Although scientific research is generally and appropriately initiated by individuals, there are limitations and inefficiencies inherent in studies done by individuals alone. Collaboration is the concept of our time. As an example, both the medical community and lay public recognize the urgent need for an effective antidementia drug. Sound clinical trials will require subjects sufficiently numerous for investigation, and a multicentered collaborative study approach, extending even to international collaborative clinical trials.

Research and practice amidst interesting dichotomies — such is the state of psychogeriatrics in the 1990s — a field that reflects interesting dichotomies, though often in a complementary manner. Alzheimer's disease (AD) is a case in point. Discoveries at the molecular level and in understanding neurobiological phenomena in AD have generated enormous scientific excitement and public hope about potential breakthroughs; findings involving chromosome 14, the amyloid precursor protein, synaptic changes, the tau protein, and the like are increasing chances of cracking the mystery that surrounds the etiology of AD. Meanwhile, neither cause nor cure is known. However, it would be incorrect to say there is no treatment for AD. While there are no treatments that can reverse or stop the progression of the disorder, there are a number of interventions that can alleviate many of the behavioral symptoms that compound the course of the disorder. These behavioral problems contribute significantly to excess disability in AD; treating these behavioral symptoms can alleviate patient suffering, improve patient coping at that point in time, and reduce family burden. Hence, while research on the molecular biology of AD offers hope for tomorrow, attention to the manifest behavioral problems of the disorder contributes to improved management today (Group for the Advancement of Psychiatry, 1988).

In the diagnosis, treatment, and care of dementia patients in the senile stage, comprehensive evaluation of ability in daily life and mental function is needed. Using a simple behavioral rating scale for the mental states (NM scale) and activities of daily living (N-ADL) of the elderly, we evaluated 250 elderly subjects. According to the NM scale, the scores for subjects in whom the severity was clinically diagnosed were as follows: normal, 50–48; borderline, 47–43; mild dementia, 42–31; moderate dementia, 30–17; and severe dementia, 16–0. Screening for dementia and determining its severity were readily accomplished using the NM scale, and basic activities in the daily life of the elderly could be evaluated effectively using the N-ADL. There was a significant correlation (r=0.863) between the Hasegawa dementia scale and the NM scale (p<0.001), a significant correlation (r=−0.947) between intellectual function scores of the GBS scale and the NM scale, and a significant correlation (r=0.944) between motor function score of the GBS scale and the N-ADL score. Evaluations of daily life activities can be made not only by psychiatrists and clinical psychologists, but by nonspecialists as well, because they are based on data obtained by observation of daily life behaviors; thus, assessment is appropriate both in clinical settings and in places of living.

A community survey and subsequent clinical assessment of 192 Cree aged 65 years and over registered in two Reserves in Northern Manitoba identified only one case of probable Alzheimer's disease among eight cases of dementia, giving a prevalence of 0.5% for Alzheimer's disease and 4.2% for all dementias. This contrasted with an age-adjusted prevalence of 3.5% for Alzheimer's disease and 4.2% for all dementias in an age-stratified sample of 241 English-speaking residents of Winnipeg. Although it was not so for all dementias, the difference between the groups for prevalence of Alzheimer's disease was highly significant (p < .001). The age-specific patterns of all dementias in the two groups were significantly different, however (p = .0254).

The purpose of this paper was to use the Wechsler Adult Intelligence Scale (WAIS) to further define the nature of the underlying factors of the Mini-Mental State Examination (MMSE) as proposed by Tinklenberg et al. (1990). The MMSE was administered to 51 patients once every 6 months for at least one year; the WAIS was administered only at the beginning of the study. Stepwise regression analyses yielded these results: for the Following Commands factor, the best correlate was the Comprehension subtest; for the Language Repetition factor, the best correlate was the Picture Arrangement subtest; and for the Language Expression factor, the best correlates were the Digit Symbol and Object Assembly subtests. These relations help clarify the correlates of decline of AD patients on the MMSE.

This community-based epidemiological survey concerns relationships between social and health factors and depression in a Finnish population aged 60 years or over. A multivariate analysis based on log-liner models is used in this study.

The log-linear model showed five interactions for the depressed men and eight for the depressed women surveyed. These indicated that the depressive persons had experienced detrimental events either of an interpersonal nature or concerning health status more often than those who were not depressed. A positive connection between life stress and depression was found even though no cause-and-effect relationship could be defined. Social stress factors seemed somewhat important prior to the onset of depression in the women studied, whereas stressful health factors played a significant role for the men. Despite this, the log-linear models for the selected variables used here did not point to a combination of interactions between a high incidence of current social stress factors and a high incidence of stressful health factors during the six-month period prior to the onset of depression.

