OLD AGE PSYCHIATRY FOR PRIMARY CARE VOCATIONAL TRAINEES Dr Nick Pearson Consultant in the Psychiatry of Old Age Reading

Older Person’s Mental Disorders in Primary Care The Dynamic Duo Depression Dementia

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 % > 65 yrs (340) Depressed patients= 42 Treatment Resistant= 14

Older Person’s Depression in Primary Care 15-30% seek help Prevalence Care homes 30-40% Nursing homes 70% General hospitals 15-20%

Older Persons’ Dementia in Primary Care Prevalence >65 yrs= 5% Patients with dementia average GP caseload-17 1in 10 receive a diagnosis >75yrs=10% >85 yrs= 20% >90yrs= 30%

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

Older Person’s Mental Disorders in Primary Care Younger onset dementia 1in 1000 < 65yrs 0.3 of a person

Older Persons’ Delirium in Primary Care Prevalence in primary care unknown 40% of>65yrs in hospital

Older Persons’ Psychotic Disorders in Primary Care Psychotic Disorders Prevalence in community >65yrs of 1% Schizophrenia Persistent delusional disorders Mania Psychotic depression

Older Persons’ Psychotic Disorders in Primary Care Severe Lethal for yr olds over a 6 yr period mortality men 30% women 20% Psychotic depression men 75 % women 40%

Older Persons’ Neurosis in Primary Care Prevalence anxiety disorders>65yrs= 4% Phobias= 10%

Older Persons’ Psychoactive Substance Use in Primary Care 4% of older males had drunk> 8 units of alcohol on at least 1 day in the previous week yr olds? Alcohol more commonly a complicating factor

Older Persons’ Mental Disorders in Primary Care: Factors Physical disorders Medication Social Context Environmental Context Individual’s meaning