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Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care: a review
- Authors:
- DE LANGE E., VERHAAK P.F.M., VAN DER MEER K.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 28(2), 2013, pp.127-134.
- Publisher:
- Wiley
Although delirium is relatively common in hospitals, especially in intensive, post-operative and palliative care, its prevalence in the general population is only about 1-2%. The aim of this systematic review was to provide an overview, with the GP in mind, of prevalence, symptoms, risk factors and prognosis of delirium in primary care and institutionalised long-term care. The evidence confirms that the prevalence of delirium among the elderly aged 65+ years is 1–2%. It rises with age, reaching about 10% among a “general” population aged 85+ years. In populations with higher proportions of demented elders prevalence can be 22%. In long-term care, it ranges between 1.4% and 70%, depending on diagnostic criteria and on the prevalence of dementia. Age and cognitive decline are significant risk factors for delirium in all groups. In terms of prognosis, most studies agree that older people who previously experienced delirium have a higher risk of dementia and a higher mortality rate. Population and long-term care studies confirm this tendency. The authors conclude that although delirium in a non-selected population aged over 65 years is uncommon, prevalence rises quickly in selected older groups. They emphasise the need for primary care doctors to be aware of a relatively high risk of delirium among the elderly in long-term care, those over 85 years and those with dementia.
Development of a delirium risk screening tool for long-term care facilities
- Authors:
- McCUSKER Jane, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(10), October 2012, pp.999-1007.
- Publisher:
- Wiley
Delirium is a frequent and serious problem in long-term care (LTC) and post acute care facilities. The aim of this study was to develop a brief risk screening tool that would facilitate the targeting of interventions to high risk patients in LTC. The study involved residents aged 65 years and over, without delirium at baseline, living in seven LTC facilities in Montreal and Quebec City. Incident delirium was diagnosed using multiple data sources during the 6-month follow-up. Six risk factors were evaluated: sociodemographic, medical, cognitive status, physical function, agitated behaviour, and symptoms of depression. Among the cohort of 206 residents there were 69 cases of incident delirium (rate 7.6 per 100 person weeks). The best-performing screening tool comprised five items, with an overall area under the curve of 0.82. These items included brief measures of cognitive status, physical function, behavioural, and emotional problems. Using cut-points of 2 (or 3) over 5, the scale had a sensitivity of 90% (63%), specificity of 59% (85%), and positive predictive value of 52% (66%). The authors conclude that this brief screening tool allows nurses to identify LTC residents at increased risk for delirium.
Assisted living facility administrator and direct care staff views of resident mental health concerns and staff training needs
- Authors:
- DAKIN Emily, QUIJANO Louise, MCALISTER Courtney
- Journal article citation:
- Journal of Gerontological Social Work, 54(1), January 2011, pp.53-72.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Assisted living facilities (ALF) provide a long-term care option that combines housing, support services and health care. Previous research has indicated that mental illness is common in ALF residents, including severe mental illnesses such as schizophrenia. This paper describes a community needs assessment which aimed to examine: perceptions of mental health and behavioural concerns among ALF residents; direct care staff capacity to work with residents with mental illness; and direct care staff mental-health related training needs. Survey instruments were completed by 21 administrators and 75 direct care staff at 9 larger and 12 smaller ALFs in a northern Colorado country. The findings showed that administrators reported an average of 26.02% of residents with mental illness. Both administrators and direct care staff perceived the benefit of mental health training for direct care staff. Direct care staff perceived themselves as being more comfortable working with residents with mental illness than administrators perceived them to be. Implications for gerontological social work are discussed.
'Help me out, help me in': reprovisioning, resettlement and the scope for social inclusion in Scotland
- Author:
- SCOTTISH HOMES
- Publisher:
- Scottish Homes
- Publication year:
- 2000
- Pagination:
- 4p.
- Place of publication:
- Edinburgh
Study of resettlement in the community from long-stay hospitals, and the extent to which it has promoted inclusion
Challenging the system
- Authors:
- RAMON Shulamit, BROWN Martin
- Journal article citation:
- Community Care, 28.3.91, 1991, pp.21-23.
- Publisher:
- Reed Business Information
Reports on the development of mental health services for people with continuing care needs as part of the mental health specific grant.
Liaison psychiatry: the way ahead: briefing
- Author:
- NHS CONFEDERATION. Mental Health Network
- Publisher:
- NHS Confederation. Mental Health Network
- Publication year:
- 2012
- Pagination:
- 8p.
