SERVICES FOR THE ELDERLY
The development of psychiatric services for the elderly has been particularly strong in the British National Health Service. Everyone in a given catchment area over a given age is dealt with by a multidisciplinary team, which includes psychiatrists and community psychiatric nurses. This offers domiciliary assessments, community nursing, day hospital care, respite inpatient admissions and liaison with physicians who look after the elderly.
PSYCHIATRIC DISORDERS
Delirium
Delirium is relatively common in the elderly, who are prone to physical disorders.
Dementia
Dementia is increasingly prevalent with increasing age. The most common dementia in the elderly is Alzheimer’s disease, followed by multi-infarct dementia. Depressive pseudodementia should be borne in mind as an important differential diagnosis in this age group.
The management of dementia should include:
• Regular respite inpatient admissions to support carers
• Community psychiatric nurse support and liaison with GPs and psychiatrists
• Occupational therapy to help in assessing and encouraging the patient’s potential abilities
• Reality orientation and reminiscence therapy
• Sheltered accommodation or a long-stay in patient ward may be required as the dementia progresses
• Regular appointments with an optician for the early detection of cataracts and glaucoma
• Regular appointments with a dentist to check dental health and replace unsatisfactory dentures, if necessary
• Chiropody for those unable to look after their own feet
• Physiotherapy to help with mobility, and muscle and joint-related pain relief
• Continence advisers can assess, advise and sometimes treat urinary and faecal incontinence
• Attendance, mobility and invalid care allowances are available in many countries
• Attendance at a day hospital and/or local authority day centre.
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