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Anxiety and the risk of death in older men and women
- Authors:
- VAN HOUT Hein P., et al
- Journal article citation:
- British Journal of Psychiatry, 185(11), November 2004, pp.399-404.
- Publisher:
- Cambridge University Press
There are inconsistent reports as to whether people with anxiety disorders have a higher mortality risk. The aim was to determine whether anxiety disorders predict mortality in older men and women in the community. Longitudinal data were used from a large, community-based random sample (n=3107) of older men and women (55–85 years) in The Netherlands, with a follow-up period of 7.5 years. Anxiety disorders were assessed according to DSM–III criteria in a two-stage screening design. In men, the adjusted mortality risk was 1.78 (95% CI 1.01–3.13) in cases with diagnosed anxiety disorders at baseline. In women, no significant association was found with mortality. The study revealed a gender difference in the association between anxiety and mortality. For men, but not for women, an increased mortality risk was found for anxiety disorders.
The criterion validity of the Center for Epidemiological Studies Depression Scale (CES-D) in a sample of self-referred elders with depressive symptomatology
- Authors:
- HARINGSMA R., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(6), June 2004, pp.558-563.
- Publisher:
- Wiley
The criterion validity of the Center for Epidemiological Studies Depression scale (CES-D) was assessed in a group of elderly Dutch community-residents who were self-referred to a prevention programme for depression. Paper-and-pencil administration of the CES-D to 318 elders (55-85 years). Criterion validity was evaluated with the Mini International Neuropsychiatric Interview (MINI), a clinical diagnostic interview based on DSM-IV. Sensitivity and specificity for various cut-off scores of CES-D were compared with the DSM-IV major depressive disorder (MDD) and with clinically relevant depression (CRD), a composite diagnosis of MDD, subthreshold depression or dysthymia. Furthermore the characteristics of true versus false positives were analyzed. For MDD, the optimal cut-off score was 25, (sensitivity 85%, specificity 64%, and positive predicted value of 63%). For CRD, the optimal cut-off was 22 (sensitivity 84%, specificity 60%, and positive predicted value 77%). True positives, MDD and CRD, reported significantly more anxiety symptomatology and more co-morbid anxiety disorders, false positives reported more previous depressive episodes. The criterion validity of the CES-D for MDD and CRD was satisfactory in this semi-clinical sample of elders. Subjects scoring 25 constitute a target group for further diagnostic assessment in order to determine appropriate treatment.
Linkages between migration and the care of frail older people: observations from Greece, Ghana and the Netherlands
- Authors:
- VAN DER GEEST Sjaak, MUL Anke, VERMEULEN Hans
- Journal article citation:
- Ageing and Society, 24(3), May 2004, pp.431-450.
- Publisher:
- Cambridge University Press
There are at least four ways in which old age and migration cross each other's paths. First of all, there are people who migrated for economic reasons, usually at a relatively young age, and who have grown old in a foreign country. Secondly, there are older people who migrate when (or because) they are old: in Europe, they are mostly from the affluent northern countries and travel southward. Thirdly, there is increasing employment of, and demand for, immigrant workers in old-age institutions in the northern countries. Finally, there is the out-migration of young people, mainly from rural areas, that results in older people being left behind without children to look after them. In all these cases, migration has a profound effect on the wellbeing and care of older people. Explores a fifth linkage between migration and old age, by focusing on the (mainly illegal) immigrants who take on roles as private carers and, in effect, replace the children who have emigrated. Two cases, from Greece and Ghana, are presented and viewed in the two countries' political, cultural and economic contexts, and are then compared to conditions in the Netherlands. In both cases, involving a ‘stranger’ in the care of an older parent is regarded as a good and respectable solution to the problem of absent children and grandchildren: it follows rules of reciprocity and normally provides a good quality of care. Ironically, hiring full-time private care for older people is feasible in low-income countries but a rare luxury in high-income societies.
Minority elderly health and social care in Europe: summary findings of the minority elderly care (MEC) project
- Editors:
- PATEL Naina, (ed.)
- Publisher:
- Policy Research Institute on Ageing and Ethnicity
- Publication year:
- 2004
- Pagination:
- 13p.
