Old people's homes: the relatives' view.

On 1 April new arrangements came into force for arranging and funding residential care for elderly people in Britain. From now on those who seem to need full time care will be assessed first by care managers employed by local authority social services departments. This may lead to admission to an old people''s home or a nursing home. Local authorities have been told to consult both users and carers about such decisions. But what about relatives who have not actually been giving care directly? The Relatives Association was set up last year as a voluntary organisation for the relatives and friends of older people living in residential homes. Below, its vice president, Mavis Nicholson, a journalist and broadcaster whose mother died of Alzheimer''s disease in a residential home last year, gives her personal view of being such a relative. And Dorothy White, the association''s founder, explains what the future may hold for elderly residents and their relatives.     

The behavior rating scale for intramural psychogeriatric inpatients (GIP-28) in homes for the elderly. A psychometric evaluation

The GIP-28 is the shortened version of the 82-item Behavior Rating Scale for Psychogeriatric Inpatients. Originally it was meant and psychometrically evaluated for use in psychogeriatric and elderly psychiatric inpatients. We supposed that the GIP-28 might be useful to detect psychosocial and cognitive problems in residents of homes for the elderly. It was therefore tested in 15 residential homes (n = 949). The instrument consists of three, factor-analytically derived, scales: 'Apathy', 'Cognition' and 'Affect'. These three principal components were also identified in the data of the inhabitants of the residential homes. Internal consistency of the scales, as measured with Cronbach's Alpha is .75, .66, .80 respectively. Construct validity of the GIP-28 is satisfactory: the correlation between the Affect scale and the GDS was .36 and between the Cognition scale and the MMSE was -.36. The GIP-28 was associated with another observation scale for care needs (r = .54). The GIP-28 can be used to detect mental health problems in the population of residential homes. However, it is neither meant nor suited to replace psychiatric diagnostic procedures.     

Evolution of an active psychogeriatric day hospital.

A geriatric day hospital was established as part of the psychogeriatric unit of the Royal Ottawa Hospital. While initially this day hospital was integrated with day hospital programs of other units, it became apparent that a separate facility was desirable. The activities and programs of the psychogeriatric day hospital, run by one registered nurse, were integrated with those of the geriatric inpatient unit. It was found to be advantageous for inpatients and day hospital patients to share the same physical facilities. The majority of day hospital patients came from the inpatient unit; almost all had affective disorders. The emphasis was on reintegration into the community. During the 1st year of operation there were 75 patients in the program; only 3 needed admission to the inpatient unit and 1 was readmitted after discharge.     

Psychiatric and nonpsychiatric facilities in the care of psychogeriatric patients.

The care of elderly patients who are mentally impaired requires reorganization in the delivery of mental health services to these patients. In this paper recommendations are made for the improvement of such services. These include the development of comprehensive psychogeriatric assessment services, which should be based mainly in general hospitals, the rationalization of the roles of facilities that provide nonpsychiatric long-term care, the development of specialized facilities for demented elderly patients, and a focus on education in psychogeriatrics for both undergraduate and postgraduate students in medicine and in other health care professions.     

Vincamine: A psychogeriatric agent blocking synaptic potentiation in hippocampus

The action of vincamine on the physiology of the CAl region of the in vitro hippocampal slice preparation was investigated. At concentrations of 1, 10 and 100 μM, a five-minute perfusion with vincamine did not affect the synaptically-mediated activation of pyramidal neurons evoked by stimulation of the Schaffer-commissural fiber system. The effect of vincamine on the excitability of the pyramidal neurons was investigated by studying its effect on the antidromically-elicited field potential and the input-output relation of Schaffer-commissural fiber input. No effect on either of the two parameters was seen at a concentration of 100 μM of vincamine.Vincamine did, however, attenuate both the post-tetanic (PTP) and long-term potentiation (LTP) evoked by repetitive stimulation of the Schaffer-commissural fiber system. At a concentration of 100 μM of vincamine, PTP was significantly reduced and LTP was almost completely suppressed.