SYNOPSISThe steps to setting up a population register of elderly residents are described. Based upon this, 87·2% of the elderly residents of an inner-city electoral area were screened for memory disorder, depression and activity limitation using the Short CARE. Contact with medical and social agencies was also recorded; 4·7% were classed as cases by the dementia diagnostic scale, sufferers being older and not living alone. Of the residents 15·9% were classed as depressed, this state being more prevalent in those not currently married. The depresse were, in contrast to the demented residents, likely to be in recent contact with hospital and general practitioner. Thirty-two per cent of the population showed impairment in daily activity, these individuals were usually older, not married and receiving hospital care. Sleep disorder and compliant of many somatic symptoms were associated with a diagnosis of depression. In contrast, most respondents with a subjective complaint of memory disorder, which was common in this population, were neither suffering from depression nor dementia.With this accurate sampling frame and a good response rate, the prevalence rate of clinical depression must be seen as disturbingly high. The prevalence rate of dementia approximated to that of other surveys. This study also indicated that general practitioners' lists may be inaccurate and that non-responders to first approaches for interview, although similar in demographic features to those responding, may contain among them many suffering from dementia.

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This technical consensus statement is jointly produced by the Old Age Psychiatry section of the World Psychiatric Association and the World Health Organization, with the collaboration of several NGOs and the participation of experts from different Regions. It is intended to be a tool for (i) promoting debate at all levels on the stigmatisation of older people with mental disorders; (ii) outlining the nature, causes and consequences of this stigmatisation; and (iii) promoting and suggesting policies, programmes and actions to combat this stigmatisation.

The mental state, demographic details, dependency level and presence of problem behaviours have been recorded for 438 (82%) of the residents of the 12 Part III homes, managed by the London Borough of Camden, using standard interview. One third of the residents were suffering from severe dementia, another third from mild to moderate dementia and one third were free of dementia. Of the latter two groups, 38% were depressed. The prevalence rate of dementia increased with the age of the resident and was higher among females. Depression was associated with the presence of visual handicap and incontinence, and was commoner when the resident had been admitted from his own home or belonged to a minority religion. A third of residents needed daily help with dressing and use of the lavatory, one quarter were incontinent each day. Depression and dementia both were associated with increased rates of dependency and of problem behaviours (incontinence, wandering, aggression). This survey has revealed evidence of sufficient psychiatric morbidity in these homes to support a re-appraisal of their current aims, staffing and health-care provision.

The psychiatric morbidity among 390 (89%) residents of the 12 Part III homes managed by the London Borough of Camden has been assessed using a standard interview, for comparison with data obtained from residents in a previous survey. Fewer residents were now assessed as having no evidence of dementia or depression, the proportion with some degree of dementia having risen in the 3.6-years follow-up period. Of the original residents, 64% were no longer present by the time of the second survey; the great majority were likely to have died. Residents who had previously been assessed as severely demented or depressed were over-represented in this group. Of the residents who remained, only 17% of those previously depressed had recovered. This evidence suggests that Part III homes are continuing to amass a large number of residents suffering from dementia and depression. The need for adequate psychogeriatric services to Part III homes remains pressing.