OLD%20AGE%20PSYCHIATRY%20FOR%20PRIMARY%20CARE%20VOCATIONAL%20TRAINEES

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OLD AGE PSYCHIATRY FOR PRIMARY CARE VOCATIONAL
TRAINEES

• Dr Nick Pearson
• Consultant in the Psychiatry of Old Age Reading
• 280206

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Older Persons Mental Disorders in Primary Care

• The Dynamic Duo
• Depression
• Dementia

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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 gt 65 yrs (340)
• Depressed patients 42
• Treatment Resistant 14

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Older Persons Depression in Primary Care

• 15-30 seek help
• Prevalence Care homes 30-40
• Nursing homes 70
• General hospitals 15-20

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Older Persons Dementia in Primary Care

• Prevalence gt65 yrs 5
• Patients with dementia average GP caseload-17
• 1in 10 receive a diagnosis
• gt75yrs10
• gt85 yrs 20
• gt90yrs 30

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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

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Older Persons Mental Disorders in Primary Care

• Younger onset dementia
• 1in 1000 lt 65yrs
• 0.3 of a person

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Older Persons Delirium in Primary Care

• Prevalence in primary care unknown
• 40 ofgt65yrs in hospital

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Older Persons Psychotic Disorders in Primary Care

• Psychotic Disorders
• Prevalence in community gt65yrs of 1
• Schizophrenia
• Persistent delusional disorders
• Mania
• Psychotic depression

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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

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Older Persons Neurosis in Primary Care

• Prevalence anxiety disordersgt65yrs 4
• Phobias 10

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Older Persons Psychoactive Substance Use in
Primary Care

• 4 of older males had drunkgt 8 units of alcohol
  on at least 1 day in the previous week.
• 16-24yr olds?
• Alcohol more commonly a complicating factor

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Older Persons Mental Disorders in Primary Care
Factors

• Physical disorders
• Medication
• Social Context
• Environmental Context
• Individuals meaning