Objective:
Clinical experience suggests a growing prevalence of borderline personality disorder in aged residential care and psychiatric facilities with attendant difficulties in their management. ...This paper reviews the literature concerning the prevalence, phenomenology and diagnosis of borderline personality disorder in old age. The aim is to elucidate the phenomenological differences in old age and thus improve identification of the disorder.
Methods:
A systematic search was conducted using MEDLINE, PubMed, EMBASE and PsycINFO databases, employing the search terms including ‘personality disorder’, ‘borderline personality disorder’, ‘aged care’, ‘gerontology’, ‘geriatric psychiatry’ and ‘life span’. The search included articles in English involving participants 65+ years. Long-term prospective studies of borderline personality disorder, long-term follow-up studies and studies involving older adults from 50+ years were also examined.
Results:
There is a paucity of literature on borderline personality disorder in the elderly. No diagnostic or rating instruments have been developed for borderline personality disorder in the elderly. The phenomenology of borderline personality disorder in the aged population differs in several respects from that seen in younger adults, causing some of the difficulties in reaching a diagnosis. Escalations of symptoms and maladaptive behaviours usually occur when the diagnosis of borderline personality disorder is either not made or delayed. Improved identification of borderline personality disorder in older patients, together with staff education concerning the phenomenology, aetiology and management of these patients, is urgently needed.
Conclusion:
Diagnostic instruments for borderline personality disorder in the elderly need to be developed. In the interim, suggestions are offered concerning patient symptoms and behaviours that could trigger psychiatric assessment and advice concerning management. A screening tool is proposed to assist in the timely diagnosis of borderline personality disorder in older people. Timely identification of these patients is needed so that they can receive the skilled help, understanding and treatment needed to alleviate suffering in the twilight of their lives.
Background
Physical inactivity significantly increases dementia risk (DR). For middle‐aged and older adults with co‐occurring cognitive concerns/impairment and mental health symptoms, DR increases ...further. Clinical trials indicate lower adherence to PA interventions for dementia risk reduction in such high risk‐group, and interventions tailored to support unique behaviour change needs are required. In EXCEL Phase 1 we developed a model to understand Physical Activity (PA) behavior change needs in this population and identify tailoring requirements to enhance engagement (see Curran et al. AAIC‐23, submitted). Here we report findings of our trial of a pragmatic online intervention to support middle‐aged and older adults with Subjective Cognitive Decline (SCD) or Mild Cognitive Impairment (MCI) and mild‐moderate symptoms of depression, anxiety or stress to adopt and maintain PA.
Method
An online individual 12‐week home‐based PA intervention. Participants aged 45‐80 years, experiencing both cognitive (SCD or MCI) and mild‐moderate mental health symptoms (measured by the Depression Anxiety and Stress Scale ‐ DASS‐21) were prescribed individually tailored PA programs combining aerobic and strength PA; plus balance training as indicated, with fortnightly online coaching from researchers. Acceptability, feasibility, safety, and effectiveness (including pre‐post change in PA and mental health scores) were measured.
Result
55 participants were enrolled (46 females/9 males; mean age = 62.2 years). Retention was high (95%) and the intervention was well received; 98% finding it useful, 100% stating they would recommend to others. The intervention was safe, utilizing a system of email alerts/queries to the study medical team (44 alerts), PA team (35 queries/requests), individual exercise specialist (3 zoom sessions) and case conferences. Mental health improved across all DASS‐21 dimensions. Community Healthy Activities Model Program for Seniors (CHAMPS) scores improved post‐intervention, with higher frequency of all moderate/high intensity exercise (from 8.1 to 12.4 times/week), more strength training frequency (0.8 to 2.5 times/week) and longer time spent strength training (25 to 65 mins/week). Balance activity (older adults only) frequency increased from 0.5 ‐ 4 times/week.
Conclusion
This home‐based online intervention, using the Capability, Opportunity, and Motivation model of behavior change, successfully helped an at‐risk cohort adopt and maintain PA in line with Australian PA guidelines.
Objectives
This paper describes the rationale for and development of an innovative mental health service for people aged over 65 years living in Northern and Eastern Melbourne, Victoria, Australia.
