scholarly journals Response to guidance on use of olanzapine and risperidone: a community-based study of primary and secondary care

2006 ◽  
Vol 30 (8) ◽  
pp. 289-292
Author(s):  
Karen L. Franks
Keyword(s):  
Older Adults ◽  
General Practitioners ◽  
Secondary Care ◽  
Older Patients ◽  
High Rate ◽  
Care Homes ◽  
Clinical Implications ◽  
Community Based ◽  
Psychiatric Case ◽  
Clinical Problems

Aims and MethodThe aim of the study was to assess the response to the guidance from the Committee on Safety of Medicines (CSM) on prescribing olanzapine and risperidone for older adults. Information on 96 older patients who were prescribed olanzapine or risperidone was gathered from psychiatric case notes, general practitioners and care homes. Data were gathered 10 weeks after the CSM guidance (Time 1) and again 6 months later (Time 2).ResultsAt Time 1, 71 out of 96 patients (74%) had been reviewed and 90 (94%) by Time 2. By 6 months after the guidance 34 of 52 patients with dementia (65%) and 10 of 35 patients with functional diagnoses had been withdrawn from medication; 29% (14/49) of those withdrawn from medication had significant problems associated with withdrawal. In many cases medication was continued following risk–benefit decisions taken at review and despite CSM guidance.Clinical ImplicationsGuidance has prompted review of prescribing in existing patients and some re-referrals, which has increased workload. The guidance has changed the management of existing patients, but there has been a high rate of associated clinical problems and numerous patients remain on, or return to, olanzapine or risperidone.

scholarly journals General practitioner referral of older patients to Improving Access to Psychological Therapies (IAPT): an exploratory qualitative study

2018 ◽  
Vol 42 (3) ◽  
pp. 115-118 ◽  
Author(s):  
Noel Collins ◽  
Laurie Corna
Keyword(s):  
Older Adults ◽  
General Practitioner ◽  
Thematic Analysis ◽  
Older Patients ◽  
Watchful Waiting ◽  
Behavioural Therapy ◽  
Clinical Implications ◽  
Psychological Therapies ◽  
Cognitive Behavioural ◽  
Willingness To Refer

Aims and methodTo understand general practitioner (GP) reticence to refer older patients to a local Improving Access to Psychological Therapies (IAPT) service providing mostly cognitive–behavioural therapy (CBT)-based interventions. Semi-structured, hour-long interviews were conducted with eight GPs and then analysed by modified grounded theory and thematic analysis.ResultsGP views regarding the treatability of older adults with CBT influenced their willingness to refer to a CBT-based IAPT service. Perceptions of local IAPT assessment processes being distressing and onerous to older patients also motivated referral inaction. GPs expressed a preference to treat depressed older patients themselves (with medication and psychological approaches such as watchful waiting).Clinical implicationsAny strategy to increase referral rates of older adults to CBT-based IAPT services should address local GP concerns regarding assessment processes and the effectiveness of offered treatments.Declaration of interestNone.

Improving Community-Based Services for Older Patients with Depression: The Benefits of an Educational and Service Initiative

2001 ◽  
Vol 35 (4) ◽  
pp. 449-454 ◽  
Author(s):  
Carolyn Mutch ◽  
Margaret Tobin ◽  
Ian Hickie ◽  
Carolyn Mutch ◽  
Margaret Tobin ◽  
...  
Keyword(s):  
Mental Health ◽  
General Practitioners ◽  
Older Patients ◽  
Community Mental Health Services ◽  
Service Development ◽  
Health Staff ◽  
Mental Health Staff ◽  
Community Based ◽  
Educational Initiative ◽  
Improvement Project

Objective: The objective of this study was to report a quality improvement project for older patients with depression. The initiative focused on both clinical practice changes (improvement of medical, neurocognitive and behavioural assessment) and service development (greater continuity of care). Method: After initial identification of key deficits, implementation of a service and educational initiative took place within a district mental health service. The service consisted of an inpatient unit, a specialized psychogeriatric service and two adult community mental health services. Mental health staff received education regarding the specific needs of older patients with depression and were provided with assessment materials, patient education and treatment aids. General practitioners participated in shared long-term management. Results: Following graded implementation, the management of 44 subjects (mean age = 65.4 years, 91% female) recruited over an 8-month period was reviewed. Compared with 99 subjects (mean age = 68.9 years, 69% female) from the earlier 12-month assessment phase, there were significant improvements in medical (43% to 92%), neurocognitive (37% to 84%) and behavioural (e.g. suicidal ideation: 78% to 100%) assessments. Similarly, relevant laboratory investigations (neuroimaging: 21% to 67%) and communication with general practitioners (73% to 97%) improved. The most change occurred in the adult community-based treatment services. Conclusions: A coordinated management and educational initiative resulted in marked improvement in basic medical and psychiatric assessment and more integrated care. These changes did not require expansion of specialist services.

