Assessment of Older People's Health and Social Care Needs and ...

Psychiatric Needs Assessmentin Older PeopleOr Ruth Loane, Consultant in Old Age Psychiatry,Mid-Western Health Board._1--------------------------,.---------The topic I have been asked to address is psychiatric needs assessment. In this paper I am going tolook at the aim of psychiatric assessment, the diagnoses that we see, the'prevalence of differentconditions, the treatment options that are available and the advice that we are asked to give. I willthen look at the standard assessment that we carry out, the kind of rating scales that are availableand needs assessment tools.Aspects of Psychiatric AssessmentAim of Psychiatric AssessmentThe primary aim of psychiatric assessment is the diagnosis of mental illness. Secondly, riskassessment is part of the overall assessment process. We assess risk in terms of the risk of suicide,bearing in mind that there is an increased incidence of suicidal behaviour in the older population andparticularly amongst older men. We also look at risk in terms of risk from emotional and physicalabuse and the individual's level of functioning, for example, how well he/she is managing at home,whether there Is wandering or other risk factors and so on. The next step is to coin a managementplan for the individual.Often on referral, we are asked to look at an individual's capacity to make decisions. For example,this might relate to:• testamentory capacity i.e. the older person's capacity to make a will; financial capacity, theperson's capacity to manage their money affairs, their pension and house• functional capacity, how the individual is managing at home• capacity to make decisions, for example, about going for surgery.Diagnosis of Psychiatric IllnessMental illness in older people can be divided into two main categories, functional illness and organic illness. Thefunctional illnesses can be broadly divided into depression, anxiety, paranoid states, bipolar affective disorderand schizophrenia, Of these, the most commonly seen in older people is depressive illness. The symptomsexperienced by an individual suffering from depression may include lo~ mood, loss of enjoyment, poormemory and concentration, tiredness, unexplained pain, feelings of gUilt, suicidal thoughts or impulses oractions of deliberate self-harm and, at the most severe end of the spectrum, delusions,Assessment of Older People's Health and Social Care Needsand Preferences