- Place of publication:
- Bolton
This report, using data from the United Kingdom, France, Germany, the Netherlands, Spain, Finland, Hungary, Bosnia and Herzegovina, Croatia and Switzerland, is designed to inform and help plan the nature and direction of provision of health and social care services in the years to come. The project has the explicit intention of seeking to draw attention to the needs of minority ethnic (ME) elders and thereby improve the provision of services for them throughout Europe. Key findings showed that family was very important to ME elders in all countries and not surprisingly, most elders preferred to be looked after by their family in their own home. It is apparent that in every country there were significant proportions of ME elders on low incomes which were substantially less than the average incomes for elderly in the country concerned. In all countries there were quite significant proportions who described their general health as poor or very poor and these elders needed more medical treatment. The use of different health and social care services is not uniform across the different ethnic groups and countries. While each country has its own systems and procedures it is apparent that in all countries there are some elders who are failing to gain access to services. There are several things an organisation can do to help ME elders to overcome barriers and gain access to services. For example, information can be provided in appropriate languages, staff can be given training in culture-specific care, or new services may be designed specifically to meet the needs of different ME groups. The report makes several recommendations including the provision of clear information about the rights of the individual in accessing and using health and social care services and in different formats and languages. Adopt a person centred approach to patients and service users. Recognise that certain ethnic groups face particularly strong access barriers. Each of the issues is described in detail for each country included in the report.
Taking the community into the home
- Authors:
- NOTTER Joy, SPIJKER Truus, STOMP Koos
- Journal article citation:
- Health and Social Care in the Community, 12(5), September 2004, pp.448-452.
- Publisher:
- Wiley
The changing demographics of the population are such that there is an increasing need for care for frail older people with both physical and mental health problems. At the same time, the increased migration of workers and their families means that care provision now has to embrace a range of cultures. The present paper explores how the concept of cultural safety has importance for those planning and providing care for older adults. The recognition that removing individuals with mental health problems from their own environment causes increased disorientation and confusion has led to some organisations trying to maintain the community aspects of life when independent living is no longer possible. The present paper focuses on two such organisations in the Netherlands, demonstrating how they have changed their practice to improve and enhance the quality of life of their clientele through 'taking the community into the home'. Whilst sharing the same goals and aspirations, each organisation, serves a different population, and therefore, has developed a unique approach.
Supported living in residential homes for the elderly: impact on patients and elder care workers
- Authors:
- DELPA M. F. I. A., et al
- Journal article citation:
- Aging and Mental Health, 8(5), September 2004, pp.460-468.
- Publisher:
- Taylor and Francis
To enable older people with severe and persistent mental illness to live in the community, the Dutch mental health sector has developed a program for supported living in residential homes for the elderly. It provides for the permanent stationing of mental health workers (MHWs) in elder care facilities to support both the resident patients and the elder care staff. The authors examined associations between the number of MHW staff and the degree to which (1) patients were integrated into the community and (2) elder care workers had developed effective working alliances with their patients. Participants included 110 patients participating in 18 supported living programs in the Netherlands. Community integration was assessed in face-to-face interviews with the patients about their perceived influence over daily life, involvement in social activities, and social network size. The quality of the worker-patient relationship was assessed using the Dutch Working Alliance Questionnaire for Community Care, completed by the elder care worker primarily responsible for each patient. After differentiation of the MHW staff into medically trained and nurse-trained professionals, associations with outcome measures were found only for the nurse-trained staff. The more hours of nurse-trained staff capacity per patient, the more influence perceived by the patients, and the more directiveness shown by the elder care workers in their contacts with patients. The impact of supported living programs in residential homes for the elderly appears to be determined in part by the caseloads of the on-site MHWs.
Does depression in old age increase only cardiovascular mortality?: the Leiden 85-plus Study
- Authors:
- VINKERS David J., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(9), September 2004, pp.852-857.
- Publisher:
- Wiley
Depression in old age is associated with an increased mortality risk of cardiovascular disease but the mortality risk from non-cardiovascular causes is disputed. The authors prospectively followed 500 subjects from age 85 years onwards within the population-based Leiden 85-plus Study. Depressive symptoms were assessed annually with the 15-item Geriatric Depression Scale (GDS-15). Mortality risks were estimated in a Cox proportional-hazards model with the annual assessment of depression (GDS-154 points) as a time-dependent covariate. During 1654 person-years of follow-up (mean per person, 3.2 years), depression was associated with a two-fold increase of all cause mortality [Relative Risk (RR), 1.83; 95% Confidence Interval (CI), 1.24-2.69] that was not explained by comorbid conditions. Both cardiovascular mortality and non-cardiovascular mortality contributed equally to the excess mortality (RR 1.95 and 1.75 respectively). Depression in old age contributes to an increase of both cardiovascular and non-cardiovascular mortality. Motivational depletion may play an important role in the increased mortality in elderly with depression.
