Annual Residential Meeting Stratford-upon-Avon March 16, 2011

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Residential Meeting Stratford-upon-Avon March 16, 2011 Rommy von

1 Old Age Psychiatry in Chile: why development ti is needed? ed? Royal College of Psychiatrists Faculty of Old Age Psychiatry Annual Residential Meeting Stratford-upon-Avon March 16, 2011 Rommy von Bernhardi dim M. MD, PhD Department of Neurology Pontificia Universidad Católica de Chile

2 The Context - Chile Some Facts: - Population: 16 million - Gross National Income - per capita: USD - Health expenditure per capita: 750 USD ( 5.3% of GNI) Elderly individuals: 17.3% health expenditure - Socioeconomics of the elderly population: 10% are bellow poverty line 13% are illiterate (census 2003 changing (2009)

3 Demography: Aging g in Chile I. Individual Aging Life Expectative at birth y 75.5 y C Women mujeres hombres Men 10 Source B,C,D: IN NE-CELAD DE.

4 II. Population Aging Elderly population in Chile ,1% 10,5% 13% 15% 28% Source: Casen.

5 Life expectative changes in Chile Decrease of disease in young and adult population Total at birth Total at 60 years Total at 65 years Source : INE-CE EPAL, 2007

6 Prevalence of Health Problems in >65 years old Cigarette Smoking Habit Diabetes Mellitus * Obesity (> 30) Cronic Respiratory Disease Total Cholesterol > 200 mg/dl * Overweight 25< CMI < 29.9) 9) Metabolic Syndrome Cavities Hypertension (> 140/90) Cardiovascular Risk (High/Very High) Sedentary Habit Source: Chilean Health Census 2003 & 2009

7 Health care of elders: Situation in Chile Information from the 2010 Health Census: High Incidence of chronic diseases and risk factors. Access to health services: 82% of elderly individuals use the public health system. 8% private health system 10% does not access the health system 1ary Health Care: Problems for detecting problems on elderly people. - Lost opportunities for early detection of diseases - Lost opportunities for education Poor psychiatric experience

8 Psychiatric care of elders: Situation in Chile - II Information from the 2003 & 2009 Health Census: Cognitive / Everyday activities iti impairment i Screening Psychiatric pathologies are not assessed Population Studies that are available: - Cross-sectional prevalence studies - Survey - Retrospective reports 12% of elderly population has a psychiatric disorder other than dementia Specialized training in geriatric psychiatry is abscent in Latinoamerica

9 Psychiatric care of elders: Situation in Chile -III Life time & 1-year prevalence rates Methodology survey (houshold stratified sample) 20-64y >65y 65-74y >75y Dysthymia 4.5 % 1.5% 1.9% 0.8% Major depressive episode Any effective disorder Generalised anxiety disorder Alcohol abuse Chile Psyc Prevalence Study Sizable proportion of psychiatric disorders have late onset: - Dysthymia 25.6% - Major depression: 36:4% - Generalised axiety disorder 50% - Alcohol abuse: 32.2% - Somatoform disorders: 53.3% Am.J.Geriatric Psychiat 16:12, 2008

10 Psychiatric care of elders: Situation in Chile -IV Most Prevalent Psychiatric pathologies in elderly people: - Delirium: 10% at admission + additional 10-15% during hospitalization - Depression: For elderly population, depression prevalence is 5.6% People living in long term residency: 17-20% (up to 30% with simptoms) At residencies: high prevalence of depresive pseudementia - Dementia disorders

11 Cognitive Impairment of people > 65 ** National: % Man: 14.5% Women: 15.2% Men Women years years or more years Health National Census 2003

12 Dementia Prevalence: sex and age Total 1,2 4,1 3,7 8,8 19,4 32,6 Men Hombres 0,9 5,9 3,6 6 18,2 24,4 Women Mujeres 1,4 3,1 3,8 10, ,5 Source e: ENADE EAM 2009

13 Dementia & Depresion % AD patients have depression. -Up to 50% 1ary dementia patients develop depression symptoms -Depression and depression symptoms show a significant increase in: p p y p g patients with disabilities patients living at a long term residence

14 Elderly yp population: p Dependency for everyday y activities Elders living in long term residencies: 50 % are dependent - 30% physical dependence - 20% cognitive/psychiatry Elders living at their home: % are dependent National Study of dependency on elderly population, 2009