...Conclusion
The Healthy Ageing Service (HAS) was established in July 2020 to provide care for people aged over 65 years experiencing mild-to-moderate mental health concerns. It embraces a prevention and early intervention model of care. It provides primary consultation and brief intervention, secondary consultation, and capacity building to the primary healthcare sector. This innovative service is a Commonwealth-funded partnership between two tertiary mental health service providers that incorporates the recommendations from two major Royal Commissions. It demonstrates a service that acts as a bridge between primary and specialist mental health care, thereby extending mental health services to target the ‘missing middle’ and is potentially a model for mental health service provision throughout Victoria and Australia.
Background
Physical inactivity is a key contributor to chronic disease burden. Physical activity (PA) offers significant health benefits, including for brain health, and to groups with increased ...dementia risk such as older people with mental illness, Mild Cognitive Impairment or Subjective Cognitive Decline. There is a global call for dementia risk reduction interventions to be implemented into clinical practice. Older people with mental health problems experience significant barriers to PA and are a ‘hard to reach’ group for health promotion. Specific programs, integrated into mental health services, are needed. We will implement behaviour change theories to investigate the effectiveness, acceptability, feasibility and sustainability of an intervention to assist consumers of public Aged Persons Mental Health Services to follow PA clinical guidelines.
Method
This three‐phased study will involve consumers, mental health clinicians and General Practitioners (GPs). An optimisation phase includes initial theory‐based design, using a comprehensive intervention logic model that identifies key anticipated behavioural determinants and matched strategies to support change. The proposed intervention will be presented to consumers and clinicians for consideration. Their feedback will inform tailoring of the intervention prior to implementation. The implementation phase involves a trial of the intervention’s effectiveness compared to usual care for increasing consumer PA levels. Clinicians will be supported to incorporate PA guidelines into clinical practice using tailored behaviour change strategies over 12‐weeks. An individual PA prescription, relevant equipment and exercise demonstrations will be offered to consumers. We will measure PA levels using a validated questionnaire (the CHAMPS) to determine the number of participants meeting PA guidelines, along with measuring changes to quality of life, psychiatric symptom burden and dementia risk. An evaluation phase will use a mixed‐methods approach to evaluate change in the identified key behavioural determinants, as well as qualitative evaluation of the intervention across the three participant groups.
Results
This study will provide pragmatic evidence‐based information for clinical practice, supporting the design of implementation programs to enhance PA in older consumers with mental health problems.
Conclusion
This research addresses the need for integrated mental, cognitive and physical healthcare, facilitating holistic healthcare for groups at increased risk of cognitive decline.
Abstract
Background
Physical inactivity is a key contributor to chronic disease burden. Physical activity (PA) offers significant health benefits, including for brain health, and to groups with ...increased dementia risk such as older people with mental illness, Mild Cognitive Impairment or Subjective Cognitive Decline. There is a global call for dementia risk reduction interventions to be implemented into clinical practice. Older people with mental health problems experience significant barriers to PA and are a ‘hard to reach’ group for health promotion. Specific programs, integrated into mental health services, are needed. We will implement behaviour change theories to investigate the effectiveness, acceptability, feasibility and sustainability of an intervention to assist consumers of public Aged Persons Mental Health Services to follow PA clinical guidelines.
Method
This three‐phased study will involve consumers, mental health clinicians and General Practitioners (GPs). An optimisation phase includes initial theory‐based design, using a comprehensive intervention logic model that identifies key anticipated behavioural determinants and matched strategies to support change. The proposed intervention will be presented to consumers and clinicians for consideration. Their feedback will inform tailoring of the intervention prior to implementation. The implementation phase involves a trial of the intervention’s effectiveness compared to usual care for increasing consumer PA levels. Clinicians will be supported to incorporate PA guidelines into clinical practice using tailored behaviour change strategies over 12‐weeks. An individual PA prescription, relevant equipment and exercise demonstrations will be offered to consumers. We will measure PA levels using a validated questionnaire (the CHAMPS) to determine the number of participants meeting PA guidelines, along with measuring changes to quality of life, psychiatric symptom burden and dementia risk. An evaluation phase will use a mixed‐methods approach to evaluate change in the identified key behavioural determinants, as well as qualitative evaluation of the intervention across the three participant groups.
