Background: The relationship between depressive symptoms and health service use among older people is not well understood. In this study we examined the two-way relationships between depressive symptoms and hospitalization and/or physician visits by older adults.

Methods: In a one-year follow-up study of 973 community-dwelling older adults in the Singapore Longitudinal Aging Studies (SLAS), depressive symptoms (15-item Geriatric Depression Scale score ≥5) were assessed at baseline and one year later. Information on self-reported physician visits and hospitalization were collected bimonthly over one year.

Results: When demographic characteristics, medical comorbidities, functional status and other covariates were controlled for, baseline depressive symptoms were associated with increased episodes of subsequent physician visits during the one-year follow-up (RR,1.34; 95% CI, 1.05–1.70), but not with subsequent hospitalization(s) during the same period. Conversely, participants with five or more physician visits (versus less than 5) over one year were more likely to be depressed at one year (OR, 10.2; 95% CI, 3.36–31.1); hospitalization during this period was also significantly associated with depressive symptoms at one year (OR = 6.43, 95% CI, 2.48–16.6).

Conclusion: Depressive symptoms and health service use have reciprocal relationships. Health service use for non-mental illnesses may be optimized by efforts at post-hospitalization interventions to recognize and treat depression in older persons.

Objective: This study investigates attitudes to the prescription of mood stabilizer drugs for older patients by old age psychiatrists.

Methods: From a sample of 508 members of the Old Age Faculty of the Royal College of Psychiatrists practicing in England and Wales, 188 (37%) took part in a postal questionnaire survey. A proforma questionnaire investigating opinions about potential indications for, and current concerns about, mood stabilizer drugs was sent to all participants.

Results: Nearly all respondents initiated prescriptions for mood stabilizer drugs and a large majority agreed that they are therapeutically appropriate for prophylaxis of affective disorder (95%), treatment resistant depression (95%), acute mania (91%) and for behavioral symptoms in dementia (75%). Concerns about safety (77%), drug interactions (68%) and lack of scientific evidence (53%) were common.

Conclusions: Old age psychiatrists are frequent prescribers of mood stabilizer drugs for a variety of indications but have understandable concerns arising from a relative lack of scientific evidence of efficacy and effectiveness in older patients.

Background: The elderly population size in the U.K. and its constituent countries is increasing. Traditionally, suicide rates increase with aging.

Methods: Time trends in elderly suicide rates and age-associated trends in suicide rates in the U.K. and its three constituent countries (England and Wales, Scotland and Northern Ireland) were examined and comparisons were made of elderly suicide rates in these three countries using data from the World Health Organization.

Results: Elderly suicide rates in both sexes declined over the 24-year period 1979 to 2002 in the whole of the U.K., England and Wales, and Scotland, but only in females in the age-band 65–74 years in Northern Ireland. Female suicide rates increased with age while male suicide rates peaked in the age-band 25–34 years in England and Wales. In Northern Ireland and Scotland male suicide rates decreased with age and peaked in the age-band 25–34 years, and female suicide rates peaked in the age-bands 25–34, 35–44 and 45–54 years. Elderly suicide rates were lowest in Northern Ireland.

Conclusion: The similarities and differences in elderly suicide rates, time trends for elderly suicide rates and age-associated trends in suicide rates between the three constituent countries of the U.K. offer an opportunity to examine the differential characteristics between these countries which may potentially explain these observations.

Background: Delirium, an acute altered level of cognition, is a frequent complication of medical illness in the elderly. Antipsychotic medications (APs) are often used to treat agitation and psychosis in delirium. The goal of this study is to compare mortality in delirious elderly medical inpatients treated with APs with those who did not receive APs.

Method: 326 elderly hospitalized patients were identified with delirium at an acute care community hospital. A nested case-control analysis was conducted on this cohort. Cases consisted of all patients who died in hospital within eight weeks of admission. Each case was matched for age and severity of illness to patients (controls) alive on the same day post-admission. Conditional logistic regression was used to assess the impact of exposure to AP on mortality. Covariates used for adjustment were the Charlson comorbidity score and the acute physiology score. Odds ratio (OR) and 95% confidence intervals were calculated from the regression coefficients.

Results: 111 patients received an AP. A total of 62 patients died, 16 of whom were exposed to an AP. The OR of association between AP use and death was 1.53 (95% C.I, 0.83–2.80) in univariate and 1.61 (95% C.I, 0.88–2.96) in multivariate analysis.

