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Age-Related Aspects and Clinical Implications of Diagnosis and Treatment of Personality Disorders in Older Adults
Tijdschriftbijdrage - Tijdschriftartikel
To investigate age-related diagnostic and therapeutic aspects of
personality disorders in later life (≥ 60 years) and implications
in clinical practice, such as the introduction of a specific mental
health care program, diagnostic assessment procedure, and treatment
criteria for personality disorders in older adults, a Delphi
study was conducted among 35 Dutch and Belgian experts in
the field of personality disorders in older adults. Consensus on astatement was defined as agreement by two thirds or more of the
experts. This Delphi study ultimately yielded consensus concerning
20 of the 21 statements. It was generally agreed that late-onset
personality disorder is a useful construct in geriatric psychiatry
and that aging can lead to a distinct behavioral expression of
personality disorders in older adults. The experts confirmed that
a specific mental health program is useful to refine the diagnostic
assessment and treatment in older patients with personality
disorders as well as older adults with mild psychiatric problems
often superimposed on personality disorders, such as adjustment
disorders, dysthymic disorders, and diffuse anxiety disorders. The
Longitudinal, Expert, and All Data (LEAD) standard combined
with a stepwise, multidimensional diagnostic approach appears
highly suitable for personality assessment. Finally, stratification of
subjects among four treatment levels was regarded as a useful strategy
and there was agreement concerning specific criteria for each
level of treatment. In conclusion, it is recommended that age-specific
aspects in the diagnosis and treatment of personality disorders
be included in guidelines and protocols and addressed in future
scientific research. Further research is indicated involving cross–
validation studies of these Delphi statements in other countries
and evaluation of the clinical implementation of the specific mental
health care program, diagnostic assessment procedure, and
treatment criteria on clinical utility.
personality disorders in later life (≥ 60 years) and implications
in clinical practice, such as the introduction of a specific mental
health care program, diagnostic assessment procedure, and treatment
criteria for personality disorders in older adults, a Delphi
study was conducted among 35 Dutch and Belgian experts in
the field of personality disorders in older adults. Consensus on astatement was defined as agreement by two thirds or more of the
experts. This Delphi study ultimately yielded consensus concerning
20 of the 21 statements. It was generally agreed that late-onset
personality disorder is a useful construct in geriatric psychiatry
and that aging can lead to a distinct behavioral expression of
personality disorders in older adults. The experts confirmed that
a specific mental health program is useful to refine the diagnostic
assessment and treatment in older patients with personality
disorders as well as older adults with mild psychiatric problems
often superimposed on personality disorders, such as adjustment
disorders, dysthymic disorders, and diffuse anxiety disorders. The
Longitudinal, Expert, and All Data (LEAD) standard combined
with a stepwise, multidimensional diagnostic approach appears
highly suitable for personality assessment. Finally, stratification of
subjects among four treatment levels was regarded as a useful strategy
and there was agreement concerning specific criteria for each
level of treatment. In conclusion, it is recommended that age-specific
aspects in the diagnosis and treatment of personality disorders
be included in guidelines and protocols and addressed in future
scientific research. Further research is indicated involving cross–
validation studies of these Delphi statements in other countries
and evaluation of the clinical implementation of the specific mental
health care program, diagnostic assessment procedure, and
treatment criteria on clinical utility.
Tijdschrift: Clinical Gerontologist
ISSN: 0731-7115
Volume: 35
Pagina's: 27-41
Jaar van publicatie:2012
Trefwoorden:Delphi method, diagnosis, elderly, older adults,
Toegankelijkheid:Closed