Pub Date : 2020-10-01DOI: 10.1093/MED/9780198807292.003.0031
R. Stewart
Vascular disease is the most important environmental risk factor for dementia but this research area has been hampered by inadequate outcome definitions—in particular, a diagnostic system that attempts to separate overlapping and probably interacting pathologies. There is now substantial evidence that the well-recognized risk factors for cardiovascular disease and stroke are also risk factors for dementia, including Alzheimer’s disease. However, these risk factors frequently act over several decades, meaning that the chances of definitive randomized controlled trial evidence for risk-modifying interventions are slim. This should not obscure the wide opportunity for delaying or preventing dementia through risk factor control and uncontroversial healthy lifestyles. Care should also be taken that comorbid cerebrovascular disease is not considered as excluding a diagnosis of Alzheimer’s disease, particularly now that this determines treatment eligibility.
{"title":"Vascular and mixed dementia","authors":"R. Stewart","doi":"10.1093/MED/9780198807292.003.0031","DOIUrl":"https://doi.org/10.1093/MED/9780198807292.003.0031","url":null,"abstract":"Vascular disease is the most important environmental risk factor for dementia but this research area has been hampered by inadequate outcome definitions—in particular, a diagnostic system that attempts to separate overlapping and probably interacting pathologies. There is now substantial evidence that the well-recognized risk factors for cardiovascular disease and stroke are also risk factors for dementia, including Alzheimer’s disease. However, these risk factors frequently act over several decades, meaning that the chances of definitive randomized controlled trial evidence for risk-modifying interventions are slim. This should not obscure the wide opportunity for delaying or preventing dementia through risk factor control and uncontroversial healthy lifestyles. Care should also be taken that comorbid cerebrovascular disease is not considered as excluding a diagnosis of Alzheimer’s disease, particularly now that this determines treatment eligibility.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132137422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/MED/9780199644957.003.0022
T. Dening
Globally increasing numbers of older people bring both challenges and opportunities for old age psychiatry services. This chapter outlines the history, underlying principles, and policy context for contemporary mental health services for older people. It discusses components of services, including community health teams, memory assessment services, consultation-liaison psychiatry, and in-patient mental health care, as well as newer types of service, such as crisis teams and outreach to care homes. Other recent developments include various models of case management and emphasis on post-diagnostic support. Equally important are issues of equality and access, and the chapter covers several key areas, such as age, gender, sexual orientation, religion and spirituality, and rurality. Major challenges to old age psychiatry come from limited resources and non-recognition of the distinct needs of older adults, as well as the demands of the growing older population, advances in science and technology, and the need to attract talented psychiatrists into this field.
{"title":"Principles of service provision in old age psychiatry","authors":"T. Dening","doi":"10.1093/MED/9780199644957.003.0022","DOIUrl":"https://doi.org/10.1093/MED/9780199644957.003.0022","url":null,"abstract":"Globally increasing numbers of older people bring both challenges and opportunities for old age psychiatry services. This chapter outlines the history, underlying principles, and policy context for contemporary mental health services for older people. It discusses components of services, including community health teams, memory assessment services, consultation-liaison psychiatry, and in-patient mental health care, as well as newer types of service, such as crisis teams and outreach to care homes. Other recent developments include various models of case management and emphasis on post-diagnostic support. Equally important are issues of equality and access, and the chapter covers several key areas, such as age, gender, sexual orientation, religion and spirituality, and rurality. Major challenges to old age psychiatry come from limited resources and non-recognition of the distinct needs of older adults, as well as the demands of the growing older population, advances in science and technology, and the need to attract talented psychiatrists into this field.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127149348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/MED/9780198807292.003.0048
K. Anderson, Zheyu Xu, U. Mosimann, B. Boeve
This chapter reviews the most common sleep disorders in older adults and their treatment. It begins with a brief review of sleep physiology and then gives an outline on how to take a comprehensive sleep history. There are physiological sleep changes related to ageing, but sleep disorders are not part of normal ageing and are often associated with mental or physical disorders, pain, and neurodegenerative disease. The most common sleep disorders include insomnia, obstructive sleep apnoea, restless legs syndrome, REM sleep behaviour disorder, excessive daytime somnolence, and circadian rhythm disorders. An in-depth clinical history, including if possible, bed-partner’s information, is the key to diagnosis. Patients need to be informed about the physiological sleep changes and the principles of sleep hygiene. Many sleep disorders have effective therapies and patients will benefit from pharmacological and nonpharmacological treatment strategies.
