ࡱ> FzFE-Qڛb>"JFIFKKMSO Palette C   ")$+*($''-2@7-0=0''8L9=CEHIH+6OUNFT@GHEC !!E.'.EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE"!!1AQqa!1 ?F3]'IƓe5,J$3?O 5LXyYL4tO%fxM\DXL`: a2HS=rtd+f\UtV5m7L?cf7 `Zx5\k[( D/ 0|DArialgs4(0(z[ 0 DGaramond4(0(z[ 0  DTimes New Roman(0(z[ 0 0DWingdingsRoman(0(z[ 0 @DSymbolgsRoman(0(z[ 0 @ .  @n?" dd@  @@`` PHXU1      ``= :"#%&'()*+,)&;<=>@ABCD GHIK,R$FE-Qڛb>" 0AAJ+@8g4GdGd@z[ 0ppp@ <4BdBdl 0x4 <4!d!dl< 0ʚ;ʚ;<4ddddl|- 0X80___PPT10 pp?  %O  =QrMental Health Issues In Later Life - Everyones Business ":9,,- Status Quo or New Ways Forward August 2004*.PJ+,J+Topics to be covered &What are the common mental health issues that effect older people. What is the prevalence of these problems. How can these problems be identified. A model of service delivery for country SA.>EMental Health Issues In Later Life - Everyone's Business Introduction$F9  From the beginning of July there has been an advertising campaign on TV for  Beyond Blue , informing us that Depression is more disabling than cancer or a heart attack and will effect 1 in 5 of us during our lifetime.  The Dementia Epidemic: Economic Impact and Positive Solutions For Australia report released in May 2003 informed us that Dementia was the second largest cause of disability burden in Australia (after depression) and will become the largest by 2016, continuing to outpace other chronic illnesses.Z?EMental Health Issues In Later Life - Everyone's Business Introduction$F9  Depression, followed by dementia are the two largest causes of disability burden in Australia (ahead of diabetes, asthma and osteoarthritis). A recent study in Sydney revealed that only 50% of GPs were able to recognise signs of an early dementia and only 70% the signs of a moderate dementia. A survey conducted in the UK found that only 39% of GPs would inform their patients of a diagnosis of dementia, compared to 95% who would inform them of a diagnosis of terminal cancer. Z@EMental Health Issues In Later Life - Everyone's Business Introduction$F9  One in four women and one in six men will have an episode of clinical depression. Depression is the leading cause of suicide. In Residential Aged Care facilities 40% of residents experience mild to severe depression. Depressive disorders diagnosed by psychiatrists are found between two and six times more frequently in nursing homes than among older people living in the general community. AEMental Health Issues In Later Life - Everyone's Business Introduction$F9  Close to 90% of depressed older patients in primary care get no treatment or inadequate treatment, despite the availability of effective treatments. Suicide rates in older males are 39.8 per 100,000 compared to 42.3 per 100,000 for males between 20 - 24 years. The levels of stigma, discrimination and ignorance which surrounds depression has been reported as disturbing with depression in rural Australia being identified as an emerging priority. Cancer rates in older people are just above 2%ZBWhat are the common mental health issues that effect older people.CC  The most common mental health problems effecting older people are: Dementia Depression Delusional Disorders Delirium or  Acute Confusional State is a common health problem faced by older people that results from: Medications Infections Physical health problems lCZ)ZjZ1ZCJ+)J+jJ+1J+\What are the common mental health issues& cont.,/)JThese conditions are not mutually exclusive and a person suffering from one disorder (eg. Dementia) may be predisposed to suffering from all the above. It is important to remember that the vast majority of older people remain untroubled by these problems. Dementia and depression are neither a normal or inevitable part of ageing.KKJ+#The prevalence of these problems *$   &Depression, followed by dementia are the two largest causes of disability burden in Australia (ahead of diabetes, asthma and osteoarthritis). Source: The Dementia Epidemic: Economic Impact and Positive Solutions for Australia. Access Economics March 2003 Alzheimer s Australia, 2003 NB:Rates vary widely depending on the information source and should be viewed as a guide only. Prevalence rates used are from  