Effect of combined support for people with dementia and carers versus regular day care on behaviour and mood of persons with dementia: results from a multi-centre implementation study
- Authors:
- DROES Rose-Marie, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(7), July 2004, pp.673-684.
- Publisher:
- Wiley
A previous study in Amsterdam showed that combined family support in the Meeting Centres Support Programme, in which dementia patients and their carers are both supported by one professional staff member, is more effective in influencing behaviour problems and mood of dementia patients living in the community than non-integrated support, such as day care only. A multi-centre implementation study tests if similar effects are achieved in other regions of The Netherlands. A pretest-posttest control group design was applied. 112 dementia patients who visited psychogeriatric day care in eight community centres across the country and in three nursing homes, and their carers participated in the study. The 89 patients in the experimental group received support from the Meeting Centres Support Programme together with their carers, while the 23 people in the control group received day care only. Behaviour problems (aggressive behaviour, inactivity, non-social behaviour) and mood (dissatisfaction, depressive behaviour) were assessed using standardized observation scales. Quality of life was assessed by interviewing the patients. After 7 months the Meeting Centres Support Programme, compared to regular day care, showed a moderately positive effect on the degree of total behaviour problems, especially on inactivity and non-social behaviour, a large effect on depressive behaviour and a moderate effect on self-esteem. Participation in the programme seems to have a positive effect on self-esteem, an important aspect of quality of life. These findings confirm the surplus value of the combined family support in the Meeting Centres Support Programme as compared to regular day care for people with mild to severe dementia.
Depression in first generation labour migrants in Western Europe: the utility of the Center for Epidemiologic Studies Depression Scale (CES-D)
- Authors:
- SPIJKER J., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(6), June 2004, pp.538-544.
- Publisher:
- Wiley
The number of elderly migrants from Turkish and Moroccan descent in Western Europe will increase sharply in the coming decades. Identifying depressed elderly migrants necessitates a screening instrument that is both acceptable and has good psychometric properties. This study examines the utility of Turkish and Arabic translations of the Center for Epidemiologic Studies Depression Scale (CES-D) among elderly labour migrants from Turkish and Moroccan descent in the Netherlands. The data were derived from a community based health survey among 304 native Dutch, 330 Turkish and 299 Moroccan migrants, aged 55-74 years, living in Amsterdam, the Netherlands. Acceptability, reliability, convergent and construct validity were studied. Acceptability of the CES-D was satisfactory, although Moroccan migrants and Turkish females had difficulty answering one or more of the (interpersonal) items from the CES-D. Translated versions of the CES-D proved to be highly internal consistent and have good convergent validity in both Turkish and Moroccan elderly. Depressed and somatic items were much more intermingled in Turkish and Moroccan elderly compared to earlier studies and native Dutch elderly. This fits to the hypothesis that Turkish and Moroccan elderly migrants tend to somatize their depressive symptoms much more than native Western elderly. The utility of the CES-D for elderly migrants of Turkish and Moroccan descent was found to be satisfactory.
Whose empowerment and independence?: a cross-national perspective on ‘cash for care’ schemes
- Author:
- UNGERSON Clare
- Journal article citation:
- Ageing and Society, 24(2), March 2004, pp.189-212.
- Publisher:
- Cambridge University Press
Uses qualitative data from a cross-national study of ‘cash for care’ schemes in five European countries (Austria, France, Italy, the Netherlands and the United Kingdom) to consider the concepts of empowerment and independence in relation to both care-users and care-givers. Locates the schemes along two axes, one of regulation/non-regulation, the other whether relatives can be paid or not. Each of the schemes has a different impact both on the care relationship and on the labour market for care. In the Netherlands where relatives can be paid, for example, a fully commodified form of informal care emerges; but in Austria and Italy with low regulation, a mix of informal and formal care-givers/workers has emerged with many international migrant workers. In the UK, direct payments allow care-users to employ local care-workers who deliver care for various lengths of time; while in France a credentialised system means that care-work is delivered by qualified workers but for very short intervals. Concludes that none of these schemes have a simple outcome or advantage, and that the contexts in which they occur and the nature of their regulation has to be understood before drawing conclusions about their impact on empowerment and independence on both sides of the care relationship.