{"title":"Sleep and circadian rhythm disorders","authors":"K. Anderson, Zheyu Xu, U. Mosimann, B. Boeve","doi":"10.1093/MED/9780198807292.003.0048","DOIUrl":"https://doi.org/10.1093/MED/9780198807292.003.0048","url":null,"abstract":"This chapter reviews the most common sleep disorders in older adults and their treatment. It begins with a brief review of sleep physiology and then gives an outline on how to take a comprehensive sleep history. There are physiological sleep changes related to ageing, but sleep disorders are not part of normal ageing and are often associated with mental or physical disorders, pain, and neurodegenerative disease. The most common sleep disorders include insomnia, obstructive sleep apnoea, restless legs syndrome, REM sleep behaviour disorder, excessive daytime somnolence, and circadian rhythm disorders. An in-depth clinical history, including if possible, bed-partner’s information, is the key to diagnosis. Patients need to be informed about the physiological sleep changes and the principles of sleep hygiene. Many sleep disorders have effective therapies and patients will benefit from pharmacological and nonpharmacological treatment strategies.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116681290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This chapter consists of four sections that consider various aspects of the journey through dementia. The first two parts (by Keith Oliver and Hilary Doxford) describe the early stages of dementia, the process of getting a diagnosis, and the challenges of living well with dementia. The third section (Louise Lafortune and Carol Brayne) discusses the tensions between ‘early’ and ‘timely’ diagnosis, and also the issues that arise from having biomarkers that potentially enable us to diagnose conditions like Alzheimer’s disease before a person has any concerns or symptoms. At the moment, there is little evidence that people stand to benefit greatly in a diagnosis before the emergence of clinical symptoms. June Hennell concludes the chapter by describing her journey as a carer and adjusting to life after bereavement. The chapter thus provides a balanced and authentic view of how people respond to the impact of diagnosis and life afterwards.
{"title":"The experience of dementia","authors":"T. Dening","doi":"10.2307/j.ctt1t89hg6.7","DOIUrl":"https://doi.org/10.2307/j.ctt1t89hg6.7","url":null,"abstract":"This chapter consists of four sections that consider various aspects of the journey through dementia. The first two parts (by Keith Oliver and Hilary Doxford) describe the early stages of dementia, the process of getting a diagnosis, and the challenges of living well with dementia. The third section (Louise Lafortune and Carol Brayne) discusses the tensions between ‘early’ and ‘timely’ diagnosis, and also the issues that arise from having biomarkers that potentially enable us to diagnose conditions like Alzheimer’s disease before a person has any concerns or symptoms. At the moment, there is little evidence that people stand to benefit greatly in a diagnosis before the emergence of clinical symptoms. June Hennell concludes the chapter by describing her journey as a carer and adjusting to life after bereavement. The chapter thus provides a balanced and authentic view of how people respond to the impact of diagnosis and life afterwards.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"146 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128437159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/med/9780198807292.003.0013
D. Bishara
The use of pharmacological agents in older adults is one of the most complex aspects of patient care. Clinicians must display expert knowledge on and careful consideration of the various factors involved. Older people exhibit an unexpected or exaggerated response to drug therapy when compared to their younger counterparts of the same body weight and gender. Often this response is explained through pharmacokinetic or pharmacodynamic changes. Understanding the common physiological changes seen in ageing is helpful in anticipating the changes expected in pharmacokinetic parameters. The pharmacodynamic variations seen in older patients may also increase or decrease sensitivity to a drug independently of the pharmacokinetic changes. In addition, age is known to be associated with increased prevalence of multiple chronic illnesses frequently requiring the use of complex therapeutic regimens, thus increasing the risk for adverse drug reactions and drug interactions in older people.
{"title":"Psychopharmacology","authors":"D. Bishara","doi":"10.1093/med/9780198807292.003.0013","DOIUrl":"https://doi.org/10.1093/med/9780198807292.003.0013","url":null,"abstract":"The use of pharmacological agents in older adults is one of the most complex aspects of patient care. Clinicians must display expert knowledge on and careful consideration of the various factors involved. Older people exhibit an unexpected or exaggerated response to drug therapy when compared to their younger counterparts of the same body weight and gender. Often this response is explained through pharmacokinetic or pharmacodynamic changes. Understanding the common physiological changes seen in ageing is helpful in anticipating the changes expected in pharmacokinetic parameters. The pharmacodynamic variations seen in older patients may also increase or decrease sensitivity to a drug independently of the pharmacokinetic changes. In addition, age is known to be associated with increased prevalence of multiple chronic illnesses frequently requiring the use of complex therapeutic regimens, thus increasing the risk for adverse drug reactions and drug interactions in older people.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130575766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/MED/9780199644957.003.0045
G. Byrne
Fear and anxiety are phylogenetically ancient emotions that confer survival advantage across species. They facilitate escape from present danger and prepare the individual to deal rapidly with future threats. In contemporary life, a moderate increase in anxiety is commonly associated with increased performance. However, anxiety that is excessive or prolonged is maladaptive and may represent a mental disorder. Individual differences and contextual factors influence the final form that an anxiety disorder takes. Like many complex behaviours, anxiety disorders result from interactions between genetic and environmental factors. In older people, anxiety often complicates physical frailty and cognitive decline. From a nosological perspective, anxiety can be conceptualized as both dimensional and categorical. Both psychological and pharmacological treatments are commonly applied to anxiety disorders in older people, with moderate efficacy. This chapter deals with classification, epidemiology, scientific underpinnings, phenomenology, and modern treatment approaches to anxiety disorders in later life.
