Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly
Successful ageing is contingent upon three elements : avoiding disease and disability, sustaining high cognitive and physical function, and engaging with life (Rowe JW, 1997).
An estimated 20 % of adults aged 65 and older meet the criteria for a mental disorder during the previous 12 months (Karel MJ, 2012).
Because of their coexisting physical conditions, older adults are significantly more likely to seek and accept services in primary care versus specialty mental health care settings (IOM, 2012).
GPs are often the first and only mental healthcare contact that older people actively seek (AIHW, 2002 ).
The factors that affect mental health and mental illness occur in biological, psychological and social domains (Engel G, 1980).
Older adults who have experienced a lifetime of chronic or relapsing mental illness have special needs. These people are often uniquely disabled by a combination of personal, social, mental and physical health disadvantage (Jolley D, 2004).
For primary care services, including general practitioners, the task at hand includes (Rickwood D, 2006):
- understanding and negotiating their role in the continuing care of a person who has experienced mental illness, particularly their role in relation to recognition of early warning signs and agreed early intervention responses;
- ensuring that the physical health needs of people who have been seriously affected by mental illness are met;
- providing integrated and seamless continuing care pathways by working in effective partnership with specialist mental health services, other primary care services, allied health services, and providers of psychosocial and psychiatric rehabilitation services; and
- being actively involved in discharge planning and continuing care plans.
The incidence of mental illness is lower in community dwellers than in nursing home residents (Meeks S, 2014).
More than 50 percent of nursing home residents have some form of cognitive impairment, and many have personality disorders exacerbated by chronic health problems (Gabrel C, 1997).
Older adults underutilize mental health services for a variety of reasons, including: inadequate insurance coverage; a shortage of trained geriatric mental health providers; lack of coordination among primary care, mental health and aging service providers; stigma surrounding mental health and its treatment; denial of problems; and access barriers such as transportation (Bartels SJ, 2005).
Older adults often prefer psychotherapy to psychiatric medications (Areán P A, 2002).
However, psychological interventions are often not offered as an alternative. (Koh S, 2010).
Older adults with evidence of mental disorder are less likely than younger and middle aged adults to receive mental health services and, when they do, they are less likely to receive care from a mental health specialist (Karel MJ, 2012)
In most locations, aged care and disability support services for older people are not geared toward those who have experienced mental illness. They are rather more suited to the frail aged and those with dementia (AIHW, 2003).
Subsequently, an unreasonable burden falls on family and carers. Late-life mental disorders pose special difficulties for the family members who assist in providing care (Light E, 1991).
This Read More page is an extension of Psychological Assessment
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The Psychological Assessment is one of 8 domains of the
Comprehensive Geriatric Assessment (CGA)
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