scholarly journals General practitioners’ attitudes and decision making regarding admission for older adults with infection: a UK qualitative interview study

2018 ◽  
Vol 36 (4) ◽  
pp. 493-500 ◽  
Author(s):  
Abigail Moore ◽  
Caroline Croxson ◽  
Sara McKelvie ◽  
Dan Lasserson ◽  
Gail Hayward
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
General Practitioners ◽  
Older Patients ◽  
Ageing Population ◽  
Structured Interviews ◽  
Suspected Infection ◽  
Qualitative Interview Study ◽  
System Factors ◽  
The Uk

Abstract Background The world has an ageing population. Infection is common in older adults; serious infection has a high mortality rate and is associated with unplanned admissions. In the UK, general practitioners (GPs) must identify which older patients require admission to hospital and provide appropriate care and support for those staying at home. Objectives To explore attitudes of UK GPs towards referring older patients with suspected infection to hospital, how they weigh up the decision to admit against the alternatives and how alternatives to admission could be made more effective. Methods. Qualitative study using semi-structured interviews. GPs were purposively sampled from across the UK to achieve maximum variation in terms of GP role, experience and practice population. Interview transcripts were coded and analysed using a modified framework approach. Results GPs’ key influences on decision making were grouped into patient, GP and system factors. Patient factors included clinical factors, social factors and shared decision making. GP factors included gut instinct, risk management and acknowledging an associated personal emotional burden. System factors involved weighing up the pressure on secondary care beds against increasing GP workload. GPs described that finding an alternative to admission could be more time consuming, complex to arrange or were restricted by lack of capacity. Conclusion GPs need to be empowered to make safe decisions about place of care for older adults with suspected infection. This may mean developing strategies to support decision making as well as improving the ease of access to, and capacity of, any alternatives to admission.

The Potential of Optometrists’ Referrals of Older Patients to Community-Based Exercise Programs: Findings From a Mixed-Methods Study

2020 ◽  
Vol 28 (2) ◽  
pp. 194-207
Author(s):  
Christina E. Miyawaki ◽  
Rebecca L. Mauldin ◽  
Carolyn R. Carman
Keyword(s):  
Older Adults ◽  
Mixed Method ◽  
Older Patients ◽  
Exercise Program ◽  
Mixed Methods Study ◽  
Routine Practice ◽  
Exercise Programs ◽  
Community Based ◽  
Cross Sectional ◽  
Cross Sectional Design

Exercise is important for older adults in order to prevent falls and live safer, healthier lives. Visual impairment is a risk factor for falling. Older adults tend to visit optometrists frequently; however, assessing patients’ physical exercise levels is not a routine practice for optometrists. The purpose of this study was to examine the potential for optometrists’ referrals to exercise programs. This study used a mixed-method, cross-sectional design. In focus groups, optometry patients (N = 42) discussed the acceptability of an optometrist’s prescription for exercise programs. The vast majority of optometry patients (90%) indicated that they would follow such a prescription for exercise from their optometrists. Texas optometrists (N = 268) were surveyed about the potential for exercise program prescriptions, and 97% indicated a willingness to prescribe exercise programs to their patients. The results suggest that there is an opportunity for community–clinical partnerships to prevent falls and to improve the health of older patients.

scholarly journals Psychological therapies provision: views from primary care

2008 ◽  
Vol 32 (10) ◽  
pp. 369-374 ◽  
Author(s):  
Anne Ward ◽  
Giovanni Polizzi ◽  
Miomir Milovanovic
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Secondary Care ◽  
Waiting Times ◽  
Clinical Implications ◽  
Care Providers ◽  
Further Training ◽  
Psychological Therapies ◽  
Effective Service ◽  
Government Level