Results
This study will provide pragmatic evidence‐based information for clinical practice, supporting the design of implementation programs to enhance PA in older consumers with mental health problems.
Conclusion
This research addresses the need for integrated mental, cognitive and physical healthcare, facilitating holistic healthcare for groups at increased risk of cognitive decline.
Screening and diagnostic instruments for Borderline Personality Disorder (BPD) are not validated in people aged over 60. We report a pilot study examining the sensitivity and specificity of a de-novo ...screening instrument in older adults.
The BPD-OA screening tool incorporates DSM 5 and literature describing the expression of BPD in older adults. This study was conducted using a case control design. The Diagnostic Interview for Borderlines-Revised (DIB-R) and the McLean Screening Instrument for BPD (MSI-BPD) were used as comparators. Comprehensive assessment by psychiatric teams determined participants to be (i) BPD-positive (n = 22) or (ii) BPD-negative (gender matched; n = 21).
The BPD-OA was the most sensitive instrument for discriminating older adult BPD from non-BPD participants (sensitivity = 0.82). No significant relationship was found between the BPD-OA score and age in BPD-diagnosed participants (r = −0.181, n = 21, p = .432). Participant age explained 3.2% of the variance in BPD-OA scores. Of the 21 BPD-negative participants, eight false positives experienced prominent mood disorders (specificity = 0.62).
The BPD-OA screening tool is clearly superior to instruments validated for use in younger people. Further refinement and evaluation will enhance its sensitivity and specificity.
Detection of BPD in older adult care settings will improve outcomes for patients, families, and staff through better understanding and appropriate management and treatment strategies.
Objectives: To develop indicators of safe psychotropic prescribing practices for people with dementia and to test them in a convenience sample of six aged mental health services in Victoria, ...Australia.
Method: The clinical records of 115 acute inpatients were checked by four trained auditors against indicators derived from three Australian health care quality and safety standards or guidelines. Indicators addressed psychotropic medication history taking; the prescribing of regular and 'as needed' psychotropics; the documentation of psychotropic adverse reactions, and discharge medication plans.
Results: The most problematic areas concerned the gathering of information about patients' psychotropic prescribing histories at the point of entry to the ward and, later, the handing over on discharge of information concerning newly prescribed treatments and the reasons for ceasing medications, including adverse reactions. There were wide variations between services.
Conclusion: The indicators, while drawn from current Australian guidelines, were entirely consistent with current prescribing frameworks and provide useful measures of prescribing practice for use in benchmarking and other quality improvement activities.
The aim of the study was to determine whether depressed aged inpatients treated with brief pulse unilateral electroconvulsive therapy (ECT) differed from those treated with bilateral (bitemporal or ...bifrontal) ECT with respect to numbers of treatments, length of hospital admission, changes in scores on depression and cognitive scales, and serious adverse effects.
An audit of routinely collected data regarding 221 acute ECT courses in 7 public aged psychiatry services in Victoria, Australia.
Patients given unilateral, bifrontal, and bitemporal treatments were similar with respect to personal, clinical, and treatment characteristics. Most treatments were administered in line with local clinical guidelines and were rated as effective. Psychiatrists preferred unilateral ECT in the first instance with stimulus dosing based on patients' seizure thresholds. Approximately a quarter of unilateral courses were switched later to bitemporal placement, most probably because of insufficient progress. Bilateral treatments were associated with a larger number of treatments, less improvement in scores on mood and cognitive scales, and more refusals to continue treatment than unilateral-only ECT.
Brief pulse unilateral ECT proved more effective than bitemporal and bifrontal ECT for most aged patients, especially when coupled with stimulus dosing based on seizure threshold.
•A course of ECT in a geriatric patient with symptomatic degenerative cervical myelopathy before corrective surgery without neurological complication.•ECT precautions were soft cervical collar and ...manual in-line stabilisation during ECT and muscle paralysis.•ECT was successfully resumed following corrective surgery.
We report the case of a 70-year-old woman who received ECT for major depression with psychotic features. The patient was identified to have symptomatic severe cervical degenerative myelopathy during treatment and she received 21 sessions of right unilateral electroconvulsive therapy (ECT) without adverse neurological outcome. Precautions were undertaken to minimize risk of ECT-associated spinal cord injury. ECT was successfully recommenced without precautions following laminectomy.
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