Alcohol use typically begins in the adolescence and peaks over the adulthood. However, its abuse is not as uncommon among the elderly though it tends to be under.recognized. Certain age.related physiologic, biologic, and psychosocial issues pose unique challenges in the diagnosis as well as management of alcohol use disorders in the elderly. Indian studies. .. specifically focusing on elderly substance users. .. are few. Screening should be a crucial component during clinical encounters with elderly populations across a variety of settings. Depending on the extent, nature and pattern of use, the elderly persons may need less intensive, brief interventions to more intensive inpatient care for safety concerns. Emphasis should always be on age.specific treatments delivered by trained personnel using nonconfrontational approaches.

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Constipation is a common complaint among the elderly patients with psychiatric disorders because of age.related physiologic and anatomical changes, lifestyle factors, comorbid physical and surgical disorders, medications, including psychotropics, and polypharmacy. Lack of timely reporting by patients as well as inadequate expertise of physician may contribute to significant delay in treatment and poor quality of life. Primary constipation is amenable to lifestyle modification. (dietary changes, exercise, and physical activity), fiber intake, and laxatives when necessary. Secondary constipation should be treated with managing underlying pathology or predisposing factors, including effective treatment of psychiatric disorders and rationalizing psychotropic prescription. This review article focuses on the definition, etiology, assessment, treatment, and prevention of constipation in elderly population with mental illness.

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Aims: There is a gap in research about the role of occupational therapy (OT) in the United States with clients with advanced dementia. The purpose of this study is to explore OT practice with clients with advanced dementia within the United States by surveying practitioners. Study questions addressed interventions, including frequency and perceived effectiveness, intervention priorities, and barriers to practice. Methods: Survey methodology was employed to obtain the practice experience of the United States OT practitioners working with clients with advanced dementia. Results: Respondents (n = 95) were mostly occupational therapists with 10 years of practice experience, some reporting dual roles as administrators or fieldwork educators, working in long-term care settings. Respondents spent minimal time per week with clients with advanced dementia, providing primarily one-to-one interventions with varied perceived effectiveness. A wide range of interventions were aemployed. Therapist and perceived facility intervention priorities differed. The most frequently reported barrier to practice was client factors, followed by institutional barriers. Thematic analysis of qualitative questions further elucidates the practice experience of respondents. Conclusions: Findings provide insight into occupational therapy practice in the United States with clients with advanced dementia. This study describes interventions utilized with this population, barriers to practice, and perceived effectiveness of interventions. Qualitative entries describe care approaches for this population and challenges to providing care. While this study adds to the evidence base for occupational therapy's role in serving clients with advanced dementia, there remains a need for more research in this area.

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Aim of the Study: This study aimed to evaluate the symptom profile, including somatic symptoms among elderly patients with first episode depression using the Geriatric depression scale (GDS-30) and Patient Health Questionnaire-15 (PHQ-15) items version scale. Additional aims were to carry out the factor analysis of symptoms reported on GDS-30 and PHQ-15 among elderly. Methodology: Seventy-nine elderly patients (age ≥60 years) were evaluated on GDS-30 item Hindi version and Hindi version of the PHQ-15. Results: As per GDS-30, the most common symptom noted among elderly was “dropped many of your activities and interests” (91.1%), mind not as clear as it used (88.6%), feeling that life is empty (86.1%), bothered by thoughts you cannot get out of your head (86.1%) and hard to get started on new projects (86.1%), prefer to avoid social gatherings (86.1%). All patients reported at least one somatic complaint as per PHQ-15. The most common somatic symptoms were trouble sleeping (97.5%), feeling tired or having little energy (96.2%), feeling that the heart is racing (52.9%), constipation, loose bowels, or diarrhea (49.6%), shortness of breath (46.8%), nausea, gas or indigestion (45.6%), pain in the arms, legs, or joints (43.3%), and back pain (41.8%). The prevalence of somatic symptoms was not influenced to a large extent by the demographic variables, clinical variables and presence or absence of physical comorbidity. However, the severity of somatic symptoms correlated positively with GDS-30 score. Factor analysis of Hindi version of GDS-30 yielded a four-factor solution, which was similar to many studies across the world. The addition of items of PHQ-15 items of factor analysis still yielded a four-factor solution. Factor 1 of combined GDS-30 and PHQ-15 items included items only from GDS-30 and Factor 3 and 4 included items only from PHQ-15. There was some overlap of items on Factor 2. Conclusion: The present study suggests that GDS-30 does not tap all the symptoms of depression among elderly in the Indian context. Further, the present study shows that GDS-30 is not a one-dimensional scale. Accordingly, the symptom evaluation among elderly depressed patient should go beyond GDS-30.

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Background: Parkinson's disease is a movement disorder that seriously affects body balance and gait; therefore, increases the risk of fall and related complications. Freezing of gait and postural instability are disabling symptoms, which compromises motor independence among Parkinson's disease patients. Aims and Objectives: The purpose of this study analyses the effects of square-stepping exercise (SSE) among Parkinson's disease patients in terms of improving balance and reducing fall risk. Materials and Methods: This is a pilot randomized controlled study, in which thirty male and female Parkinson's disease patients between 60 and 70 years of age were selected by simple random sampling method and randomly divided into SSE group (N-15) and conventional physiotherapy (CPT) group (N-15). Interventions were provided for 4 weeks. Baseline and posttest outcomes were measured using the Berg balance scale (BBS) and timed up and go test (TUG). Results: Statistical measures of mean, standard deviation, and t-test were performed using SPSS 21. SSE exhibited statistical significant improvement in BBS (P < 0.05) and TUG (P < 0.0001) compared to CPT group. Conclusion: SSE is more effective in improving balance and gait in Parkinson's disease. Although further studies with larger samples are required, the result of this study implies that SSE could be used as a mean of rehabilitation in Parkinson's disease.

