Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-18T15:05:39.607Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychiatric services for the “old” old

Published online by Cambridge University Press:  15 March 2010

Brian Draper  and
Lee-Fay Low
Brian Draper*
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, NSW, Australia
Lee-Fay Low
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Primary Dementia Collaborative Research Centre, Sydney, NSW, Australia
*
Correspondence should be addressed to: Brian Draper, Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Barker Street, Randwick, NSW, 2031, Australia. Phone: +61-2-93823759; Fax: +61-2-93823762. Email: b.draper@unsw.edu.au.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Few studies have specifically examined mental health service delivery to persons aged over 84 years, often described as the “old” old. Our aim was to compare mental health service provision in Australia to persons aged 85 years and over with the “young” old and other age groups. We hypothesized that the “old” old would differ from the “young” old (65–84 years) by diagnostic category, rates of specialist psychiatric hospital admission, and use of Medicare funded psychiatric consultations in the community.

Methods: Mental health service delivery data for 2001–02 to 2005–06 was obtained from Medicare Australia on consultant psychiatrist office-based, home visit and private hospital services subsidized by the national healthcare program and the National Hospital Morbidity database for separations (admitted episodes of patient care) from all public and most private hospitals in Australia on measures of age, gender, psychiatric diagnosis, location and type of psychiatric care.

Results: Use of specialist psychiatric services in the community per annum per 1000 persons declined with age in men and women from 137.28 and 191.87 respectively in those aged 20–64 years to 11.84 and 14.76 respectively in those over 84 years. However, men and women over 84 years received psychiatric home visits at 377% and 472% respectively of the rates of persons under 65. The annual hospital separation rate per 1000 persons for specialist psychiatric care was lowest in those aged over 84 (3.98) but for inpatient non-specialized psychiatric care was highest in those over 84 (21.20). Depression was the most common diagnosis in specialized psychiatric hospitalization in those aged over 84 while organic disorders predominated in non-specialized care in each age group over 64 years with the highest rates in those aged over 84.

Conclusion: Mental health service delivery to persons aged over 84 is distinctly different to that provided to other aged groups being largely provided in non-specialist hospital and residential settings.

Keywords

aged 85 yearspsychiatric servicesdiagnosis
Type
Research Article
Information
International Psychogeriatrics , Volume 22 , Issue 4 , June 2010 , pp. 582 - 588
Copyright
Copyright © International Psychogeriatric Association 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Australian Bureau of Statistics (2007). 2006 Census of Population and Housing. Canberra: Australian Bureau of Statistics.Google Scholar
Blazer, D. (2000). Psychiatry and the oldest old. American Journal of Psychiatry, 157, 1915–1924.CrossRefGoogle ScholarPubMed
De Leo, D., Draper, B. and Krysinska, K. (2009). Treatment and suicide prevention in elderly people in clinical and community settings – the five continents perspective. In Wasserman, D. and Wasserman, C. (eds.), The Oxford Textbook of Suicidology: The Five Continents Perspective (pp. 703–719). Oxford: Oxford University Press.CrossRefGoogle Scholar
Draper, B. and Koschera, A. (2001). Do older people receive equitable private psychiatric service provision under Medicare? Australian and New Zealand Journal of Psychiatry, 35, 626–630.CrossRefGoogle ScholarPubMed
Draper, B. and Low, L-F. (2004). What is the Effectiveness of Old Age Mental Health Services? Copenhagen: World Health Organization Regional Office for Europe Health Evidence Network.Google Scholar
Draper, B. and Low, L-F. (2005). What is the effectiveness of acute hospital treatment of older people with mental disorders? International Psychogeriatrics, 17, 539–555.CrossRefGoogle ScholarPubMed
Forsell, Y., Jorm, A. F., von Strauss, E. and Winblad, B. (1995). Prevalence and correlates of depression in a population of nonagenarians. British Journal of Psychiatry, 167, 61–64.CrossRefGoogle Scholar
Issakidis, C. and Andrews, G. (2006). Who treats whom? An application of the Pathways to Care model in Australia. Australian and New Zealand Journal of Psychiatry, 40, 74–86.CrossRefGoogle ScholarPubMed
Jorm, A. F. and Jolley, D. (1998). The incidence of dementia: a meta-analysis. Neurology, 51, 728–733.CrossRefGoogle ScholarPubMed
Low, L-F. and Draper, B. (2009). Hospitalisation patterns for psychiatric disorders across the lifespan in Australia from July 1998 to June 2005. Psychiatric Services, 60, 113–116.CrossRefGoogle ScholarPubMed
Macdonald, A. et al. (2007). The birth of a specialty: the first ten thousand patients of an old age psychiatry service. International Psychogeriatrics, 19, 53–63.CrossRefGoogle ScholarPubMed
Meller, I., Fichter, M. M. and Schroppel, H. (1997). Risk factors and psychosocial consequences in depression of octo- and nonagenerians: results of an epidemiological study. European Archives of Psychiatry and Clinical Neuroscience, 247, 278–287.CrossRefGoogle ScholarPubMed
NSW Department of Health (2006). NSW Service Plan for Specialist Mental Health Services for Older People (SMHSOP) 2005–2015. North Sydney: NSW Department of Health.Google Scholar
Paivarinta, A., Verkkoniemi, A., Niinisto, L., Kivela, S. L. and Sulkava, R. (1999). The prevalence and associates of depressive disorders in the oldest-old Finns. Social Psychiatry and Psychiatric Epidemiology, 34, 352–359.Google ScholarPubMed
Rittmannsberger, H. et al. (2004). Changing aspects of psychiatric inpatient treatment: a census investigation in five European countries. European Psychiatry, 19, 483–488.CrossRefGoogle ScholarPubMed
Skoog, I. et al. (1996). Suicidal feelings in a population sample of nondemented 85-year-olds. American Journal of Psychiatry, 153, 1015–1020Google Scholar
U.S. Census Bureau Population Division (2008). Available at http://www.census.gov/population/www/projections/projectionsagesex.html. Last accessed 13 March 2009.Google Scholar
Xie, J., Matthews, F. E., Jagger, C., Bond, J. and Brayne, C. (2008). The oldest old in England and Wales: a descriptive analysis based on the MRC Cognitive Function and Ageing Study. Age and Ageing, 37, 396–402.CrossRefGoogle Scholar