementia victims.

OBJECTIVE: To compare elderly co-resident caregivers of stroke and dementia patients on measures of burden and psychological morbidity. DESIGN: Cohort study. SETTING: Caregivers interviewed at home. SUBJECTS: Convenience sample, 99 co-resident caregivers of dementia and stroke patients registered with a community rehabilitation and geriatric service and who were 60 years or over. MAIN OUTCOME MEASURES: Caregiver burden as measured by self-administered questionnaire and subsequent interview, using the Relatives Stress Scale (RSS) and psychological morbidity as measured on the General Health Questionnaire (GHQ). RESULTS: Forty-six percent of caregivers had significant psychological morbidity (GHQ greater than 4). Mean RSS score was 12.2 (SD 5.4). No significant differences were found between stroke and dementia caregivers on these measures. Caregiver burden was significantly correlated with psychological morbidity in both caregiver groups. Behavior and mood disturbance in the patient was significantly correlated with burden (dementia caregivers r = 0.66; stroke caregivers r = 0.49, P less than 0.0001) and psychological morbidity (dementia caregivers r = 0.44, P less than 0.01; stroke caregivers r = 0.30, P less than 0.05). Caregiver's dissatisfaction with participation in life activities was correlated with burden (dementia caregivers r = 0.58; stroke caregivers r = 0.63, P less than 0.0001) and psychological morbidity (dementia caregivers r = 0.67, stroke caregivers r = 0.56, P, 0.0001). CONCLUSION: Elderly co-resident caregivers for stroke and dementia patients experience similar degrees of burden and high levels of psychological morbidity. Psychiatric aspects of chronic disability, rather than physical aspects, were found to be more stressful to caregivers. All assessments of the disabled elderly should include measures of caregiver burden and psychological distress.