OBJECTIVES: As the elderly population is continuing to increase, psychiatric diseases of the elderly are becoming an important social issue. This study looks into the demographical and clinical features of the elderly patients diagnosed with bipolar disorder in a University hospital. METHODS: The study subjects include patients admissioned in the closed wards of Soonchunhyang Seoul hospital and Cheonan hospital from March, 2000 to February, 2005 who met the DSM-IV-TR criteria for bipolar disorder at the time of discharge. A total of 146 patients (76 men, 70 women) medical records were studied retrospectively. Subjects older than the age of 50 at time of admission were grouped as the old age group, whereas those who were younger than 50 as the young age group. Also among the old age group, those who had the first onset of episode under the age of 50 were grouped as the early onset group, whereas those who had the first onset after the age 50 were grouped as the late onset group. RESULTS: The number of bipolar disorder patients in the young age group and old age group were 73 and 73 respectively. The number of early onset group and late onset group were 46 and 23 respectively. The old age group had a relatively higher incidence of bipolar II disorder than the young age group. Also in the old age group there was a higher incidence of hypomanic or depressive episode rather than manic episode compared to the young age group. And in the old age group psychotic symptoms were less common and the mean admission length shorter than the young age group. Additionally in the old age group treatment with Lithium monotherapy or with no mood stabilizers at all were relatively common. Among the old age group, late onset group had a higher rate of bipolar II disorder than the early onset group. CONCLUSION: This study shows differences in the demographical and clinical features among different age groups. But additional research would be required to determine whether the bipolar disorders in the elderly or late onset group are actually a different type of disorder from those of the young.
Age of Onset ; Aged* ; Bipolar Disorder* ; Chungcheongnam-do ; Humans ; Incidence ; Lithium ; Male ; Medical Records ; Retrospective Studies ; Seoul

OBJECTIVES: The purpose of this study was as follows: 1) to compare the current status of management for dementia between city and country health center. 2) to check the amount and detailed items of budgets for dementia in dementia counseling center, referral courses for registration of dementia patient, number of dementia patient referred to welfare institutions for the elderly. 3) to understand the troubles in management for dementia in health center and to provide baseline data about future community dementia management system. METHOD: The questionnaire was administered to 248 public health centers. The 162 collected questionnaires were used in analysis and the whole response rate was 65.3%. Questionnaire composed by general contents about dementia management in health center and dementia counseling center. Statistical analysis was conducted to compare the difference about each item in city and country health center. RESULTS: City and country health center showed differences in number of registered dementia patient, budgets for dementia, referral courses for registration of dementia patient, number of dementia patient referred to institution, troubles in management for dementia in health center. CONCLUSION: Current dementia management system does not meet the various needs of community for management of dementia. Thus, complementary strategies are needed to solve this problem.
Aged ; Budgets ; Counseling ; Dementia* ; Humans ; Public Health ; Surveys and Questionnaires ; Referral and Consultation

BACKGROUND: The number and proportion of live-alone elders in Korea have been increasing dramatically. We tried to identify the physical health status of live-alone elders in community and their needs for public health service in order to provide basic data for effective public health service to promote health and quality of life. METHODS: The subjects for this study were 38 nurses who provide visit-nursing service to live-alone elders in Seoul and Kyunggi Province. Data were collected by semi-structured questionnaires. RESULTS: The half of live-alone elders had disease, but only half of them took appropriate treatment. Barrier to treatment were difficulty to access to medical center, immobility, lack of drive and also poor insight. CONCLUSION: To solve the problems related to the elderly living alone in community, the instillation of public health policy that encompass professional medical service and comprehensive team approach are needed.
Aged ; Gyeonggi-do ; Humans ; Korea ; Public Health* ; Quality of Life ; Surveys and Questionnaires ; Seoul ; United States Public Health Service*