Aims and MethodRecent National Health Service (NHS) policy and guidelines support the increased provision of psychological therapies. As secondary care providers of psychological therapies, we carried out a questionnaire study of how our services were perceived by local general practitioners (GPs). All GPs in the borough of Southwark were included.ResultsGeneral practitioners value secondary care psychotherapeutic input across a spectrum of complex diagnostic groups and are interested in further training/education. They also consistently complain about long waiting times and confusion about accessing the various services.Clinical ImplicationsWith increasing interest in and willingness to fund the delivery of psychological therapies, there is the potential for working more effectively across the primary–secondary care divide. However, improved communication between primary and secondary care is essential if the increased commitment at government level is to be translated into a locally effective service.

scholarly journals Probable delirium is a presenting symptom of COVID-19 in frail, older adults: a cohort study of 322 hospitalised and 535 community-based older adults

2020 ◽  
Author(s):  
Maria Beatrice Zazzara ◽  
Rose S Penfold ◽  
Amy L Roberts ◽  
Karla A Lee ◽  
Hannah Dooley ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Older Patients ◽  
Severe Disease ◽  
Adverse Outcomes ◽  
Self Report ◽  
Multivariable Logistic Regression Analysis ◽  
Nasopharyngeal Swab ◽  
Community Based ◽  
Atypical Presentations

Abstract Background Frailty, increased vulnerability to physiological stressors, is associated with adverse outcomes. COVID-19 exhibits a more severe disease course in older, comorbid adults. Awareness of atypical presentations is critical to facilitate early identification. Objective To assess how frailty affects presenting COVID-19 symptoms in older adults. Design Observational cohort study of hospitalised older patients and self-report data for community-based older adults. Setting Admissions to St Thomas’ Hospital, London with laboratory-confirmed COVID-19. Community-based data for older adults using the COVID Symptom Study mobile application. Subjects Hospital cohort: patients aged 65 and over (n = 322); unscheduled hospital admission between 1 March 2020 and 5 May 2020; COVID-19 confirmed by RT-PCR of nasopharyngeal swab. Community-based cohort: participants aged 65 and over enrolled in the COVID Symptom Study (n = 535); reported test-positive for COVID-19 from 24 March (application launch) to 8 May 2020. Methods Multivariable logistic regression analysis performed on age-matched samples from hospital and community-based cohorts to ascertain association of frailty with symptoms of confirmed COVID-19. Results Hospital cohort: significantly higher prevalence of probable delirium in the frail sample, with no difference in fever or cough. Community-based cohort: significantly higher prevalence of possible delirium in frailer, older adults and fatigue and shortness of breath. Conclusions This is the first study demonstrating higher prevalence of probable delirium as a COVID-19 symptom in older adults with frailty compared to other older adults. This emphasises need for systematic frailty assessment and screening for delirium in acutely ill older patients in hospital and community settings. Clinicians should suspect COVID-19 in frail adults with delirium.

General practitioners’ assessment of, and treatment decisions regarding, common mental disorder in older adults: thematic analysis of interview data

2013 ◽  
Vol 35 (1) ◽  
pp. 150-168 ◽  
Author(s):  
JENNIFER STRACHAN ◽  
GILL YELLOWLEES ◽  
APRIL QUIGLEY
Keyword(s):  
Older Adults ◽  
Mental Disorder ◽  
General Practitioners ◽  
Thematic Analysis ◽  
Secondary Care ◽  
Clinical Decision Making ◽  
Care Service ◽  
Local Level ◽  
Explanatory Power ◽  
Service Development

ABSTRACTPrimary and secondary care services are charged with failing to adequately detect and treat mental disorder in older adults due to the ‘understandability phenomenon’; the belief that mental disorder in old age is inevitable and therefore not worthy of intervention. Quantitative data appear to support this hypothesis but lack the explanatory power of detailed accounts. Nine general practitioners (GPs) participated in group interviews about their assessment and treatment of older patients, and their expectations and experience of referral to secondary care. Resulting transcripts were subject to Thematic Analysis. Respondents recognised the unique features of these clients, and their impact on the detailed, recursive processes of assessment, clinical decision-making and intervention. GPs described confidence in managing most cases of mental disorder, describing the role of secondary care as one of consultancy in extreme or unusual cases. GPs did view mental disorder as commonly originating in adverse circumstances, and queried the validity of pharmacological or psychological interventions in these cases. They did not, however, equate understandability with acceptability, and called for social interventions to be integrated with health-care interventions to tackle the cause of mental disorder in older adults. At a wider level, findings highlight the discrepancy between assumptions about GP attitudes and actions, and their own accounts. At a local level, findings will assist in focusing secondary care service development where need is perceived, into consultancy and training.

