scholarly journals Fear of flying, reviewed: An example of evidence-based old age psychiatry

2002 ◽  
Vol 26 (5) ◽  
pp. 188-190 ◽  
Author(s):  
Gianetta Rands
Keyword(s):  
Clinical Practice ◽  
Old Age ◽  
Evidence Based ◽  
Significant Deterioration ◽  
Fear Of Flying ◽  
Number Of Patients ◽  
The Family ◽  
Old Age Psychiatry ◽  
Person With Dementia ◽  
Patients Experience

‘Doctor, would it be alright to take mum to Cyprus for a family wedding?’ In a cosmopolitan city such as London hardly a month goes by without hearing a similar sort of query. If ‘mum’ has dementia I tend to advise the family against flying. This advice is based on anecdotal observations from past clinical practice. I have witnessed a number of patients experience significant deterioration in cognition following flying. While disorientation in unfamiliar environments may explain some of the difficulties in travelling for a person with dementia, as illustrated by John Bayley in Iris (1998), this may not be the only explanation. On this occasion, I decided to use evidence-based practice to review the situation.

Ethics and old age psychiatry

2013 ◽  
Author(s):  
Julian C. Hughes
Keyword(s):  
Clinical Practice ◽  
Old Age ◽  
Final Section ◽  
Ethical Dilemmas ◽  
Ethical Reasoning ◽  
Assisted Dying ◽  
Ethical Theories ◽  
Ethical Concerns ◽  
Ethical Decisions ◽  
Old Age Psychiatry

This chapter starts by reviewing four of the main ethical theories – consequentialism, deontology, principlism, and virtue ethics – looking at their relevance to old age psychiatry. Next comes a practical framework, which can be used to deal with particular ethical dilemmas. The chapter goes on to consider the report on dementia produced by the Nuffield Council on Bioethics in 2009, with its emphasis on the importance of personhood and solidarity. In the final section arguments around assisted dying are discussed. Throughout the chapter the aim is to locate clinical practice in the broader field of ethical concerns, in which the person’s inter-relatedness with the broader social context is emphasized. Clinical decisions need to be seen as ethical decisions, which are either right or wrong, and which reflect the fundamental nature of ethical reasoning.

Practical application of family and systems theory in old age psychiatry: three case reports

2006 ◽  
Vol 18 (2) ◽  
pp. 345-353 ◽  
Author(s):  
Carmelle Peisah
Keyword(s):  
Systems Theory ◽  
Old Age ◽  
Psychological Symptoms ◽  
Case Reports ◽  
Home Based ◽  
The Family ◽  
Potential Benefits ◽  
Old Age Psychiatry ◽  
Family Based

The role of the family or carer in old age psychiatry is well acknowledged. However, carer interventions are often focused on addressing carer burden alone and are usually individually rather than family based. Interpersonal conflict and family dynamics are rarely addressed. This is not surprising as there is a paucity of literature in family and systems theory applied to the older person, and clinicians are often skeptical about the efficacy of this treatment mode or daunted by the complexity of family and systems theory. Three cases are presented to illustrate the potential benefits of family-based interventions in the setting of commonly encountered clinical situations: (i) the treatment of chronically depressed older people in the community; (ii) the management of behavioral and psychological symptoms of dementia (BPSD) in residential care; and (iii) home-based support and care of the older patient with dementia.

Older people with enduring or recurrent severe mental illness in the Eastern Region of Ireland

2006 ◽  
Vol 23 (4) ◽  
pp. 145-150 ◽  
Author(s):  
Margo Wrigley ◽  
Bernadette Murphy ◽  
Martin Farrell ◽  
Brendan Cassidy ◽  
Jim Ryan
Keyword(s):  
Mental Illness ◽  
Older People ◽  
Severe Mental Illness ◽  
Old Age ◽  
Eastern Region ◽  
Service Utilisation ◽  
Number Of Patients ◽  
Adult Psychiatry ◽  
Comprehensive Survey ◽  
Old Age Psychiatry

AbstractObjectives: There has been no specific planning for older people with enduring or recurrent severe mental illness in Ireland. This survey aims to identify the number of affected over 65 year olds (graduates) and 55-64 year olds (prospective graduates) in the Health Service Executive, Eastern Region, their diagnoses and their use of psychiatric services.Method: A comprehensive survey of the ten general adult psychiatry and four old age psychiatry services in the (HSE) Eastern Region was undertaken for the year 2003 to determine the number of patients, their diagnoses and service utilisation.Results: 649 people over 65 years old were identified within the general adult psychiatry services and a further 279 within the old age psychiatry services giving a total of 928. (This number rose to 1141 after correcting for missing outpatient data.) 1,397 people between the ages of 55-64 were identified. (This number rose to 1,916 after correcting for missing outpatient data.)Conclusions: There are substantial numbers of ‘graduates’ and ‘prospective graduates’ in the Eastern Region. It is essential that services for this population are specifically planned for and further qualitative research is required to inform this process.

