Objective - In view of the lack of both a tradition and research, or systematic reflections, on the issue of health care for demented patients, and taking into account the many initiatives set up also in Italy to search for new models of care for old demented people, we feel it can be of some interest to suggest some thoughts on the issue. The ultimate objective of this paper is to stimulate a debate and further contributions on the eveluation of psychogeriatric services and effective «styles of care». Method - A review of the literature (MEDLINE) starting from 1980 with the keywords quoted below has been performed. Then, due to the need for tackling (or, at least, listing) a wide range of subjets — from the organisation of the internal space in the institutional setting, to the interpersonal aspects and the use of psychotropic drugs — we referred to other various sources of information. Results and conclusions - Reflections on care needs of elderly demented people identify, first of all, a priority: in psychogeriatrics, more studies on services are needed. Secondly, the crucial role of the interpersonal domain and of the spatial organisation comes up. Finally, it is clear that the valuable anti-institutional strategies and culture produced by the social psychiatry need, for psychogeriatrics, to be reframed especially regarding the value of the autonomy of the patient (vs the dignity of disability), of his/her involvement in an active life (vs the «respect of apathy») and his/her re-socialisation (vs a different balance between stimulation and protection).

Objective - In view of the lack of both a tradition and research, or systematic reflections, on the issue of health care for demented patients, and taking into account the many initiatives set up also in Italy to search for new models of care for old demented people, we feel it can be of some interest to suggest some thoughts on the issue. The ultimate objective of this paper is to stimulate a debate and further contributions on the eveluation of psychogeriatric services and effective «styles of care». Method - A review of the literature (MEDLINE) starting from 1980 with the keywords quoted below has been performed. Then, due to the need for tackling (or, at least, listing) a wide range of subjets — from the organisation of the internal space in the institutional setting, to the interpersonal aspects and the use of psychotropic drugs — we referred to other various sources of information. Results and conclusions - Reflections on care needs of elderly demented people identify, first of all, a priority: in psychogeriatrics, more studies on services are needed. Secondly, the crucial role of the interpersonal domain and of the spatial organisation comes up. Finally, it is clear that the valuable anti-institutional strategies and culture produced by the social psychiatry need, for psychogeriatrics, to be reframed especially regarding the value of the autonomy of the patient (vs the dignity of disability), of his/her involvement in an active life (vs the «respect of apathy») and his/her re-socialisation (vs a different balance between stimulation and protection).

Objective - In view of the lack of both a tradition and research, or systematic reflections, on the issue of health care for demented patients, and taking into account the many initiatives set up also in Italy to search for new models of care for old demented people, we feel it can be of some interest to suggest some thoughts on the issue. The ultimate objective of this paper is to stimulate a debate and further contributions on the eveluation of psychogeriatric services and effective «styles of care». Method - A review of the literature (MEDLINE) starting from 1980 with the keywords quoted below has been performed. Then, due to the need for tackling (or, at least, listing) a wide range of subjets — from the organisation of the internal space in the institutional setting, to the interpersonal aspects and the use of psychotropic drugs — we referred to other various sources of information. Results and conclusions - Reflections on care needs of elderly demented people identify, first of all, a priority: in psychogeriatrics, more studies on services are needed. Secondly, the crucial role of the interpersonal domain and of the spatial organisation comes up. Finally, it is clear that the valuable anti-institutional strategies and culture produced by the social psychiatry need, for psychogeriatrics, to be reframed especially regarding the value of the autonomy of the patient (vs the dignity of disability), of his/her involvement in an active life (vs the «respect of apathy») and his/her re-socialisation (vs a different balance between stimulation and protection).

The Organic Brain Syndrome (OBS) and the Depression (D) scales derived from the Comprehensive Assessment and Referral Evaluation (CARE) were translated into Italian and used in a survey of geriatric institutions in Milan. During the survey validity and reliability tests of the scales were conducted.

Inter-rater reliability (total score weighted kappa) was highly satisfactory for both scales (0·96 for OBS and 0·83 for D scale). Reliability was assessed three times during the survey and showed good stability for both scales, with a slight but significant trend towards reduction over time for the D scale. Reliability of the D scale was significantly lower when the subjects interviewed scored highly on the OBS scale (severe cognitive impairment).

Criterion validity was highly satisfactory both for the OBS scale (cut-off point 4/5: sensitivity 77%, specificity 96%, positive predictive value 91%) and the D scale (cut-off point 10/11: sensitivity 95%, specificity 92%, positive predictive value 84%).

Results are discussed with special reference to longitudinal assessment of reliability, the choice of the cut-off point, and the context-dependent properties of questionnaires.