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Aim: To evaluate the sociodemographic, clinical, and treatment characteristics profile of late-onset (LO) bipolar affective disorder (BPAD) (onset ≥50 years) and compare the patients with LO BPAD with early age of onset (10–25 years) and intermediate age of onset (26–40 years) BPAD for the demographic features, illness characteristics, and treatment characteristics. Methodology: In this retrospective study, data (demographic features, clinical characteristics, and treatment characteristics) of 115 patients with LO BPAD (onset ≥50 years) were extracted and were compared with 93 patients with intermediate-onset (IO) (26–40 years) and 130 patients with early-onset (EO) (10–25 years) BPAD groups. Results: Patients with LO BPAD differ from EO and IO BPAD in having higher rates of family history of mental disorders, higher rates of comorbid psychiatric disorders (especially substance use disorders) and physical illnesses, higher rates of suicidal ideations, lower rates of suicidal attempts, higher rates of Type-II BPAD, lower prevalence of psychotic symptoms during the episodes, shorter interepisodic duration, higher use of combination of mood stabilizers and antidepressants, lower preference of lithium, higher preference for valproate, and lower use of benzodiazepines. In addition, patients with LO BPAD differed from those with EO BPAD in having higher rates of having a depressive-manic illness pattern, longer duration of depressive episodes, and lower number of manic episodes. Patients with LO BPAD differed significantly from IO BPAD in having lower number of episodes and more often use of antipsychotic monotherapy during the acute phase. Conclusions: LO BPAD differs from IO and EO BPAD on several of the clinical characteristics. Treatment preferences by the clinicians for LO BPAD also differ from EO and IO BPAD.

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Psychotic symptoms are not uncommon in patients with Parkinson's disease (PD). Several studies have evaluated the prevalence of psychotic symptoms in PD. Psychosis in PD can either occur independently or due to the effect of dopaminergic antiparkinsonian drugs or as a part of behavioral and psychological symptoms of dementia with PD. Often, it is difficult to manage psychosis in PD as there are very few pharmacological agents which can be used with relative safety. Effective management includes early identification of symptoms, ruling out other differential diagnoses, using appropriate psychopharmacological agents along with proper psychoeducation, and applying nonpharmacological strategies. In this report, we report the case of an 84-year-old woman with PD who developed dementia and psychosis during her illness and discuss the various challenges in managing psychosis in patients with PD.

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Over the years, there is an increase in the prescription of antipsychotics among elderly patients, and these are used for various clinical indications such as psychotic disorders, affective disorders, behavioral and psychological symptoms of dementia and delirium. Quetiapine is one of the preferred antipsychotics among elderly because of its safety profile. However, quetiapine has been rarely been associated with the development of neuroleptic malignant syndrome (NMS) among elderly. In this report, we discuss a case of NMS in a 70-year-old female, who developed symptoms of NMS at the dose of 200 mg/day, while quetiapine was being used along with lithium. A review of literature suggests that there are 12 cases of NMS reported in subjects older than 55 years of age.

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Context: The increased demand on long-term old age care homes in urban India is a result of demographic transition together with the disintegration of joint family system and changing social values which make them increasingly vulnerable to mental health problems. Aims: This study attempted to find out an array of mental health problems and associated morbidity among inhabitant of government old age homes. Settings and Design: This was a cross-sectional study which included government run old age homes (OAHs) in Delhi. Subjects and Methods: The sample comprised a total of 148 elderly in four OAHs with a mean age of 72.81 years. The World Health Organization Quality of Life-BREF Scale (QOL), Mini-Mental State Examination, Geriatric Depression Scale, Hamilton Anxiety Rating Scale, Brief Psychiatric Rating Scale, and Kesseler-10 Scale were administered. Statistical Analysis: Data were analyzed through SPSS version 20.0 version. Frequency distribution and cross-tabulation used to create summary tables and compare items. Results: Female constituted two-third of study population whereas one-third of subjects were illiterate and two-third without income. The study demonstrated psychiatric morbidity profile among OAH inhabitants and exhibited mild-moderate anxiety symptoms in almost 95% followed by mild-severe depression reported by 85%, mild-moderate psychotic illnesses, psychological distress, cognitive impairments, and poor QOL. Low income and education, low social connections and loss of spouse were key risk factors. Conclusions and Recommendation: Psychiatric morbidity profile and QOL among OAH residents is influenced by various psychological, social, and economic factors. This emphasized the need for better management of the government-run OAHs to ensure better overall mental health of the residents.

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Background: Health system that is chiefly financed by out of pocket expenditure can have varying impact on patients belonging to different income groups. The main objective of the present study was to assess the health-care utilization pattern and socioeconomic features of elderly who incurred catastrophic health expenditure. Materials and Methods: A community-based cross-sectional study was conducted employing multi-stage sampling technique to collect data from a total of 404 elderly residing in Lucknow district. Data were collected on health care utilization and related health care expenditure with by the means of a questionnaire. Results: Out of 404 elderly, 15.8% incurred catastrophic expenditure. Among all the study participants, 33.1% who sought in-patient care and 13.8% who sought exclusive out-patient care incurred catastrophic health expenditure. Conclusion: Proportion of those facing catastrophic expenditure was high among lower income group. Thus, patients who lie at the bottom of income pyramid need higher protection as compared to those who are at the top.

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