scholarly journals Lithium monitoring in patients over 65 in NHS Greater Glasgow and Clyde

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S32-S32
Author(s):  
Catriona Ingram ◽  
Karli Dempsey ◽  
Gillian Scott ◽  
Joe Sharkey
Keyword(s):  
Old Age ◽  
Catchment Area ◽  
Current Practice ◽  
High Variability ◽  
Health Board ◽  
Data Set ◽  
Number Of Patients ◽  
Adult Psychiatry ◽  
Old Age Psychiatry ◽  
Plasma Monitoring

AimsOur aim was to identify current practice for Lithium monitoring for >65s in NHS GGC and assess compliance to local Lithium monitoring guidelines.MethodA retrospective analysis was undertaken of patient data (demographics, diagnosis, biochemistry results) with Caldicott approval at two points over the course of 2018/19. For the first analysis, old age Community Mental Health Teams (CMHTs) were approached and asked to provide a list of their patients on Lithium. This was then assessed for compliance to Lithium monitoring guidelines.For the second analysis, pharmacy provided data for every patient in the health board dispensed lithium, regardless of whether they were open to a CMHT or not. We were then able to identify patients who we had not picked up on our initial analysis, and re-assess the entire data set for compliance to Lithium monitoring guidelines.ResultFrom our first analysis, 13 CMHTs identified 155 patients on Lithium. There was a high variability in how these patients were identified. 44% of patients were monitored by CMHTs who took bloods and chased them, 38% were monitored by GPs who were prompted by CMHTs in routine clinic letters, and 14% were monitored by GPs who were prompted by CMHTs more assertively using a lithium register. Overall, Lithium plasma monitoring was done well irrespective of method (91%), however compliance to the local standards was poor (58%) with proactive CMHT prompting GPs appearing to be the most effective method (71%).In our second analysis, we identified 508 patients >65 in NHS GGC prescribed Lithium. Of those, 44% were open to old age psychiatry, 25% general adult psychiatry and 19% were not open to anyone. Of those open to old age services, only 58% had been identified in the previous audit. Lithium monitoring compliance was better in those open to a CMHT versus those not (61% to 23%), and better in CMHTs where monitoring was done by CMHTs rather than GPs. For each CMHT, there were roughly 7 patients per catchment area on Lithium not open to psychiatry.ConclusionLithium monitoring does appear to be highly variable and not particularly compliant with local standards. CMHTs have inconsistent methods of identifying patients prescribed Lithium. There are a significant number of patients not open to old age CMHTs prescribed Lithium, and these patients have poorer compliance to Lithium monitoring. Of patients open to CMHTs, CMHT-led monitoring appears superior to other forms.

Attitudes of UK psychiatrists to the diagnosis of MCI in clinical practice

2012 ◽  
Vol 25 (2) ◽  
pp. 286-291 ◽  
Author(s):  
Joanne Rodda ◽  
Santhosh Dontham Gandhi ◽  
Naaheed Mukadam ◽  
Zuzana Walker
Keyword(s):  
Clinical Practice ◽  
Old Age ◽  
Postal Survey ◽  
Cognitive Testing ◽  
Assessment Tools ◽  
Transitional Stage ◽  
The United Kingdom ◽  
General Functioning ◽  
Old Age Psychiatry ◽  
State Examination

ABSTRACTBackground: Mild cognitive impairment (MCI) may represent a transitional stage between normal functioning and dementia. Following the initial criteria developed by Petersen et al. in 1999, which focused on memory deficit in the context of otherwise normal cognition and general functioning, the concept has evolved with the introduction of subtypes of MCI and improved understanding of etiology. Our aim was to investigate current practice as well as familiarity with and attitudes toward the concept of MCI amongst UK old age psychiatrists.Method: We sent an anonymized postal survey to all clinicians on the Royal College of Psychiatrists Old Age Psychiatry register. Questions covered attitudes toward the concept of MCI in addition to diagnostic criteria and assessment tools used.Results: The response rate was 39% (453 of 1,154 questionnaires returned completed). The majority of respondents were consultants (83%) and 91% diagnosed MCI. Only 4.4% of the respondents thought that the concept of MCI was not useful and 79% of them required a memory complaint from either the patient or an informant for a diagnosis, but the majority did not have a specific cut-off on cognitive testing. Eighty-two percent reported that they required no or minimal impairment in activities of daily living for a diagnosis of MCI. The two most frequently used tools for assessment were the Mini-Mental State Examination and the Addenbrooke's Cognitive Examination–Revised.Conclusions: Our survey shows that in the United Kingdom, the term MCI has become part of everyday clinical practice in psychiatry, suggesting that clinicians find it a useful term to conceptualize the transitional stage between normal aging and dementia. However, there is variability in diagnostic practice.