Evidenced based medicine in dementia and old age depression Lundbeck  ZZZ J+J+J+J+[J+h:Prevalence - Dementia $  J+ 65 - 74 yrs 5% 75 - 79 yrs 15% 80 - 85 yrs 25% 86 - 90 yrs 30% 91 - yrs 35% Alzheimer s Disease 60% Vascular Dementia 15% Lewy Body Dementia 15% Other Causes 10%BUJ+J+ J+ J+J+J+BJ+ Prevalence - Depression  Community 10% - 15% Nursing Homes 30% - 40% Hospitalised > 65 10% - 45% Seen in outpatients (GP) 13% - 40% 70% of suicides follow an episode of depression. Increased mortality rate of 2  4 times over non-depressed older people. @{{xJ+|J+ BPrevalence  Delusional Disorders"" SPrevalence rates vary widely but delusions feature in: Delirium Depression Dementia477J+J+ Prevalence - Delirium  Community 10%  14% Hospitals 10%  40% Medical Wards 10% Gerontic Wards 18% Orthopaedic 38% Nursing Homes 25% Increased risk with polypharmacy, diabetes, visual impairment. Greater incidence where there is a pre-existing dementia. x/Z6ZZzZ.J+6J+J+zJ+  $How can these problems be identified%% Early recognition is vital. Delays in recognising the presence of a problem and obtaining an accurate diagnosis can have devastating effects for the client and their family and carers.  Dementia  Unrecognised Dementia can lead to: Delays in establishing a differential diagnosis and commencing treatment. Premature placement in residential care. A worsening of cognitive functioning due to treatable/reversible causes. Needless suffering for the individual and their family. Increased carer stress. A recent study in Sydney revealed that only 50% of GPs were able to recognise signs of an early dementia and only 70% the signs of a moderate dementia. Source: Creasey and Brodaty, 1998, cited in The Dementia Epidemic: Economic Impact and Positive Solutions for Australia. Access Economics March 2003 Alzheimer s Australia, 2003#P PKP J+J+J+ J+J+J+J+J+,  Depression  Unrecognised Depression can lead to: Delays in commencing treatment. Premature placement in residential care. Incorrect diagnosis of dementia. Needless suffering for the individual and their family. Increased carer stress. Increased mortality rate from physical health problems. Death from suicide. People suffering from depression are more aware of the problem and more likely to complain about symptoms (Blackmun, 1998). The symptoms may be misinterpreted as indicating a dementia.%PPP J+ J+J+J+J+iJ+J+J+J+=J+F Delirium  Unrecognised Delirium can lead to; Premature placement in residential care. Incorrect diagnosis of dementia. Increased use of medications and a worsening of the condition. Needless suffering for the individual and their family. Death. Non detection rates for delirium are as high as 33 - 66% Source: Meagher D J Delirium: optimising management, BMJ Vol. 322 January 2001 Pgs 144  148# J+J+J+J+J+9J+^J+ Recognition  VThe challenge is to be aware of the common features of each of these disorders so that medical intervention can be sought at the earliest opportunity to obtain an accurate diagnosis and commence treatment. This task is made more complex by commonly held beliefs and attitudes that depressive features and memory loss are inevitable and expected outcomes of ageing that do not warrant investigation to establish a differential diagnosis or to commence treatments. There are significant similarities in the symptoms of depression and dementia that pose a challenge for those involved in a person s care. Changes in memory, thoughts, perceptions, emotions and sleep are common to both.$Z[J+QC%,A model of service delivery for country SA "-* Living in metropolitan Adelaide we take for granted a level of health service that is comprehensive and accessible with minimal waiting times. Choice of General Practitioners with minimal waiting period. Specialist services; Geriatricians, Neurologists, Memory Disorder Clinics. Psychiatrists and specialist aged care mental health teams for assessment and case management. Large public hospitals with screening facilities - CT Scans, MRI etc. Anonymity and privacy.