The prevalence of mental disorders was studied in a representative sample of 85-year-old living in Gothenburg, Sweden, (n=494). All subjects were examined by a psychiatrist, whose diagnoses were defined according to the DSM-III-R criteria. In the sample, the prevalence of dementia was 29.8%, and of any other mental disorder was 24.3%. Psychotic disorders were present in 4.7%, depressive disorders in 12.6%, and anxiety disorders in 10.5%. Anxiety disorders were more common in women than in men. Of all subjects, 42.5% used a psychotropic drug (men 30.1%, women 47.6%, p<0.001), 34.2% used anxiolytic-sedatives, 14.0% used antidepressants, and 5.7% used neuroleptics. Women used significantly more anxiolytic-sedatives and antidepressants than did men. Of those with no mental disorders, 29.1% used a psychotropic drug. Although the prescription of psychotropic drugs was high, only one fifth of those with depressive disorders received antidepressant drug therapy and one tenth of those with psychotic disorders received neuroleptics.

The Center for Epidemiological Studies Depression scale (CES-D) was administered in Swedish to two representative samples, one aged 84 to 90 (mean = 87), the second aged 29 to 95 (mean = 61). There were both linear and quadratic differences with age: the oldest individuals were highest on depressive symptoms, but younger adults were higher than middle-aged. Dimensions or subscales identified by previous studies were generally replicated, including a sadness and depressed mood factor, a psychomotor retardation and loss of energy factor, and a well-being factor (on which items are reverse-scored to indicate depression). The findings support cross-national use of the CES-D to assess self-reported symptoms of depression in adults and older adults.

The purpose of this study was to establish whether physical health and cognitive function in married long-term patients or in their spouses determines why some patients are cared for in home care while others reside in nursing homes. Out of 38 married couples with a sick spouse cared for in a nursing home, 23 couples were studied; out of 34 couples with a sick spouse cared for in home care, 22 patients and 25 spouses were studied. The results showed no significant differences in physical health score either between the two groups of patients, or between the two groups of spouses. Both home-care patients and nursing home patients had low cognitive function scores, but nursing home patients had significantly lower scores. A multivariate analysis showed that physical health and cognitive function explained only 20% of patients' residence. Between the two groups of spouses there was no difference in cognitive function score. The conclusion is that physical health status and cognitive function explain only to a small extent why married long-term care patients are cared for in nursing homes or in home care.

The study explores the relationship between hearing impairment and psychotic illness in twenty hospitalized patients (aged 55–77) using as controls twenty age-matched community-based older subjects with no psychiatric illness. All subjects received full psychiatric evaluations and comprehensive audiologic assessments. Data were analyzed by discriminant analysis and ANOVA. Experimental subjects were found to have significantly poorer unilateral pure tone average (PTA) and significantly poorer bilateral speech discrimination ability than control subjects. Patients with a mood disorder had poorer unilateral PTAs than controls, but did not exhibit significantly poorer speech discrimination. Subjects with specifically paranoid ideation were found to have significantly better left ear speech discrimination than nonparanoid subjects. Our data suggest that hearing impairment should possibly be considered a potential risk factor for the development of psychosis in the elderly.

This study explored problems older adults experience when using a mnemonic technique known as the method of loci. Older subjects received six hours of imagery, judgment, and relaxation pretraining followed by mnemonic training for either four or six hours (Regular or Extended training, respectively). At the end of training, subjects were given a list of the constituent steps of the method of loci and asked to indicate which, if any, were problematic. The factor structure of the relations among the problems varied according to the length of the training subjects received. Specifically, the factor structure of the difficulties reported by the Regular training group reflected problems with using the steps involved in the application of the method of loci, whereas for the Extended training group the factor structure reflected problems with abilities called upon in using the technique. Thus, even with Extended training, subjects may need additional pretraining to develop specific abilities necessary for the successful application of the mnemonic.

An extensive new caring program—including the introduction of Individual Care Plans and changes in ward organization, caring techniques, and caring philosophy—was introduced at two psychogeriatric wards with severely demented patients. The hypotheses were that the patients (n=31) would improve in psychosocial capacity and orientation and the staff work load would decline in contrast to two other wards with a similar clientele (n=31). After ten months the milieu was more “homelike,” routines were more flexible, and the staff communicated more with the patients. However, the hypotheses were not proven. All patients in both groups deteriorated in ADL capacity, orientation, and behavior. The patients in the program wards became significantly more restless and disoriented and ate less than the patients in the contrast wards. The conclusion is that, despite optimal care, a humanistic approach, and support from staff, the progression of dementia symptoms is inevitable.