Ethics and old age psychiatry

2020 ◽  
pp. 803-822
Author(s):  
Julian C Hughes
Keyword(s):  
Clinical Practice ◽  
Old Age ◽  
Ethical Issues ◽  
Clinical Decisions ◽  
Ethical Decisions ◽  
Moral Theories ◽  
Old Age Psychiatry ◽  
Patterns Of Practice

This chapter is about ethics, i.e. about right or wrong decisions and good or bad judgments in clinical practice. It starts by reflecting on the extent to which all clinical decisions are, at one and the same time, ethical decisions. This is reflected in the idea of values-based practice. It outlines the major moral theories and a range of approaches to ethical issues. These theories and approaches have to be put into practice and it is not always clear how this should be done. The notion of patterns of practice, which will be described, may be helpful. There is a great variety of ethical issues that emerge in old age psychiatry, in particular in connection with dementia. The notion of patterns of practice is used, with the help of fictional vignettes, to discuss and understand such issues.

Evidence Based Health Care in Old Age Psychiatry

1997 ◽  
Vol 27 (3) ◽  
pp. 283-292 ◽  
Author(s):  
Sube Banerjee ◽  
Edward Dickinson
Keyword(s):  
Health Care ◽  
Old Age ◽  
Systematic Reviews ◽  
Cochrane Collaboration ◽  
Current Status ◽  
Future Research ◽  
Evidence Based ◽  
Old Age Psychiatry ◽  
The Cochrane Collaboration ◽  
Evidence Based Health Care

Objective: The purpose of this article is to present the current status and future needs of old age psychiatry in relation to evidence-based health care. Method: The opportunities and difficulties of evidence-based medicine as applied to old age psychiatry are described. Depression is used as a specific example. The role of the Cochrane Collaboration and of clinical guidelines in dealing with these difficulties are discussed. Results: There has been a tendency for drug studies to focus on younger age groups and to exclude patients with comorbidity or polypharmacy. Aspects of clinical management separate from drugs are given insufficient attention. The generalizability of current studies is a problem in old age psychiatry. Conclusions: Psychiatry is no less part of medicine than any other specialty. Increased attention to studies of effectiveness, as opposed to efficacy, is indicated. The Cochrane Collaboration is an international network which promotes and conducts systematic reviews of the effectiveness of health care. Systematic reviews can increase the generalizability of the current knowledge base and better define the needs for future research.

Meeting the Best Practice for Hearing Aid Verification in Children: Challenges and Future Directions

2019 ◽  
Vol 28 (4) ◽  
pp. 877-894
Author(s):  
Nur Azyani Amri ◽  
Tian Kar Quar ◽  
Foong Yen Chong
Keyword(s):  
Clinical Practice ◽  
Hearing Aids ◽  
Best Practice ◽  
Hearing Aid ◽  
Evidence Based ◽  
Future Directions ◽  
Major Barrier ◽  
Klang Valley ◽  
Age Range ◽  
Fitting Hearing Aids

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight ( N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23–48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

What Does Evidence-Based Practice Mean to You? A Follow-Up Study Examining School-Based Speech-Language Pathologists' Perspectives on Evidence-Based Practice

2020 ◽  
Vol 29 (2) ◽  
pp. 688-704
Author(s):  
Katrina Fulcher-Rood ◽  
Anny Castilla-Earls ◽  
Jeff Higginbotham
Keyword(s):  
Clinical Practice ◽  
Research Evidence ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Speech Language Pathologists ◽  
School Based ◽  
Research Findings ◽  
Ebp Implementation

Purpose The current investigation is a follow-up from a previous study examining child language diagnostic decision making in school-based speech-language pathologists (SLPs). The purpose of this study was to examine the SLPs' perspectives regarding the use of evidence-based practice (EBP) in their clinical work. Method Semistructured phone interviews were conducted with 25 school-based SLPs who previously participated in an earlier study by Fulcher-Rood et al. 2018). SLPs were asked questions regarding their definition of EBP, the value of research evidence, contexts in which they implement scientific literature in clinical practice, and the barriers to implementing EBP. Results SLPs' definitions of EBP differed from current definitions, in that SLPs only included the use of research findings. SLPs seem to discuss EBP as it relates to treatment and not assessment. Reported barriers to EBP implementation were insufficient time, limited funding, and restrictions from their employment setting. SLPs found it difficult to translate research findings to clinical practice. SLPs implemented external research evidence when they did not have enough clinical expertise regarding a specific client or when they needed scientific evidence to support a strategy they used. Conclusions SLPs appear to use EBP for specific reasons and not for every clinical decision they make. In addition, SLPs rely on EBP for treatment decisions and not for assessment decisions. Educational systems potentially present other challenges that need to be considered for EBP implementation. Considerations for implementation science and the research-to-practice gap are discussed.

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