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Ask the Mental Health Expert Archives 2001-2004

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Mentally Ill Elders

Q. I am doing a research project on elderly people with mental illness. Can you tell me what percentage of the nursing home population is mentally ill? What special needs do the elderly have and what medications may be able to help them specifically (including anything in the works)? Also, how easy would it be for the average person to care for someone like this, such as a family member?

A. You have asked a series of questions that would require a textbook to answer thoroughly! But, here is a start: first, the prevalence of mental illness in nursing home populations is not an easy figure to pin down. It may depend, in part, on the particular nursing home; how mental illness is diagnosed (structured interviews vs. subjective reports); and what criteria for diagnosis are used (e.g., DSM-IV versus other classifications).

In one study (Borson et al, Journal of the American Geriatric Society Oct. 1997 45:1173-81), fewer than 10% of all nursing home residents were referred for psychiatric evaluation. Within this 10%, 60% were found to have either a mood disorder or a psychotic disorder, while dementia or mental retardation was found in 25%. But, it seems likely that the initial 10% referred for assessment represents a dramatic undercount of the actual prevalence of mental illness in this population.

Using more rigorous methods, many studies have found mental illness prevalence rates of 80-90% in nursing homes. See, for example, Rovner et al, Int Psychogeriatr 2:13-24, 1990, which study found a psychiatric disorder prevalence of 80.2% among new admissions to a proprietary chain of nursing homes. For more details on the special needs of the elderly, review of medications, caring for the elderly, etc., I suggest you get hold of the book, "Comprehensive Review of Geriatric Psychiatry", 2nd edition, edited by Joel Sodovoy et al, American Psychitric Press, 1996. In a pinch, you can also contact the Alzheimer's Disease Education and Referal Center (800-438-4380; www.alzheimers.org/adear) or the National Institute on Aging (800-222-2225). Good luck tracking down the data!

July 2001

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