This controlled study showed significant short-term efficacy of carbamazepine for agitation with generally good safety and tolerability.

Although team-oriented geriatric assessment clinics are growing throughout the country, little documentation exists regarding their clinical efficacy, cost-effectiveness, or impact on patient functioning and well-being. This report describes a randomized controlled clinical trial to evaluate the effectiveness of a team-oriented geriatric assessment approach compared to traditional care. One hundred-seventeen subjects 65 years of age and over, meeting eligibility criteria to target frail older persons with changing medical and social needs, were randomly assigned to receive a comprehensive geriatric assessment by a multidisciplinary team (treatment) or by one of a panel of community internists who were reimbursed according to their usual and customary fee (controls). Extensive analysis of baseline information failed to identify any significant differences between groups. Over the 1-year follow-up period, treatment participants experienced 26 hospital admissions and used 670 hospital days compared with 23 admissions and 1113 days for controls (a 39.8% difference). Annual hospital costs averaged $4297 for treatment subjects and $7018 for controls. Overall institutional costs including hospital and nursing home care revealed an average saving of $2189 per person for treatment subjects compared with controls, a 25% reduction. A small proportion of subjects accounted for this difference. No significant differences were noted in patient or caregiver satisfaction with the evaluation process, functional ability, or health status. These findings suggest that team-oriented outpatient geriatric assessment provides a promising way to deliver high-quality, satisfying care to older persons without increasing (and possibly decreasing) health care costs.

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This preliminary study suggests that carbamazepine in low doses can reduce agitated behaviors in some patients, with limited adversity resulting. Further research is required to confirm and extend this finding before it can be considered routine clinical practice.

There is a pressing public health need to find interventions that reduce suicide risk in later life. Psychiatric and physical illness, functional decline, and social factors place seniors at risk for suicide. Reflecting this body of evidence, the Centers for Disease Control and Prevention (CDC) has identified the promotion and strengthening of social connectedness, between and within the individual, family, community, and broader societal levels, as a key strategy for suicide prevention. The Senior Connection, a randomized trial of peer companionship for older adults, is described here, with an emphasis on the most novel features of the study design—grounding in a psychological theory of suicide and intervening at an early stage in the suicide risk trajectory by linking primary care patients with the Aging Services Provider Network.

only one in five nursing home residents met minimal participation criteria, suggesting limited utility of the SF-36 in nursing homes. Reliability and validity characteristics were fairly good. Skewed scores were noted for some SF-36 scales. The utility of the SF-36 may be limited to assessments of subjects with higher cognitive and physical functioning than typical nursing home residents. The SF-36 might benefit from modification for this setting, or by tests of proxy ratings.

Objectives-To define the prevalence and correlates of depression among older adults receiving assessments by nonmedical community-based care managers at the point of entry to care and thus prior to provision of aging services. Our long-term goal is to inform development of collaborative care models for late life depression that incorporate Aging Services Providers. Methods-Aging Services Provider Network (ASPN) clients receiving in-home assessments were administered the Structured Clinical Interview for Diagnostic and Statistical Manual ofMental Disorders, Fourth Edition module for affective disorders and measures of depression symptom severity, alcohol use, physical health, functional status, social support, stressful life events, and religiosity. Engagement in mental healthcare was documented.Results-Subjects (N = 378) were primarily white (84%) and women (69%) with household incomes under $1,750/month (62%). Half lived alone (48%). Their mean age was 77 years. Thirty-one percent had clinically significant depressive symptoms and 27% met criteria for a current major depressive episode, of which 61% were being treated with medication and 25% by a mental health provider. Nearly half (47%) had experienced one or more episodes of major depression during their lives. Disability, number of medical conditions, number and severity of recent stressful life events, low social support, and low religiosity were independently associated with current major depression.Conclusion-Depressive illness was common among this sample of ASPN clients. Because ASPN care managers have expertise in managing many of the problems correlated with depression, they may play a significant role in identifying, preventing, and collaborating in the treatment of depressive illnesses among community-dwelling older adults. KeywordsAged; depression; depressive disorder; depressive disorder; major depressive symptoms; health services for the aged; mental health services; social services; social work; social work; psychiatric NIH Public Access Author ManuscriptAm J Geriatr Psychiatry. Author manuscript; available in PMC 2013 April 1. NIH-PA Author ManuscriptAffective illness is common among older adults and is associated with worse health outcomes, 1 greater healthcare utilization and costs, 2 and increased risk of death from suicide and other causes. 3,4 Improving outcomes of late life depression depends on accurate detection of affected older adults, early intervention, and effective treatment.Because many older adults do not recognize the need for or are reluctant to use mental health care services, emphasis has been placed on primary care as the preferred site for detection and treatment of older patients with affective illness. Yet numerous barriers prevent adequate care for mood disorders in primary care settings, 5,6 including the social morbidities that are so common in this population and with which primary care physicians are typically ill-equipped to deal. In addition to a past history of depression and physical illhealth, disabil...

Results indicate that passive SI rarely presents in vulnerable older adults in the absence of significant risk factors for suicide (i.e., psychological distress or active SI). Thus, the desire for death and the belief that life is not worth living do not appear to be normative in late life.