Conclusion: In elderly medical inpatients with delirium, administration of APs was not associated with a statistically significant increased risk of mortality. Larger studies are needed to clarify the safety of AP medication in elderly patients with delirium.

Background: Little is known about sleep quality and alcohol use problems in the elderly minority population. This study aimed to identify a one-month prevalence of poor sleep quality and alcohol use problems among elderly Taiwanese aboriginal women and to examine the association between them.

Methods: A cross-sectional survey with stratified random sampling was conducted in eight aboriginal communities in Taiwan. The 1261 elderly aboriginal women (response rate 84%) completed all assessments. Sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI), while the CAGE questionnaire was used to evaluate alcohol use problems.

Results: Of the study participants, 20.54% and 25.59% had poor sleep quality and alcohol use problems, respectively. Controlling for confounding factors, alcohol use problems were a risk factor for poor sleep quality (AOR = 1.44, p = 0.0433). Alcohol use problems were associated with three components of PSQI: sleep disturbances, subjective sleep quality, and daytime dysfunction.

Conclusions: The elderly Taiwanese aboriginal women with problematic alcohol drinking experienced poorer sleep quality. Development of a program to reduce alcohol use problems might improve sleep quality among elderly Taiwanese aboriginal women.

A 69-year-old man presented with Cotard's delusions, insomnia, profound depression, amnesia, difficulty concentrating, and cognitive deficit after two different surgical interventions. Brain imaging showed frontotemporal-subcortical atrophy and lateral ventricular enlargement. He responded poorly to a combination of sertraline, amisulpride and mirtazapine, with modest benefit on insomnia, and developed hypotension. After 18 days he was switched to olanzapine and venlafaxine, but his cognition worsened. He underwent bilateral electroconvulsive therapy (ECT). His mood improved, cognitive performance increased and anxiety symptoms remitted. This improvement persisted through the one-month post-discharge follow-up and depression eventually remitted.

A recent review of the prevalence of dementia in all world regions revealed a particular paucity of data from the Middle Eastern region (Ferri et al., 2005). Iran is one of the largest countries in this region, with a population of 70 million, of whom 5.2% are aged 65 years and over and where life expectancy is already 71 years (www.amar.ir – Iranian Government Statistics site). Our best estimates suggest that there may be nearly 200,000 people living with dementia in Iran at the moment (Ferri et al., 2005). The 10/66 Dementia Research Group developed and validated a cultural- and education-fair dementia diagnosis in 26 centers worldwide (Prince et al., 2003). We have now assessed the feasibility and validity of a Farsi version of the 10/66 dementia diagnostic system in Ekbatan, Tehran, Iran.

We recently reported age-associated suicide rates and trends over time for elderly suicide rates for the whole of the U.K. and its three constituent countries (England and Wales, Scotland and Northern Ireland) (Shah and Coupe, 2009). That study, in part, was conducted to examine the impact of the suicide prevention policies for each of the three constituent countries as the governmental suicide reduction targets for 2010, 2011 and 2013 move closer for England, Northern Ireland and Scotland respectively.

Suicide rates increase with aging in many countries (Shah and De, 1998). In a recent study of 62 developed and developing countries, suicide rates increased with age for males and females in 25 and 27 countries respectively, and in both sexes in 17 countries (Shah, 2007). Suicide rates increased with age in 47 of the 49 medium- and high-income countries (Kiemo, 2004). Comprehensive understanding of the substantial worldwide variation in population patterns of suicide may be critical for developing prevention programs (Knox et al., 2004). Much is known about individual level proximal risk factors (Shah and De, 1998) and preventative strategies can target identified high-risk groups (Shah and De, 1998). Also, proximal risk factors for elderly suicide victims are generally different from those for younger suicide victims (Shah and De, 1998). However, distal risk factors may be similar for older and younger suicide victims. Such factors include societal socio-economic status (Kennedy et al., 1999; Shah et al., 2008), societal income inequality (Kowalski et al., 1987; Shah et al., 2008), education (Kowalski et al., 1987; Shah and Chaterjee, 2008), degree of urbanization (Stack, 1993; Shah, 2008a), degree of social integration (Durkheim, 1992; Shah, 2008b) and provision of health and mental health service provision (Shah and Bhat, 2008). In general, preventative measures targeting distal risk factors require development of public health strategies at a societal level.