Meeting Report

Asia Pacific Regional Meeting: Hong Kong 
Science and Culture: The “Yin and Yang” of Geriatric Psychiatry

Lesley M. Blake

The first IPA regional meeting to take place in Hong Kong was held from October 23rd to 26th, 2002 at the Gold Coast Resort in Hong Kong. The main theme of the meeting was “Dementia, Depression and Suicide in the Elderly: Cultural and Clinical Aspects.” This was particularly relevant to this region with marked cultural diversity. There were over 500 attendees from 30 countries. Helen Chiu and her team did a truly remarkable job in organizing the meeting, and even with all of the temptations of Hong Kong close by, most sessions were well attended. 

Alistair Burns presided as Tom Arie opened the meeting. Tom Arie, from the University of Nottingham in the UK, gave the keynote address. He had been a strong mentor to members of the audience, including Helen Chiu. Arie, most appropriately, spoke about the ‘yin and yang’ of geriatric psychiatry, and the co-existence of the science and humanity in the field. He gave an informative talk on the history of geriatric psychiatry in the UK, and whilst the science of the field has increased exponentially, he stressed that so, too, has the humanity. Geriatric psychiatry is about caring for the aged. 

Plenary Talks focus on Suicide, Dementia, Research 

Linda Lam, the co-chair of the scientific committee, gave an introductory speech, discussing the high rate of suicide and the lack of adequate dementia care in many parts of the region. Lam said she hoped that the meeting would boost interest in geriatric psychiatry in the region. She reminded us about the exciting and vibrant atmosphere of Hong Kong, and encouraged us to at least try the local food delicacies.

A Continuum of Care. Peter Lee provided a very informative talk on the policy objective of increasing the quality of life in the older adult population, and their focus on providing a continuum of care. His goal is to increase the focus on promoting healthy aging, and attempt to decrease functional dependence. Several strategies have involved health screening, early detection of cognitive impairment, community education projects, training of front line staff, development of support centers, and training and respite for caregivers.

Suicide Among the Elderly. In keeping with the theme of suicide, Yeates Conwell delivered a plenary lecture on suicide in older adults, discussing prevention guidelines and the extent of the problem worldwide (about 1 million people commit suicide annually). He focused on the positive impact of social support as well as the negative impact of having a handgun relative to the rate of suicide. There seem to be few prevention programs that have targeted the elderly, and the need for further research in this area worldwide is evidence.

Neuropathological and Neurochemical Correlates in Dementia. George Grossberg, President-Elect of IPA, gave his plenary speech on the cholinergic deficits seen in the various dementias, and their potential contribution to behavioral symptoms. The presentation was databased and organized in such a way as to consider the implications for new treatments and future study.

Research in Psychogeriatrics. Alistair Burns’ address on Research in Psychogeriatrics really highlighted how diverse our research enterprises have become in the 21st century. He explained the contributions of geriatric psychiatry to the field of geriatrics with the work on molecular biology, development of assessment scales, clinical descriptions of syndromes and the natural history of illnesses, clinical pathology and neuroimaging, and the role in drug development and clinical trials. He provided examples of his team’s research that included assessment of effects of having a pharmacist in nursing homes. Physicians readily accepted many of the pharmacists’ recommendations, which in turn led to a decrease in costs and mortality. Another example illustrated the use of cognitive behavioral therapy in the elderly (it works). The research presented was as diverse as brain imaging to psychotherapy, but Burns stressed the importance of combining treatment modalities. A limitation of psychogeriatrics is that it takes a long time to get funding to complete the research and to publish results, but the benefits of following through on our research ideas tend to great benefits.

Elderly Suicide in China. Perhaps the highlight of the meeting was Helen Chiu’s presentation on Elderly Suicide in China, with a focus on the population in Hong Kong. Whilst there are nearly a million suicides worldwide each year, well over a fifth of them occur in China. The true elderly, women, and rural populations are over represented in the suicide rate. She gave an excellent discussion on the cultural aspects of suicide in China, and depictions of suicide in Chinese literature. Although suicide is not officially condoned, it is seen by many as being acceptable, and by some as a great moral act (such as the suicide of an elderly widow to defend her chastity). The suicide rate in Hong Kong, however, is more similar to that in Westernized nations, and has remained stable over the past 20 years. The rate of suicide in the elderly is high compared to the rest of the population, with about 50% associated with a primary mood disorder. She discussed the elderly suicide prevention programs that have been implemented in Hong Kong.

The Scientific Program Was Exceptional

Over the three days of the meeting there were an interesting assortment of symposia, oral presentations, lectures and poster sessions. Over 80 people were present at Jacobo Mintzer’s 7:30 a.m. breakfast symposium; that is very impressive for that early hour! Although I like to think that the outstanding attendance represents the quality of the presentation, it may also have reflected the level of jet lag and confusion among those of us who never really worked out what day or time it was. John O’Brien did not seem to be suffering from jet lag, and gave an interesting discussion on vascular depression, including the fact that “organic” factors are important in late-onset depression, and further addressing the link between vascular damage to the frontostriatal area and late-life depression. Zhang’s perspective on mild cognitive impairment was very interesting, including the response of half of study patients with MCI to Huperzine A, a kind of cholinesterase inhibitor which is widely used in China.

Post Sessions and Social Events

Post sessions showcased a range of topics including alcohol abuse, detection of oxidized protein in CSF in Alzheimer’s disease, genetic risk factors and age of onset of dementia in Down’s syndrome, association of tumor necrosis factor—alpha polymorphism and the risk of Alzheimer’s disease. The posters were submitted from a wide range of countries, including Canada, Japan, China, Sweden and the UK.

The gala dinner was a night to remember. There was so much wonderful food that we all had to try a bit of everything. It was amazing! We were charmed by the dancing of a not-so-ferocious lion, and then entertained by the truly talented IPA members singing for us, including Sandy Finkel; it would not be an IPA meeting without a song from Sandy. Tom Arie had opened the meeting by talking about the ‘yin and yang’ of geriatric psychiatry, and the meeting really addressed the pure science of old age psychiatry, as well as the importance of cultural issues and caring for the elderly.

Again, Helen Chiu and her remarkable team are to be congratulated for a truly fantastic meeting where she was able to showcase the cutting edge of geriatric psychiatry from around the world and the Asia Pacific Region.

Lesley Blake is the director of geriatric psychiatry at Northwestern University Medical School, and chief of geriatric psychiatry services at Northwestern Memorial Hospital in Chicago. Contact her at lblake@nmh.org.

Reprinted from IPA Bulletin, Volume 20, Number 1