The initial features and progress of depressive symptomatology over 42 to 104 months are presented for 100 elderly patients admitted with severe, non-neurotic depressive states; none had experienced a previous hypomanic episode. Sixty per cent either remained well throughout or had further episodes followed by full recovery; only 7% suffered continuous depressive symptoms. Of potential prognostic factors, only male sex and poor physical health, both at presentation and developing subsequently, were associated with poorer outcomes. The view is supported that treatment with well established methods achieves worthwhile and sustained improvement for most patients.

Many elderly people who commit suicide are not in close contact with primary care services; those who are may not be prescribed appropriate treatment, and few are referred for specialist care. Specialist services will fail to reduce suicide rates unless they embark upon programmes to increase public awareness of therapeutic possibilities and work more closely with primary care agencies to realise these possibilities.

Palliative care is an approach that stands well with the aims of person-centred dementia care. There is no doubt that the standards of care for many people with advanced dementia are poor. There is a lack of good-quality evidence, however, to support any particular approach for palliative care in dementia. Still, there are a number of areas in relation to caring for people with severe dementia where a palliative approach might be beneficial. In general, the relevant decisions have to be made on an individual basis but within a palliative framework. Advance care planning is likely to be crucial in encouraging this process. There is certainly a moral imperative behind the idea that care at the end of life for people with dementia should be improved.

Objectives to evaluate the frequency of potentially inappropriate medication (PIM) prescription among older people with dementia (PwD) from eight countries participating in the European study ‘RightTimePlaceCare’, and to evaluate factors and adverse outcomes associated with PIM prescription. Methods survey of 2,004 PwD including a baseline assessment and follow-up after 3 months. Interviewers gathered data on age, sex, prescription of medication, cognitive status, functional status, comorbidity, setting and admission to hospital, fall-related injuries and mortality in the time between baseline and follow-up. The European Union(7)-PIM list was used to evaluate PIM prescription. Multivariate regression analysis was used to investigate factors and adverse outcomes associated with PIM prescription. Results overall, 60% of the participants had at least one PIM prescription and 26.4% at least two. The PIM therapeutic subgroups most frequently prescribed were psycholeptics (26% of all PIM prescriptions) and ‘drugs for acid-related disorders’ (21%). PwD who were 80 years and older, lived in institutional long-term care settings, had higher comorbidity and were more functionally impaired were at higher risk of being prescribed two PIM or more. The prescription of two or more PIM was associated with higher chance of suffering from at least one fall-related injury and at least one episode of hospitalisation in the time between baseline and follow-up. Conclusions PIM use among PwD is frequent and is associated with institutional long-term care, age, advanced morbidity and functional impairment. It also appears to be associated with adverse outcomes. Special attention should be paid to psycholeptics and drugs for acid-related disorders.

Reynolds notes of behavioural neurology: â€oe¿ itis a discipline that does not appear to exist in the UK―. If the sighting of one black swan disproves the premise that all swans are white, then I submit that behavioural neurology does exist in the UK.M and physical ill-health, but not with regard to the prognostic significance of severity of depression and delusions. However, we have also hopefully widened the area of research.Hence, Post's four-fold categor ies of outcome were used not only to replicate his work, but also because a dichotomous ‘¿ good' versus ‘¿ poor' approach conceals significant differences in the quality of mood during life â€"¿ something we believe to be immensely important. Also, we have specified the range of treatments and after-care offered, since they can hardly be discounted in assessing outcome.It is hoped that future research can synthesise the different emphases in these studies, so that at least we are drinking from the same pint pots! Department of Psychiatry for the Elderly Prognosis of Depression in Old AgeSIR: Murphy (Journal, February 1987, 150, 268) is incorrect in assuming that our mortality rate is re markably similar to that obtained in her study. The figureof 35% she quotes for our patients refersto the entire follow-up period, which was as long as 104 months for some patients. We have already calcu lated the four-year rate for our cohort as part of another study (Journal, in press). For the 97 ascer tained (three were untraceable) the deaths at four years amount to 25(18 women and 7 men), i.e. 26%.Itisusualto assume a year-on-year rateof 5% for this age group, or 20% at four years â€"¿ not much different from our findings and in marked contrast to the 37% quoted by Murphy for her study. Thus, the difference in death rates between the two cohorts of patients that was evident at one year seems to persist at four-year follow-up. This is certainly not the only difference identified, but it is the one that most robustly withstands argu ments about the validity and reliability of our data.Murphy raises doubts about these on account of our retrospective methodology, although survivors were interviewed and information from GPs and, in some instances, personal contacts was collected for others. In fact, she too used a retrospective method for her own assessment of the course of depressive symptomatology, and unless patients are interviewed by a researcher extremely frequently it is hard to see how it can be otherwise. We have attempted some replication of Murphy's work and found concurrence over major life events Do the intra-class correlation coefficient and the Pearson product-moment correlation coefficient dis tinguish between agreement and association? Agree ment is a special kind of association of interest in reliability studies, and it is possible for association to be very high while agreement is poor.Would the authors like to say why they did not place screensbetween the raters?This strategy would have made the authors' claim that the raters were independent more ...