Oxford Textbook of Old Age Psychiatry Oxford Textbooks in Psychiatry Oxford Textbook of Community Mental Health Edited by Graham Th ornicroft , George Szmukler, Kim T. Mueser, and Robert E. Drake Oxford Textbook of Suicidology and Suicide Prevention Edited by Danuta Wasserman and Camilla Wasserman Oxford Textbook of Women and Mental Health Edited by Dora Kohen Oxford Textbook of Old Age Psychiatry SECOND EDITION Edited by Tom Dening Institute of Mental Health, University of Nottingham, Nottingham, UK Alan Thomas Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK 1 3 Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press 2013 The moral rights of the authors have been asserted First Edition published in 2008 Second Edition published in 2013 Impression: 1 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 2013936563 ISBN 978–0–19–964495–7 Printed in China by C&C Offset Printing Co. Ltd Oxford University press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breast-feeding To our families, with love. Karen, Lizzy, Jon, and Alex; and Shona, Elspeth, Douglas, and Bethan. This page intentionally left blank Preface Although this is the second edition of the O xford Textbook of Old another. Somewhat surprisingly, in countries such as the UK that Age Psychiatry , it is also the fi ft h edition of the book that originally have specialists in old age psychiatry, there may paradoxically be appeared as P sychiatry in the Elderly in 1991. It is the fi rst edition not threats to the existence of the speciality at a time of ever-increasing to have been edited by Robin Jacoby and Catherine Oppenheimer, demand. Nonetheless, the core of knowledge about the science of whose brilliant conception 25 years ago of the need for this book and practice in relation to mental disorders in later life is robust and has stood the test of time. Both of us were privileged to work along- continues to improve. It is the latest version of this canon that we side Robin and Catherine in producing the last edition, which we are proud to share with you in this volume. hope has allowed for handover and continuity as well as evolution- Whilst maintaining the tried and tested book structure, in this ary change. It has nonetheless been daunting and exciting for us to edition all chapters have again been thoroughly revised and updated take responsibility for what we believe is the leading textbook in and we have benefi ted from an increase in the number of authors to our speciality across the world. 96, of whom 59 have written for this book for the fi rst time. Th ese One of the central features of ‘Jacoby and Oppenheimer’ has new contributors have brought fresh perspectives, helped perhaps always been its clear structure, leading from basic science (both by them bringing a larger breadth of international experience (rep- neurobiological and social varieties), through clinical practice, spe- resenting Australia, Austria, Canada, China, France, Germany, cifi c disorders, and service provision, to a collection of ethical and Ireland, the Netherlands, Norway, Sweden, Switzerland, the UK, legal chapters on some of the hard challenges for old age psychia- and the US). Developments have led us to add some wholly new trists. We think this structure was visionary, and we have retained chapters (on palliative care, ethics of caring, and of living and dying it as we believe that old age psychiatrists and those in related dis- with dementia) and to ask for expansions and larger changes in ciplines will appreciate the breadth of information and scholarship the chapters on brain stimulation therapies (rather than just ECT), that is contained within it. memory clinics (now more broadly known as memory services), Old age psychiatry has arisen because of the particular health and capacity (now widened to all mental capacity and decision- and social issues that surround ageing, dementia, comorbidity, making from the narrower focus before on testamentary capacity). dependency, and the end of life in ageing societies across the world. We are grateful to all our contributors, especially those who have Th e global burden and cost of dementia is enormous; so too is that shared their personal experiences. It has been a pleasure working of depression and other mental illnesses. Dementia has become a with you all. We would also like to thank our editors, Martin Baum major public policy issue in many countries across the world, so and Charlotte Green, and Pete Stevenson and Eloise Moir-Ford, at our ability to recognize the condition and to off er appropriate and Oxford University Press for their support and diligence. aff ordable help and support is already really important and will only become more so. However, the way in which mental health Tom Dening, Nottingham services are organized for older people varies from one country to Alan Th omas, Newcastle upon Tyne This page intentionally left blank Acknowledgements T.D. acknowledges the support of the NIHR Cambridgeshire A.T. expresses thanks to the NIHR Biomedical Research Centre in and Peterborough CLAHRC (Collaboration for Leadership in Ageing and the Biomedical Research Unit in Lewy Body Dementia Applied Health Research and Care) and the Cambridgeshire and at Newcastle University and to Gateshead Health NHS Foundation Peterborough NHS Foundation Trust. Also thanks to Nottingham Trust for their support. University, Nottinghamshire Healthcare NHS Trust, and Barchester Healthcare for their encouragement.