This paper reviews the Cognitive-Behavioral Treatment (CBT) of late-life anxiety disorders, mainly focused on generalized anxiety disorder. CBT for late-life anxiety disorder is usually based on the same programs with demonstrated efficacy in younger adults, with specific treatment components included relaxation training, cognitive restructuring, and exposure. CBT for late-life anxiety disorders was proved to be more effective than no treatment. But, the existing body of work does not clearly indicate the superiority of CBT over alternative psychosocial interventions. Another serious limitation of CBT is that the rates of attrition in many trials are higher among older adults than among younger adults. Those limitations are strongly suggested that augmented CBT to meet the late-life adult's characteristics and needs, like as execute function, should be developed. Enhanced CBT is the one of the example, it includes the standard CBT elements, as well as additional attention to at-home practice assignments, reminder telephone call and weekly reviews of concepts and techniques. In conclusion, this review suggested the potential value of CBT for late-life anxiety disorders. Based on the current literature, nonstandard and augmented therapies appear to produce best results.
Adult ; Anxiety Disorders* ; Anxiety* ; Executive Function ; Humans ; Relaxation ; Telephone

Anxiety disorders are common psychiatric illnesses in the elderly. However, anxiety disorders in older people have not drawn much attention from researchers and clinicians alike, compared with late-life depression or dementia. The author searched for articles published from 1986 to 2006 using the key words including "anxiety", "elderly", "aged", and "pharmacological" therapy in the MEDLINE, PsychINFO, and KMbase in order to clarify effective pharmacological therapy in the elderly with anxiety disorders. Well designed studies for pharmacologic intervention in late-life anxiety disorders were rarely found. Nonetheless, studies on young adults demonstrated a number of pharmacological treatment options that can be applied to these patients. Pharmacologic treatments for the elderly include therapies using antideprssants, especially SSRI or SNRI, buspirone, or benzodiazepines. The latter requires special caution in the administration in the elderly because it can lead to adverse events. Therefore, well designed clinical trials are further needed to obtain optimal pharmacological intervention for the elderly with anxiety disorders.
Aged ; Anxiety Disorders* ; Anxiety* ; Benzodiazepines ; Buspirone ; Dementia ; Depression ; Drug Therapy* ; Humans ; Young Adult

The frequent comorbidity of anxiety and depression, particularly among elderly, is widely recognized by clinicians, but the debate continues as to whether the combined diagnostic designation is merited. There remains a group of patients with depression and anxiety symptoms who are not well classifyed. This article reviews the debate over anxious depression, generalized anxiety disroder in patients with major depressive disorder, mixed anxiety-depressive disorder, and reviews anxiety symptoms in elderly patients with depression. Comorbid anxiety symptoms are associated with a more severe presentation of depressive illness, including greater suicidality. Most antidepressant treatment studies in the elderly have found poorer treatment outcomes in those with comorbid anxiety (including delayed or diminished response and increased likelihood of dropout from treatment). Since comorbid anxiety affect clincal course and prognosis, and may worsen long-term disability in late life depression, considerably more research in this field is needed.
Aged* ; Anxiety* ; Comorbidity ; Depression* ; Depressive Disorder, Major ; Humans ; Patient Dropouts ; Prognosis

Anxiety disorder is the one of the most prevalent psychiatric disorders in the elderly. However, there were no sufficient studies on the anxiety disorder in late life. Geriatric anxiety disorders are under-diagnosed and under-treated. For the proper evaluation and diagnosis of anxiety disorder in the elderly, comprehensive approaches considering medical, psycho-social aspects are needed. Various treatment modalities including pharmacotherapy and psycho-social treatments were reported. In this article, the author reviewed the general features of geriatric anxiety disorders, epidemiological characteristics, clinical features of each anxiety disorders, and treatment issues. We need more systematized studies for the advances on the diagnosis and treatment of geriatric anxiety disorders.
Aged ; Anxiety Disorders* ; Anxiety* ; Diagnosis ; Drug Therapy ; Humans

