A tiered model of psychogeriatric service delivery: an evidence-based approach.
BACKGROUND
Previous models of mental health care for older persons have not considered the full spectrum of mental disorders.


OBJECTIVE
To describe a tiered model for comprehensive evidence-based planning of service delivery for mental disorders in late life.


METHODS
The model depicts tiers of mental disorders in ascending order of severity and consequent interventions required.


RESULTS
Interventions aim both to avert individuals from moving up tiers (prevention) and to move individuals down tiers (treatment). Individuals in the lower tiers have no mental disorders and prevention strategies are targeted at known risk factors. In the middle tiers, individuals with mild-moderate mental disorders will mainly be treated in primary care, often in collaboration with specialist mental health services for older people. Individuals in the top tiers with severe mental disorders usually require institutional care.


CONCLUSIONS
The tiered model provides a basis for planning comprehensive service delivery.
Draper
Brian
B
School of Psychiatry, University of NSW, Sydney, Australia. b.draper@unsw.edu.au
Brodaty
Henry
H
Low
Lee-Fay
LF
D000368:Aged; D000544:Alzheimer Disease / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D003695:Delivery of Health Care / Q000592:standards*; D005852:Geriatric Psychiatry / Q000458:organization & administration*; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy; D008605:Mental Health Services / Q000458:organization & administration*; D014944:World Health Organization