15 Psychiatric care of elders: Situation in Chile -V Population study: -Geriatric Depression Scale (5-GDS) - 47% classified as depressed - Depression is strongly associated to low education levels, as well as functional dependence High incidence of depression in elderly people - Why? - Life quality - General health (Chronic pathologies) - Physical functioning & perception of health level - Social Support - Socio-economical level (49% can not satisfy needs) - Educational level - Perception of disrespect by society (up to 82% of low income)

16 Dementias are a Public Health Problem in Chile 1. High prevalence of problem 2. Prevalence is increasing 3. Important consequences of the disease 4. High social cost 5. High impact on public opinion 6. Existence of education and prevention measures 7. Diagnosis and treatment not properly implemented 8. Access to diagnosis and treatment is not equitative ( Dartigues et al. 2006)

17 Population under regular control for dementia 2 Increasing Demand: 2. Increasing Demand: - Aging population - Education

18 Impact of neurocognitive / psychiatric diseases in Chile Demand on the health system AVISA: First 25 specific causes of attention all ages (

19 Impact of neurocognitive / psychiatric diseases in Chile Demand on the health system AVISA: First 20 specific causes of attention all ages AVISA adults years (

20 Psychiatric care of elders: Access to treatment <65 65y >65 y Non especialized Mental Health Service Especialized Mental Health Service 35.0% 40.4% 12.2% 3.9% Am.J.Geriatric Psychiat 16:12, 2008

21 Dementias are a Public Health Problem High Social cost The 2nd Patiente : The CAREGIVER Dementia AD patients are: 8 years with a caregiver 93 % are a family member 76 % are women 2/3 receive NO payment Dependence & behavioural impairments Consequences for the caregiver - Psychologicals Physicals Socials Economicals

22 Taking care of the dementia patient 100% 80% 80% 60% 56% 40% * 26% 40% 20% 0% Live with the patient Has mental Reports Health problems Family Dysfunction Stop working For caregiver duties * *+ 46% that would work if possible (Budnich, Martorell, Nuñez, Bedweell & Slachevsky 2009)

23 Demographic changes Good quality of life at later ages Social structure -Family ychanges - Education access - Information access Rethinking Aging & Dementia Patient changes -Independence - Right of choosing Diagnostic and treatment changes Diagnostic and treatment changes - Research on preclinical stages - Protection factors, prevention and non-pharmacological therapy

Residency Program (SENAMA - training) 5.

24 What tools do we have in CHILE? 1. Clinical Guides for Primary health care 2. Clinical Guides for Specialists 3. Diagnostic approach and study 4. Residency Program (SENAMA - training) 5. Study for the disease load 6. And NOW: Nti NationalPlan for Dementia

25 The challange: Next Steps Seps 1. Confront and inform general public about dementia 2. Educate 3. Design Public Policy regarding gdementia patients NATIONAL PROGRAM FOR DEMENTIA PATIENTS

Psychiatry Day Hospital Cognitive & Behavioral Impairments Unit Day Centre Therapeutic

26 Our effort! -Geriatrics - Neurology -Psychiatry y Centro Integral de la Memoria y la Conducta Psychiatry Day Hospital Cognitive & Behavioral Impairments Unit Day Centre Therapeutic Unit Research: - Experimental - Clinic Teaching: - Epidemiologic - Undergraduate - Psychosocial - Graduate - Other professionals Training i & Support: - Familty - Caregivers

27 A PERSON Centered view Spiritual Support Medical Support Affective Support Self Care Social Interaction Training Occupation Person Integral Support Environment Autonomy Family Support Housing Rehabilitation Caregiver Training

28 Team: Laboratory Neuroscience Faculty of Medicine PUC - Dr. Dagoberto Soto - Gigliola Ramírez - Juan Tichauer - Paola Murgas - Dr. Pablo Arroyo - Dr. Bernardita Soler - Dr. Maximiliano Rovegno - María González - Bárbara Godoy - Loreto Olavarría - Betsi Flores - Laura Eugenín Grant Support: - FONDECYT -NIH - VRI-PUC

29 Pontificia Universidad Catòlica de Chile

30 Faculty of Medicine PUC

31 Thank you!

Basic Standards for Residency/Fellowship Training in Geriatric Psychiatry

Basic Standards for Residency/Fellowship Training in Geriatric Psychiatry American Osteopathic Association and American College of Osteopathic Neurologists and Psychiatrists Approved 2/2005 Revised 2/2008,