OBJECTIVE: Aims to observe temporal change in dementia prevalence, identify factors related to regional diversity of dementia subtype and propose explanatory hypothesis. METHOD: Studies qualifying selection criteria were chosen after PubMedline search, to identify prevalence of all dementia, Alzheimer's disease(AD) and vascular dementia(VaD) and to compare those analytically with related data. RESULT: 1) There has been temporal change of dementia prevalence in Far-eastern countries;more prevalent VaD(before year 1989), mutually contradictory reports(1990-1994)-more prevalent VaD in Japan, more prevalent AD in Korea and China-, more prevalent AD(after 1995). 2) Dementia prevalence in Africa seems relatively low and AD is more prevalent than VaD. 3) Reports from India are mutually contradictory;more prevalent VaD, more prevalent AD. 4) Reports from America and Europe have been consistent that AD is more prevalent as previously reported. CONCLUSION: Author' hypothesis is as follows. It may be hard to find dementia case in a society until average life expectancy reaches to the threshold age of dementia. Once it is over the threshold age, incidence of dementia may upsurge in a short period. High incidence-high mortality society may last for a while. With the efforts to control risk factors of dementia and improve medical services, incidence and mortality of dementia may gradually decline to reach low incidence-low mortality society at the end. The transition from high incidence-high mortality society to low incidence-low mortality society may develop in various ways according to social health policies and efforts to control risk factors of dementia and improve medical services. The reason why dementia case was not found in Nigeria is because average life expectancy in Nigeria was not reached to the threshold age of dementia. The reasons why VaD is less prevalent than AD in Far-eastern countries are mainly due to low incidence of VaD in Japan, but mainly due to high mortality of VaD in Korea and China. Namely, Japan is closer to the low incidence-low mortality society than Korea and China.
Africa ; Alzheimer Disease* ; Americas ; China ; Dementia* ; Dementia, Vascular* ; Europe ; Health Policy ; Incidence ; India ; Japan ; Korea ; Life Expectancy ; Mortality ; Nigeria ; Patient Selection ; Prevalence ; Risk Factors

Concurrent medical problem is common in dementia patients and critical to their care. Despite its importance, there was no bedside global rating scale for the seriousness of medical comorbidity. Lykestos et al. newly developed a reliable bedside scale, the General Medical Health Rating(GMHR). The objective of this study was to standardize the GMHR in form of Korean version(KGMHR). The study population consisted of 35 dementia patients in nursing home. Rating was performed by 1 physician and 2 nurses. Forty percent(14/35) of patients had one or more unstable medical illnesses. KGMHR ratings no more than 3 were 71.5%(25/35) of patients. The value of interrater reliability coefficient alpha was 0.9121. Correlations between KGMHR ratings and number of unstable medi-cal illnesses were high(r=-0.487, p<0.01). KGMHR ratings were also correlated with number of medications being taken for comorbid conditions(r=-0.542, p<0.01). In conclusion, KGMHR is a very reliable and simple rating scale for medical comorbidity in dementia patients. So the KGMHR could be a useful tool for evaluation of comorbidity in dementia patients. To verify the prognostic value of KGMHR, further large sized long-term study are needed.
Comorbidity ; Dementia* ; Humans ; Nursing Homes

OBJECTIVE: Depression in the elderly is a major health concern that can be life threatening if not recognized and treated. Despite considerable interest, there in no consensus regarding the prevalence of depression in later life. This study was aimed to investigate the prevalence of major depressive disorder in the population over age 65 years and provide fundamental data for community mental health programs. METHOD: 500 elderly people aged over 65 years and oner in Kwachon were interviewed according to DSM-IV and examined Geriatric Depression Scale(GDS), Korea Depression Scale(KDS), MMSE-K, Korea-Dementia Rating Scale(K-DRS), etc. by trained researchers. RESULTS: Of the sample, prevalence of mild, moderate and severe depressive symptoms are 18.8%, 7.4%, and 17.8%, respectively. Prevalence of major depressive disorder is found to be 7.8%. There is no significant differences between depressive & non-depressive groups in the sociodemographic variables such as sex, age, education, family type, etc. Major depressive disorder is associated with physical illness, stressful life events, and cognitive dysfunction. CONCLUSION: The results showed similar prevalence rates to other epidemiological studies. Depressed group showed more psychological distress, stressful life events and cognitive dysfunctions than non-depressed group. Accurate and early diagnosis and adequate treatment favor a good prognosis.
Aged ; Consensus ; Depression* ; Depressive Disorder, Major ; Diagnostic and Statistical Manual of Mental Disorders ; Early Diagnosis ; Education ; Epidemiologic Studies* ; Epidemiology ; Gyeonggi-do ; Humans ; Korea* ; Mental Health ; Prevalence ; Prognosis