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To provide a picture of availability and equality of access to mental health services for older people prior to the Equality Act. In 2010, a questionnaire was sent to health commissioners in England, Scotland and Wales under a Freedom of Information request.
Overall, 132 (76%) replied. Of 11 services, 7 were either unavailable or did not provide equality of access to older people in more than a third of commissioning areas. When provided by specialist older people's mental health, services were more often considered to ensure equality.
Increasing need resulting from an ageing population is unlikely to be met in the face of current inequality. Inequality on the basis of age is the result of government policy and not the existence of specialist services for older people. Single age-inclusive services may create indirect age discrimination. Availability alone is insufficient to demonstrate equality of access. Monitoring the effects of legislation must take this into account.
Depression and dementia often exist concurrently. The associations of depressive syndromes and severity of depression with incident dementia have been little studied.
To determine the effects of depressive syndromes and cases of depression on the risk of incident dementia.
Participants in China and the UK aged ⩾565 years without dementia were interviewed using the Geriatric Mental State interview and re-interviewed 1 year later in 1254 Chinese, and 2 and 4 years later in 3341 and 2157 British participants respectively (Ageing in Liverpool Project Health Aspects: part of the Medical Research Council – Cognitive Function and Ageing study).
Incident dementia was associated with only the most severe depressive syndromes in both Chinese and British participants. The risk of dementia increased, not in the less severe cases of depression but in the most severe cases. The multiple adjusted hazard ratio (HR)=5.44 (95% CI 1.67–17.8) for Chinese participants at 1-year follow-up, and HR=2.47 (95% CI 1.25–4.89) and HR=2.62 (95% CI 1.18–5.80) for British participants at 2- and 4-year follow-up respectively. The effect was greater in younger participants.
Only the most severe syndromes and cases of depression are a risk factor for dementia.
Little is known about patterns of healthcare use by people with
depression in Europe.
To examine the use and cost of services by adults with depressive or
adjustment disorders in five European countries, and predictive
People aged 18–65 years with depressive or adjustment disorders
(n=427) in Ireland, Finland, Norway, Spain and the UK
provided information on predisposition (demographics, social support),
enablement (country, urban/rural, social function) and need (symptom
severity, perceived health status) for services. Outcome measures were
self-reported use Client Services Receipt Interview and costs of general
practice, generic, psychiatric or social services in the past 6
Less frequent use was made of generic services in Norway and psychiatric
services in the UK. Severity of depression, perceived health status,
social functioning and level of social support were significant
predictors of use; the number of people able to provide support was
positively associated with greater health service use.
Individual participant factors provided greater explanatory power than
national differences in healthcare delivery. The association between
social support and service use suggests that interventions may be needed
for those who lack social support.
Does incidence of dementia follow the age pattern of prevalence? Is gender a risk factor? Do patterns of incidence differ between dementias?
To assess age-specific incidence rates of undifferentiated dementias, Alzheimer's disease and vascular dementia.
5222 individuals aged $65 years, were interviewed using the Geriatric Mental State/History and Aetiology Schedule. The AGECAT package was used to identify cases at three interviewing waves at two-year intervals. Diagnoses were made using ICD −10 Research Criteria and validated against neurological and psychological examination, with imaging and neuropathology on unselected subsamples.
Incidence rates of the dementias increase with age. Age patterns are similar between Alzheimer's disease and vascular dementia. Gender appears influential in Alzheimer's disease. In England and Wales, 39 437 new cases of Alzheimer's disease (4.9/1000 person-years at risk); 20 513 of vascular dementia (2.6/1000 person-years) and 155 169 of undifferentiated dementia (19/1000 person-years) can be expected each year.
Incidence rates for Alzheimer's disease and vascular dementia appear to behave differently with an increased risk of Alzheimer's disease for women compared to vascular dementia.
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