Older people in hospitals for the insane in New South Wales, Australia, 1849–1905

Abstract

Older people had high admission rates to hospitals for the insane in New South Wales, Australia, in the second half of the nineteenth century. The medical casebooks of 226 patients aged 60 years and over admitted to two hospitals for the insane between 1849 and 1905 were examined. Aggressive behaviour (35.4%), suicidal behaviour (23.9%), fears of harm to self (19.9%) and alcohol issues (13.7%) were identified. Physical health factors (35.8%), functional impairment (18.6%) and poor nourishment (8.8%) were noted. Common diagnoses were mania (36.7%), dementia (31.9%) and melancholia (17.7%). Twenty-first-century diagnoses were assigned in nearly 94 per cent of cases with concordance that varied by diagnosis. The majority of admissions had serious mental disorders, with only 29.6 per cent being discharged.

Melancholia in late life in New South Wales and Victoria, Australia, 1871–1905: symptoms, behaviours and outcomes

“…In an earlier publication from the study, the diagnosis of melancholia in this sample (including senile melancholia and delusional melancholia) was found to have a concordance of 75% with the modern diagnosis of probable major depression. Dementia was the most frequent alternative modern diagnosis but six other modern diagnoses were captured (Draper, 2021). Whatever modern diagnosis was assigned to the case, the individual was most often in an acute phase of a severe mental disorder.…”

“…The main difference between NSW and Victorian late-life outcomes was the higher number of discharges and fewer transfers at Kew Hospital. In both NSW and Victoria, the outcomes of the older melancholia admissions were better than the overall outcomes of older admissions, with a higher proportion of discharges and lower mortality (Draper, 2021). Importantly for melancholic patients, discharges outnumbered deaths, the reverse of the overall outcome for older admissions.…”

“…In fact, while the number of admissions was very low at the age of 55, at the age of 60 and over it was higher and represented 7.7% of the total at a time when the estimated proportion of people aged 60 years and over in France was about 8.5%, suggesting that admission rates were about what would be expected if based on the proportion of older people in the community (Esquirol, 1845: 211; see also Dupâquier (1988) cited in Bourdieu and Kesztenbaum, 2007: 183). Just over 16% of admissions aged 60 years and over to each of the Littlemore and Warneford Hospitals in Oxford during the nineteenth century were given a melancholia diagnosis (Yorston and Haw, 2005), while 17.7% of admissions aged 60 years and over were given a melancholia diagnosis at Gladesville and Callan Park Hospitals in Sydney during a similar period (Draper, 2021). These reports suggest that melancholia was far from being an uncommon diagnosis in late life in the nineteenth century.…”

Attempted suicide in older people in New South Wales, Australia, 1870–1908

“…This is largely reflected in the casebook diagnoses that had a higher proportion of melancholia diagnoses in patients with suicide attempts and mania diagnoses in those with suicidal ideation (see Table 3). Delusional melancholia, a diagnosis largely equivalent to the modern diagnosis of major depression with psychosis, was the most frequent diagnosis made in both groups (Draper, 2021). An example was a 63-year-old single surveyor with a three-month history of being melancholy and morose, lacking in volition, with little interest in his usual activities, hypochondriacal delusions that various bodily organs were not working, and persecutory delusions about his closest relatives.…”

“…No other clinical details were provided about these specific patients. Similarly in NSW, as reported by Draper (2021) , 24% of admissions of people aged 60+ years to Gladesville and Callan Park hospitals for the insane, between 1849 and 1905, presented with self-harm or had suicidal ideation with higher rates in females, but no details were provided of these cases.…”