>hP'PP DPDD$*A model of service delivery for country SA++ Living in rural and remote SA people take for granted a level of health service that is less comprehensive, more difficult to access with lengthy waiting times. Limited choice of GPs with up to 2 week wait to see your preferred GP. No local based Geriatricians, Neurologists or Psychiatrists with over a 3 month waiting list for an appointment to see a visiting Geriatrician or Psychiatrist. No locally based specialist aged care mental health teams and in some regions, no specialist mental health cover at all.>lP5PP `P`E#*A model of service delivery for country SA++ Cont. No Memory Disorder Clinics or MRI screening facilities or personnel for ADAS-Cog. Reduced anonymity and privacy with greater concern over stigma. Visiting services from Mental Health Services For Older People, Country Liaison Service.  F"*A model of service delivery for country SA++ This lack of specialist mental health services for older people in country regions increases dramatically the importance of the role played by main stream health workers. Mental Health Services For Older People, Country Liaison Service (MHSfOP,CLS) provide a visiting and remote consultation liaison service to rural and remote areas of SA. Currently we are able to service 5 of the 7 regional health service areas in South Australia.I(*A model of service delivery for country SA++ With staffing resources of only 3 FTE s it has been necessary to explore options for attempting to provide a viable and sustainable service that is able to assist locally based service providers with the ongoing provision of care. Clearly a case management model was not an option as the ability to assess new clients would become impossible in the short term.iiJ'*A model of service delivery for country SA++ oMHSfOP,CLS uses a model of service delivery that seeks to: Be accessible and responsive. Build on the existing knowledge and skills of locally based aged care service providers. Increase the extent to which front line workers are able to recognise the common features of depression and dementia. Involve the key workers in the overall referral and assessment process.*;5;5K&*A model of service delivery for country SA++ 6Cont. Attempt to maximise local capacity rather than build reliance on MHSfOP,CLS. Support local service providers in their efforts to better understand and manage the problems faced by older persons with mental health issues. Represent the concerns of country service providers to MHSfOP and other key bodies.*11L)*A model of service delivery for country SA++ ,MHSfOP,CLS offers: A regular monthly visiting service to 5 of the 7 regional health service areas conducted under Memorandum of Understanding. A remote consultation service including: Video-conferencing based assessments. Telephone consultation service. Case conferencing service. Discharge planning.@uuM**A model of service delivery for country SA++ 3Cont. Working partnerships with aged care service provider networks. Education sessions for aged care service providers (including GPs), carers and the general community on topics related to mental health issues in later life. Web site with links to articles and training resources. http://www.mhsfopcls.com6Q."N+*A model of service delivery for country SA++ With limited health resources and no prospects in the immediate future for additional resources to better service older persons with mental health issues in rural and remote parts of South Australia it is necessary to explore all options for addressing the short fall.O,*A model of service delivery for country SA++ Depression and dementia are simply health problems that effect a vulnerable group of people and just as all health care workers have a role in recognising the common features and warning signs of diabetes or skin cancers, we all have a role in mental health.G!rMental Health Issues In Later Life - Everyones Business ":9,,- Status Quo or New Ways Forward August 2004*.PJ+,J+/ !"#$&'() * + , - ;HP  ` 3333ff3` 3333f33ff3` "3333̙ff3` Kf3̙` &e̙3g3f` f333̙po7` ___f3̙;/f9` ff3Lm` ff3LmNLm>?" dd@*?nAd@q<nAqFLK#M n?" dd@   @@``PR    M`2p>> ZR(    H|? ?" `}  X Click to edit Master title style!! @  H? ?" `  RClick to edit Master text styles Second level Third level Fourth level Fifth level!    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