A cross-sectional study of 60 men aged 65–80 was carried out to test the impact of the aging process on sexual hormones (testoterone, FSH, LH, prolactin), sexual activity, and the relations between them. Blood samples for hormone assays were taken between 8–9 A.M. in the primary care clinic at which the participants were registered. Data on sexual activity (coitus), sexual desire (libido), marital status, and age were obtained from the respondents by means of a structured interview. No relationship was found between testosterone (T) or prolactin (PL) and sexual activity. Nevertheless, a statistically significant relationship between FSH and LH versus age, and an inverse relationship between sexual activity and age were found. Hypogonadism (T level less than 3ng/ml) with normal levels of FSH and LH was observed in 11 respondents.

Thirty-seven dementia patients and their caregivers were studied before and after a two-week in-hospital respite stay. Institutional respite care did not alter behavior problems in dementia patients, nor did changes in performance of activities of daily living (ADLs) by Alzheimer's disease (AD) patients exceed those expected from disease progression. Caregivers exhibited an improvement in burden and depression during the respite study, but levels returned to baseline following the patient's return home.

During the years 1983–1989 an action research/intervention study in a 40-bed Finnish home for the elderly had as its goal the development of a modified therapeutic community. This paper focuses on the gender roles. Logistic regression analysis indicated that males (N=17) were best differentiated from females (N=38) by extramural functional activity, extramural social passivity, religious neutrality, passivity in contacts with a personal nurse, and better education. These five explanatory variables correctly predicted gender in 84% of the cases. These mild gender differences reflect the traditional sex roles of an agrarian Finnish village and were seen mainly as a positive phenomenon. The findings and some other gender identity themes in the elderly, also were illustrated by qualitative case material. These data suggested that the therapeutic community of aged people should permit active preservation of even conservative and stereotyped gender roles, thereby aiding in the defense and continuity of their often frail identity. The search for new role elements should be supported as well, however, because some elderly continue to develop their gender roles during their final years.

Pick's disease is a rare cause of dementia frequently misdiagnosed as Alzheimer's disease. Because patients with Pick's disease often present with psychiatric symptoms, the psychiatric aspects of this disorder are reviewed, as well as the pathology and epidemiology of the disease. Two case reports illustrate many of the clinical features of PD. A detailed examination of the psychiatric aspects of the disorder is followed by an elucidation of the many clinical differences between Pick's disease and Alzheimer's disease.

Elderly residents of rural areas are at significant risk for mental health problems, yet have less access to mental health services. Thus, most mental health problems among rural elderly remain either undiagnosed or untreated. We describe two models of mental health outreach programs to rural elderly in Iowa and Virginia, serving demographically, culturally, and epidemiologically different populations in geographically and economically dissimilar regions. Programs are compared on the basis of initiation, community partnerships, target population, target region, clinical disciplines involved, coordinating discipline, referral sources, operational model, initial home assessment, care planning, sustainability, cost, patient demographics, and primary and secondary diagnoses. Outreach programs are argued to be effective models of delivering services to geographically and/or socially isolated elderly populations. The experiences of our programs, though limited to rural populations, may be of relevance to any outreach program attempting to serve elderly presenting with or at risk for mental health problems.

The purpose of this paper was to determine the impact of geriatric medical services on mental state by reviewing all controlled trials of such services. Two computer data bases were searched for relevant articles published from January 1980 to August 1990, and the bibliographies of retrieved articles were searched for additional references. Eleven reports were located that met the four inclusion criteria: original study, published in English or French, controlled trial (nonrandomized or randomized) of a geriatric medical service, and inclusion of at least one measure of mental state in the study. Ten reports met the validity criteria for intervention studies. There was little evidence that geriatric medical services improved the mental state of aged patients; all trials had limitations in design and measures. These findings challenge mental health professionals in two ways: first, services must be developed to address the apparently unmet mental health needs of aged medical patients; second, research methods must be developed to measure the impact of these services.

A retrospective case study of ten years of psychiatric consultation with elderly in a Dutch general hospital is presented. The number of psychiatric consultations is increasing more than would be expected from admission rates or demographic changes. Of these, 24.4% were diagnosed as suffering from mood disorder and 34.1% from organic mental disorder. Somatic and psychiatric diagnoses alone seem inadequate to describe the severe problems of this specific group of patients.

Nursing homes, or verpleeghuizen, play an important role in the health care system in the Netherlands. These multifunctional institutions provide clinical and ambulatory (day hospital) care for somatic and psychogeriatric elderly with multiple pathology, disabilities, and handicaps. Quantitative data on morbidity, admission, and discharge of (psychogeriatric) nursing home patients are presented. The data on the nursing home institutions—number of residents, costs, and staff ratios—are placed in the context of the whole health care system. A new trend is to organize nursing home care in homes for the aged via substitution projects and dependences.