OLD AGE PSYCHIATRY FOR PRIMARY CARE VOCATIONAL

TRAINEES

Dr Nick PearsonConsultant in the Psychiatry of Old Age Reading

280206

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