scholarly journals Delirium is a presenting symptom of COVID-19 in frail, older adults: a cohort study of 322 hospitalised and 535 community-based older adults

2020 ◽  
Author(s):  
Maria Beatrice Zazzara ◽  
Rose S. Penfold ◽  
Amy L. Roberts ◽  
Karla A. Lee ◽  
Hannah Dooley ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Older Patients ◽  
Severe Disease ◽  
Multivariate Logistic Regression Analysis ◽  
Adverse Outcomes ◽  
Self Report ◽  
Nasopharyngeal Swab ◽  
Community Based ◽  
Atypical Presentations

AbstractBackgroundFrailty, increased vulnerability to physiological stressors, is associated with adverse outcomes. COVID-19 exhibits a more severe disease course in older, co-morbid adults. Awareness of atypical presentations is critical to facilitate early identification.ObjectiveTo assess how frailty affects presenting COVID-19 symptoms in older adults.DesignObservational cohort study of hospitalised older patients and self-report data for community-based older adults.SettingAdmissions to St Thomas’ Hospital, London with laboratory-confirmed COVID-19. Community-based data for 535 older adults using the COVID Symptom Study mobile application.SubjectsHospital cohort: patients aged 65 and over (n=322); unscheduled hospital admission between March 1st, 2020-May 5th, 2020; COVID-19 confirmed by RT-PCR of nasopharyngeal swab. Community-based cohort: participants aged 65 and over enrolled in the COVID Symptom Study (n=535); reported test-positive for COVID-19 from March 24th (application launch)-May 8th, 2020.MethodsMultivariate logistic regression analysis performed on age-matched samples from hospital and community-based cohorts to ascertain association of frailty with symptoms of confirmed COVID-19.ResultsHospital cohort: significantly higher prevalence of delirium in the frail sample, with no difference in fever or cough. Community-based cohort :significantly higher prevalence of probable delirium in frailer, older adults, and fatigue and shortness of breath.ConclusionsThis is the first study demonstrating higher prevalence of delirium as a COVID-19 symptom in older adults with frailty compared to other older adults. This emphasises need for systematic frailty assessment and screening for delirium in acutely ill older patients in hospital and community settings. Clinicians should suspect COVID-19 in frail adults with delirium.

Access to mental health care in depressed older patients

2013 ◽  
Vol 28 (S2) ◽  
pp. 44-44
Author(s):  
M. Tournier ◽  
F. Etchepare ◽  
T. Sanglier
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Cohort Study ◽  
Older Patients ◽  
Treatment Duration ◽  
Antidepressant Treatment ◽  
High Rate ◽  
Late Life Depression ◽  
Historical Cohort ◽  
Younger Adults

Late-life depression presents clinical challenges, including more comorbidities, longer time to treatment response, longer treatment duration, and older age stigmatization. Such characteristics may increase the perception that depressed older adults are difficult to treat, but evidence suggests that benefits from treatment are similar to these observed in younger adult patients. Antidepressant treatment may confer even greater protection against suicide in older than younger adults. However, a retrospective matched cohort study carried on in American managed care population showed that depression goes commonly untreated in older people compared with younger adults. Despite a high rate of comorbidity that was associated with more frequent antidepressant dispensing, this age group was at higher risk of untreated illness either by antidepressant (25.6% vs. 33.8%) or by psychotherapy (13.0% vs. 34.4%) and of later treatment after depression diagnosis (51 vs. 14 days), showing a lower access to treatment. In this study, before 2006, older adults treated for depression received more frequently antidepressants at lower prescribed doses, had poorer adherence and higher non-persistence to treatment than younger adults. However, these differences disappeared or reversed after Medicare Part D implementation, which improved the refunding of drugs in the elderly population. Similarly, a historical cohort study showed, in the French universal health care system, that antidepressant treatment duration and adherence were better in the treated older patients than in the younger ones. This favourable finding may be partly attributed to the universal healthcare system in which all subjects are treated in the same way, regardless of age. However, the reasons for the more appropriate use of antidepressants in the older subjects remain to be elucidated.

Sign in / Sign up

Export Citation Format

Share Document