Conference Abstracts

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Dementia is a symptom, not a definitive diagnosis

McDonald, T. A., 2009

IAHSA Conference Workshop, London, England


Background: The set of symptoms which has come to be known as ‘dementia’ is typified by mental confusion. In older people there are many causes of mental confusion that are not necessarily connected to the central nervous system diseases that result in dementia. Mental illness resulting in behavioural problems is easily categorised as dementia when in fact the cause could be non-cognitive psychiatric symptoms such as depression, delusions, hallucinations, anxiety or agitation among many others. These symptoms can also arise from the use of medications in different combinations as well as environmental triggers for behaviour. The more flamboyant symptoms associated with psychiatric conditions frequently lead to psychotropic management whereas depression in the aged person is easy to overlook and can remain untreated. More poignantly, people who have a psychiatric condition as well as dementia arising from nervous system deterioration can be in even greater danger of not having their mental illness acknowledged let alone appropriately treated.

Objective: In this paper the growing demand for mental health services in aged care contexts is examined along with a discussion of options for introducing effective mental health services in a residential aged care setting. Examples of mental health strategies and approaches to establishing a differential diagnosis for psychiatric conditions such as schizophrenia, bi-polar disorder and anxiety neuroses as well as dementia-causing diseases will be provided.

Methods: Standard approaches for assessing the extent of psychiatric illness within a residential aged care village go some way toward identifying the need for specialist care and treatment. Usually a clinical psychologist is contacted to conduct assessments and recommend treatments however referrals are often limited due to lack of staff awareness of differences between psychiatric and dementia symptoms. Assessment and staff training sessions identify the prevalence of psychiatric issues and the skills needed to provide appropriate care and treatment. An example of a mental health clinical pathway developed by front-line practitioners will be presented along with reports of progress for people who have been placed on the pathway.

Results: Most mental health problems are amenable to help from generalist staff, with backup support from mental health specialists. Reversal of common views held about older people’s mental health status requires staff to be aware of these issues and to assist residents to seek help from a mental health specialist as necessary. These themes need to be taken into account when designing mental health interventions for aged care communities.

Description of what will take place during the presentation: Professor McDonald will use slides and graphs to show how this applied research project was set up in a residential aged care home in Sydney. A brief overview of the project findings over time will pave the way to a discussion of management strategies informed by the results. The session will be concluded with an opportunity for participants to raise questions about the strategy and the presentation.

CITATION McDonald T. (2009) Dementia is a symptom, not a definitive diagnosis 8th International Conference of the International Association of Homes and Services for the Ageing (IAHSA) London, 20-22 July


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