Because they are so complex, the problems which elderly people present require very careful analysis and attentive treatment by the physician and other people as well. The author suggests several postulates concerning how to care for the elderly.
The ageing of society is a fact which requires modifications in the organization of care for the elderly, particularly those old people who are also mentally disturbed. The authors discuss the current situation in Poland and the directions of development of psycho-geriatrics against the backdrop of organization of care of elderly mentally disturbed patients in other countries.
The author discusses the terminological aspects of dementia syndromes and the diagnostic criteria for these syndromes. He also presents a nosological classification of dementia.
Recent years have witnessed increased interest in the Clock-Drawing Test as a simple and reliable method of early detection of disturbed cognitive functioning in the elderly. Four versions of the test are presented, two proposed by Shulman et al. and those proposed by Sunderland et al. and Watson et al. All versions of the Clock-Drawing Test combine simplicity with high sensitivity and specificity with respect to diagnosis of disturbed cognitive efficiency. This test seems particularly useful as a selective diagnostic instrument for disturbed cognitive efficiency associated with the early stages of Alzheimer's disease when general cognitive efficiency has not yet reached the level of dementia.
Brain changes in the elderly, as detected by the MR imaging are discussed. Deviations are mainly found in the white matter of the brain hemispheres and consist in: (1) hyperintensive, small diffuse foci (in PD – and T2-related pictures), (2) a similarly hyperintensive zone along the walls of the ventricular system (leukoaraiosis) and (3) diffuse atrophy. These changes are caused by disturbances in general and local circulation. If slight, these changes need not lead to clear-cut clinical symptoms.
The author reviews selected issues from the current state of knowledge on the mechanisms of programmed cell death and its possible contribution to Alzheimer's disease.
The author presents his observations collected during many years' experience as a legal expert in psychiatry in cases concerning the legality of wills. Situations are discussed in which the testator is capable of making a legally valid will despite dementive changes. Situations in which the testator is incapable of making a valid will due to dementive changes are also indicated.
The authors draw attention to several ethical doubts related to the diagnostic-therapeutic process involving mental disturbances in the elderly. Modifications of previous cultural sets and stereotypes with respect to the specific nature of this stage of life are taken into account.
When treating mental disorders in the elder/y it is necessary to select the medication and its dosage appropriately to the biological mechanisms underlying the ageing process. The article presents a brief review of the most important practical problems in the pharmacotherapy of elderly patients. The factors which must be taken into account ill the pharmacotherapy of the most frequent mental disorders ill the elderly are discussed. Principles underlying choice of medication and dosage and the possible side-effects of neuroleptics, anti-depressants and anxiolytics – the drugs most frequently used ill the treatment of geriatric patients – are also discussed.
The author presents current directions in the rehabilitation of patients with Alzheimer-type dementia syndromes. These include: sense of reality training, every-day activities, reality and orientation training.
The author discusses a useful form of self-therapy practiced on gerontopsychiatric wards, i.e., the collage method. She presents and analyzes the productions of selected patients.
The paper presents the most important problems in the pharmacotherapy of mental disorders accompanying malignant tumours in the elderly. The most frequent psychopathological syndromes in this group of patients are briefly reviewed, with special focus on the difficult psychological situation of patients with a diagnosis of cancer. Attention is drawn to the need for careful selection of psychotropic drugs and to possible interactions with drugs of a different profile. Particular stress is given to the discussion of therapeutic procedures in depressive and anxiety syndromes – the most frequent concomitants of cancer. In an attempt to predict the outcome of pharmacotherapy it is stressed that it is necessary to adopt a proper approach to the patient and to select an appropriate strategy of informing the patient about the cancer diagnosis.