Changing Patterns in Mental Illness in the Elderly

Abstract

The study of Graylingwell Hospital conducted by Roth (1955) has in part been replicated in order to study the changing patterns of mental illness in the elderly over a 25-year period. Important changes in the diagnostic distribution and outcome of cases admitted have occurred. Functional illness has given way to dementia, not as a proportion of patients admitted but in the number of beds employed for their care 6 and 24 months after their index admission. Discharge rates for all diagnostic groups except acute confusional states, have undergone considerable change and death rates have fallen. The study has concentrated on the residual in-patient population, paying particular attention to increasing demand for beds for the dementing group. These changes have been quantified and reflect a four-year increase in bed requirements for cases of dementia at two years. Despite a striking reduction in requirement for functional cases, there is an overall increase in bed requirement of 38 per cent at the two-year mark.

Mortality in elderly patients with organic brain disorder enrolled on the Salford psychiatric case register

“…For the Salford OBD cohort, however, progress through the calendar years 1968±1985 showed improvements in mortality only among males aged 65±69 years; this important observation will require further investigation among later recruited cohorts for con®rmation. However, these results suggest that for the majority of elderly individuals with OBD their increased risk of dying has remained stable during this 18-year period and cautions against the predictions made by the Oce of Health Economics (1979), Christie (1982) and others that very considerable increases in life expectancy for those with dementia will continue and have crippling consequences for health and welfare provision.…”

“…Increased mortality in OBD is a phenomenon shared with other serious psychiatric disorders (Baxter, 1996) but is more widely accepted to be an intrinsic feature of the condition and associated with progressive decline towards death as part of`degenerative' change (Black and Jolley, 1991). Nevertheless, a number of authors suggest that mortality in OBD has fallen in recent years (Christie, 1982;Oce of Health Economics, 1979) and this has implications for an understanding of the biology of the condition, its response to environmental changes and for economic considerations resulting from the need to provide appropriate patient care.…”

“…Firstly, the Salford study is unique because the numbers of patients is such that the eect on mortality risk of particular variables can be determined while simultaneously controlling for the eects of age, gender and calendar year of follow-up. And secondly, because the cohort was observed between 1968 and 1985 it can help clarify whether mortality risk in OBD has declined throughout the 1970s and 1980s as claimed by some workers (Christie, 1982;Christie and Train, 1984;Wood et al, 1991;Blessed and Wilson, 1982;Oce of Health Economics, 1979).…”

Treatment of Depression in the Elderly – Progress or Confusion?

“…The methodology adopted was essentially thai of Roth [5] in his Graylingwell study previously applied to Crichton cohorts covering the periods 1974-1976 [6] and 1984-1986 [7] with two modifica tions. The lower age limit of cases reported was reduced to 65 and the follow-up period extended to 4 years.…”

Life expectation in organic brain disease

“…Yet Christie and co-workers (Christie, 1982(Christie, ,1985Christie & Train, 1984;Wood et al, 1991) and Blessed & Wilson (1982) drew attention to falling death rates among patients admitted to psychiatric care. Only 32% of admissions died within six months in Newcastle in the 1970s (25% in Crichton Royal at the same time), compared with Roth's 1950s figure of 55%.…”