{"title":"Anxiety disorders in older people","authors":"G. Byrne","doi":"10.1093/MED/9780199644957.003.0045","DOIUrl":"https://doi.org/10.1093/MED/9780199644957.003.0045","url":null,"abstract":"Fear and anxiety are phylogenetically ancient emotions that confer survival advantage across species. They facilitate escape from present danger and prepare the individual to deal rapidly with future threats. In contemporary life, a moderate increase in anxiety is commonly associated with increased performance. However, anxiety that is excessive or prolonged is maladaptive and may represent a mental disorder. Individual differences and contextual factors influence the final form that an anxiety disorder takes. Like many complex behaviours, anxiety disorders result from interactions between genetic and environmental factors. In older people, anxiety often complicates physical frailty and cognitive decline. From a nosological perspective, anxiety can be conceptualized as both dimensional and categorical. Both psychological and pharmacological treatments are commonly applied to anxiety disorders in older people, with moderate efficacy. This chapter deals with classification, epidemiology, scientific underpinnings, phenomenology, and modern treatment approaches to anxiety disorders in later life.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115404748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/MED/9780198807292.003.0017
K. Laidlaw, P. Wilkinson
Cognitive behaviour therapy (CBT) is a dominant psychological treatment in the management of a range of psychiatric disorders and is increasingly being refined to suit the needs of older adults. This chapter summarizes the theory and practice of CBT, and emphasizes assessment, formulation, and adaptation of treatment with older patients. It describes in detail management of depressive disorder, anxiety disorders and dementia caregiver distress and includes relevant case examples. It also covers problem-solving therapy and behavioural activation. The chapter also describes mindfulness-based cognitive therapy (MBCT), which has potential benefits in the treatment of older adults, and it reviews applications with older people. It outlines newer applications, including treatment of psychological symptoms associated with physical illness, psychosis, and memory impairment. Finally, it describes how the evidence base for CBT-based interventions with older adults is limited and reviews the extent of the current evidence.
{"title":"Cognitive behavioural therapy","authors":"K. Laidlaw, P. Wilkinson","doi":"10.1093/MED/9780198807292.003.0017","DOIUrl":"https://doi.org/10.1093/MED/9780198807292.003.0017","url":null,"abstract":"Cognitive behaviour therapy (CBT) is a dominant psychological treatment in the management of a range of psychiatric disorders and is increasingly being refined to suit the needs of older adults. This chapter summarizes the theory and practice of CBT, and emphasizes assessment, formulation, and adaptation of treatment with older patients. It describes in detail management of depressive disorder, anxiety disorders and dementia caregiver distress and includes relevant case examples. It also covers problem-solving therapy and behavioural activation. The chapter also describes mindfulness-based cognitive therapy (MBCT), which has potential benefits in the treatment of older adults, and it reviews applications with older people. It outlines newer applications, including treatment of psychological symptoms associated with physical illness, psychosis, and memory impairment. Finally, it describes how the evidence base for CBT-based interventions with older adults is limited and reviews the extent of the current evidence.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130203676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/med/9780199644957.003.0048
T. Dening
Severe and enduring mental illness refers mainly to the long-term experience of schizophrenia and psychosis but also to other chronic functional disorders. The prevalence of psychoses in older people is hard to measure but estimates are around 0.5% of the population. Historically many people with long term illness resided in psychiatric hospitals but now most are in the community, receiving variable amounts of support from mental health, primary care, and social services. The physical health of this population is often poor and they receive less treatment and support than other older people with comparable physical health needs. Problems with psychiatric comorbidity (e.g. depression and substance misuse), cognitive impairment and social exclusion are also common. Treatment includes the judicious use of medication, nonpharmacological approaches, and social support—especially appropriate accommodation. Positive outcomes can be achieved by a recovery approach that attends to all aspects of the person’s health.
{"title":"Severe and enduring mental illness","authors":"T. Dening","doi":"10.1093/med/9780199644957.003.0048","DOIUrl":"https://doi.org/10.1093/med/9780199644957.003.0048","url":null,"abstract":"Severe and enduring mental illness refers mainly to the long-term experience of schizophrenia and psychosis but also to other chronic functional disorders. The prevalence of psychoses in older people is hard to measure but estimates are around 0.5% of the population. Historically many people with long term illness resided in psychiatric hospitals but now most are in the community, receiving variable amounts of support from mental health, primary care, and social services. The physical health of this population is often poor and they receive less treatment and support than other older people with comparable physical health needs. Problems with psychiatric comorbidity (e.g. depression and substance misuse), cognitive impairment and social exclusion are also common. Treatment includes the judicious use of medication, nonpharmacological approaches, and social support—especially appropriate accommodation. Positive outcomes can be achieved by a recovery approach that attends to all aspects of the person’s health.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"144 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132525715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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