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Epidemiology and social policy

With the publication of The Rising Tide there has been an increased interest in the relevance of psychiatric illness for the care of the elderly. Mann and his colleagues focus on one aspect: the prevalence of psychiatric illness among residents of residential homes for the elderly, by reporting on a large survey of residents in the homes of one London borough. The study investigated the demographic and dependency characteristics of all the residents of 12 old peoples homes in one London borough. Seven of the homes surveyed contained between 45 and 70 residents and five between 20 and 30 residents. Data were collected for 438 (82%) of residents. Each resident received a standard interview the Brief Assessment Schedule (B.A.S.) which included questions to identify depression and dementia, demographic details and interviewer assessments of the subjects' mobility, hearing and sight. The validity and reliability of the instrument are summarised, indicating its relevance to this investigation. Four categories of mental state are identified: no indication of psychiatric illness, mild or moderate dementia but no depression, mild or moderate depression with dementia, depression but no dementia, severe dementia. Dependency data reported concerned walking, dressing, toileting and eating ability and problems with incontinence, wandering and aggression as reported by the head of home. This paper reports that one-third of residents were suffering from severe dementia, another third from mild to moderate dementia and one-third were free of dementia. Of the latter two groups two-fifths were depressed. The prevalence rate of dementia increased with the age of residents and was higher among women. Logistic regression analysis was undertaken to predict the relative importance of age, gender and length of stay in relation to the prevalence of dementia. The prevalence of depression was found to be associated with the presence of visual handicap and incontinence, and was commoner when the resident had been admitted from their own home or belonged to a minority religious group. No relationship between the prevalence of depression and age, gender, marital status, educational level or social class of resident was found. Logistic regression analysis identified the importance of religious