- Place of publication:
- London
People with a long-term physical health condition are more than twice as likely to have a mental health problem as the general population. This can have a huge effect on a patient’s chances of recovery; for example, someone with chronic heart failure is eight times more likely to die within 30 months if they also have depression. Liaison psychiatry services provide immediate access to specialist mental health support for people being treated for physical health problems, most often in general hospitals and in some cases, in the community. This reports finds that liaison psychiatry services can save an average hospital £5 million a year by reducing the number and length of admissions to beds. Even bigger savings could be achieved in future if liaison psychiatry services were extended to work in the community to prevent crises from happening at all.
Facility organizational and facility resident characteristics in nursing homes serving residents with a mental health history
- Authors:
- FRAHM Kathryn, et al
- Journal article citation:
- Journal of Social Service Research, 37(1), January 2011, pp.61-72.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Nursing homes have been identified as the primary source of institutional care for older adults with a mental health history, and to have a higher prevalence of mental health disorders among their residents compared to older people in the community. The purpose of this study was to identify characteristics among nursing homes serving residents with a mental health history, and to examine the characteristics of the facilities that serve this population. A retrospective, cross-sectional design was conducted using the 2003 national Online Survey, Certification, and Reporting facility data merged with the resident-level Minimum Data Set resulting in 2,499 nursing homes. Across these facilities, 22% of the total residents had a diagnosis of a mental disorder not including any form of dementia. Among those with a mental health history, 53% of facility residents had depression, 37% had schizophrenia, 19% had anxiety disorder, and 15% had manic depression. Nursing homes serving people with a mental health history are more likely to be for profit, have a greater number of beds, have lower occupancy rates, and have more residents with Medicaid as the primary payer. This information can be used to inform nursing home practice and policy to ensure adequate mental health care provision.
Perceptions of the need for social work in assisted living facilities
- Author:
- VINTON Linda
- Journal article citation:
- Journal of Social Work in Long-Term Care, 3(1), 2004, pp.85-100.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
A growing number of assisted living facilities (ALFs) in the United States are caring for elders with disabilities. Residents often need a broad array of supports as their physical, mental, and social functioning declines. The need for social work competencies was examined in this study of 140 ALF administrators. The 31 competencies were borrowed from the CSWE/SAGE-SW National Competencies Survey Report. Only 17 of the respondents employed professional social workers but facilities with social workers were significantly more likely to offer bereavement, crisis, family, and substance abuse counseling. The majority of administrators agreed that social work competencies could be useful in their facilities; however, non-social workers appeared to be performing many of these tasks. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Emergency referrals to an acute psychiatric service: demographic social and clinical characteristics and comparisons with those receiving continuing services
- Authors:
- HATFIELD Barbara, SPURRELL Mark, PERRY Amanda
- Journal article citation:
- Journal of Mental Health, 9(3), June 2000, pp.305-317.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
The characteristics of individuals referred to psychiatric emergency services serve as one indicator of the functioning of the service system as a whole. A two-month cohort of emergency referrals is described and comparisons made with a Community Mental Health Team (CMHT) caseload group. The characteristics of the individual, dimensions of the crisis, and the outcome of the emergency assessment were recorded in each case. The study raises the issue of whether prioritising of specialist mental health services to those with severe and enduring mental illness serves to exclude other vulnerable groups. Whilst most individuals in the study had a history of episodic psychiatric contact, many would be likely to satisfy the criteria for continuing support. Some may only have transient needs related to the life crisis; for others with more chronic difficulties, an emergency response alone cannot be expected to make an impact.
Use of community and long-term care by people with dementia in the UK: a review of some issues in service provision and carer and user preferences
- Author:
- MORIARTY J.M.
- Journal article citation:
- Aging and Mental Health, 3(4), November 1999, pp.311-319.
- Publisher:
- Taylor and Francis
In the UK, one of the effects of the National Health Service and Community Care Act 1990 has been to highlight the impact of policy changes and changes to service organisation upon the types and levels of service provision. However, much of the existing literature on the use of community and long-term care services by people with dementia is based upon data collected prior to the implementation of the Act. The article identifies some of the methodological issues and highlights the increasing importance that is likely to be attached to incorporating the service preferences of people with dementia and their carers in the future.