The rapid growth of the field of psychogeriatrics, spurred on by aging populations, substantially increased funding, and growing interest by professionals, government, and society, has led, in turn, to a rapid growth of medical information. The management of this information poses a significant challenge to health care professionals and scientists. This rapid growth of knowledge has spawned a whole new field, “Medical Informatics.” This field concerns itself with the “cognitive, information processing, and communication tasks of medical practice, education and research, including the information science and the technology to support these tasks” (Greenes & Shortliffe, 1990).

An intensive 10-day residential training program for dementia carers has previously been shown to be associated with increased patient survival at home and decreased psychological morbidity in carers (Brodaty & Gresham, 1989). Results from a further follow-up, about 39 months after entry into the trial, were even more impressive. Patients whose carers had trained in the program had much higher adjusted rates of survival at home (53% versus 13%) and, unexpectedly, fewer deaths (20% versus 41%) than those whose carers did not have training. Patients whose carers had delayed training achieved intermediate results (31% surviving at home and 21% dying). These results were achieved with an average saving of $A7,967 ($U.S.5975) per patient over the first 39 months.

The Geriatric Depression Scale (GDS) is commonly used to measure depression in the elderly. However, there have been no reports of the underlying structure of the GDS. To this end, the GDS was administered to 326 community-dwelling elderly subjects, and the data were subjected to a factor analysis. A five-factor solution was selected and, after a varimax rotation, the factors that emerged could be described as: (1) sad mood, (2) lack of energy, (3) positive mood, (4) agitation, and (5) social withdrawal. This solution accounted for 42.9% of the variance. Knowledge of the factor structure should aid both clinicians and researchers in the interpretation of responses on the GDS.

Rates of cognitive impairment in a representative population of the oldest old (aged 84 to 90) were examined using two indicators: The Global Deterioration Scale (GDS), and a Cognitive Rating (CR) derived from performance on five neuropsychological tests. Prevalence was estimated at 25.3%, using the GDS, and 30% with the CR. The overall degree of congruence between the measures was high, with most disagreements involving mildly impaired cases. The results indicate a high degree of convergence of clinical and neuropsychological indicators. The findings also confirm high rates of impairment among the oldest old.

Records of eight elderly patients identified as BPD by a geriatric team were analyzed for compliance with DIB-R and DSM-III-R criteria. A nonborderline control group was randomly selected and matched for age, gender and residence. Clinicians experienced in geriatric mental health performed retrospective chart reviews and found that not one clinically diagnosed BPD patient was identified by either instrument. Although there appear to be a number of constant features of BPD throughout life, this study delineated two major areas of change in BPD in late life.

We obtained season-of-birth data in 727 autopsy-confirmed cases of Alzheimer's Disease (AD) and compared these data with expected general population birth rates. There were no significant differences between quarterly birth rates in the AD group and expected quarterly birth rates. Edward's test for cyclical trends did not establish a peak period of birth in the AD sample. No significant differences between observed and expected quarterly birth rates were found when data were analyzed with regard to either family history of dementia or to gender. Edward's test for peak quarter was significant for AD females, however, with the peak period occurring early in the first quarter. These negative findings between observed and expected quarterly birth rates, based on the large number of autopsy-confirmed AD cases in this study, suggest that a season-of-birth effect in AD is highly unlikely.

The authors report preliminary data from a psychological autopsy study of completed suicide in late life. Sixteen of 18 victims had diagnosable psychopathology, most commonly major depression of late onset. Symptoms manifest prior to death are described and directions for future investigation discussed. The psychological autopsy is shown to be a viable method for studying suicide in the elderly.

The effects of hospitalization on affective status were assessed by an original protocol in 214 consecutive elderly patients (mean age=78.3+/−5.0 years, range=70–92 years). Psychological decompensation was significantly related to length of stay (p<0.01) and drug use (p<0.05) and unaffected by sex, marital status, prior living place, diagnostic category. Affective status and functional status were directly correlated (p<0.0001), although in 51% of medical patients the affective status worsened or remained unchanged despite improved physical function. Improvement in affective status occurred more frequently in surgical patients (p<0.001) due to psychological improvement following surgery. Physicians providing medical and surgical care for geriatric patients must remain aware of the patients' emotional response to hospitalization and illness, given the accompanying risk for psychological decompensation.

The Max Planck Institute for Psychiatry (MPIP; Director: Florian Holsboer, M.D., Ph.D.) is a clinical research institute which serves psychiatric inpatients and several outpatient clinics (e.g., lithium clinic, memory clinic, anxiety disorder clinic, neuroleptic clinic). Affiliated with the Krankenhaus München-Schwabing, the largest general hospital in Bavaria (approximately 1,400 beds), the MPIP provides neurological and psychiatric consultation services for this center. According to the scientific concept envisioned by the first director of the MPIP, Emil Kraepelin, the Clinical Institute runs numerous on-site, state-of-the-art laboratories for basic research (molecular biology, neuroendocrinology, neuropharmacology, electrophysiology, neuropsychology, brain imaging) in order to bridge the gap between preclinical and clinical scientific activities.