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Diagnostic accuracy of the original 30-item and shortened versions of the Geriatric Depression Scale in nursing home patients
- Authors:
- JONGENLIS K., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(11), November 2005, pp.1067-1074.
- Publisher:
- Wiley
The aim was to determine the diagnostic accuracy of the 30-item and shortened versions of the Geriatric Depression Scale (GDS) in diagnosing depression in older nursing home patients. Three hundred and thirty-three older nursing home patients participated in a prospective cross-sectional study in the Netherlands. Sensitivity and specificity, positive and negative predictive values, and the area under the receiver operating curve (ROC) were assessed. Cronbach alphas were also calculated. Both major depression (MDD) and minor depression (MinD) according to the DSM-IV criteria, measured with the Schedules of Clinical Assessment in Neuropsychiatry (SCAN), were used as gold standard. The cut-off point 11 on the GDS-30 gave a sensitivity of 96.3% for MDD and 85.1% for MinD, with a specificity of 69.1%. The sensitivity of most of the shortened versions was sufficient, varying between 88.9% and 100% for MDD, and between 63.8% and 97.9% for MinD. With regard to the shortened versions, best sensitivity (96.3% and 78.7%) and specificity (69.5%) were found for the GDS-10 developed by D'Ath et al. (1994). The specificity rates for most of the shortened versions were found to be less satisfactory, varying between 18.9% and 74.1%. Sufficient internal consistency was found for the GDS-30, the GDS-15, the GDS-12 and the GDS-10, with Cronbach's alphas varying between 0.88 and 0.72. The GDS-30 was found to be a valid and reliable case-finding tool for both major and minor depression in nursing home patients with no cognitive impairment and in patients with mild to moderate cognitively impairment (MMSE 15). The GDS-10 (D'Ath et al., 1994) appeared to be the best least time-consuming alternative for the nursing home setting.
Predicting transitions in the use of informal and professional care by older adults
- Authors:
- GEERLINGS Sandra, et al
- Journal article citation:
- Ageing and Society, 25(1), January 2005, pp.111-130.
- Publisher:
- Cambridge University Press
To prepare the care system for a rising population of older people it is important to understand what factors predict the use of care. This paper reports a study of transitions in use of informal and professional care using Andersen-Newman models of the predictive predisposing, enabling and need factors. It draws on Longitudinal Ageing Study Amsterdam data on care use and contextual factors. Data were collected at 3-yearly intervals from a random sex- and age-stratified population-based sample of adults aged 55-85. In summary, findings for those who initially did not receive care were that almost one-third received some kind 3 years later, most provided by informal carers. Need factors were important predictors of most transitions, and predisposing and enabling factors, such as age, partner status and income also played a role. On the relationship between informal and professional care, evidence was found for both 'compensatory processes (informal substitutes for professional care) and 'bridging processes' (informal care facilitates professional care). In view of the increasing discrepancy between the demand for professional care and supply, the significant impact of predisposing and enabling factors offers opportunities for intervention.
Prevalence of depression in older patients consulting their general practitioner in the Netherlands
- Authors:
- LICHT-STRUNK Els, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(11), November 2005, pp.1013-1019.
- Publisher:
- Wiley
Data of The West Friesland Study were used. Five thousand, six hundred and eight-six GP attendees of 55 years and older filled in the Geriatric Depression Scale - 15 items as a screening instrument for depression (response 62%). Of those screened positive on the GDS-15, 846 (77.5%) were interviewed using the Primary Care Evaluation of Mental Disorders (PRIME-MD). A random sample of 102 patients scoring below the threshold of the GDS-15 was interviewed to estimate the proportion of false negatives. Major depression was prevalent in 13.7% and minor depression in 10.2% of the patients. Depressed patients were older, more often female and lived more often in urban districts. Patients with major depression were younger and more often female than those with a minor depression. Only 22.9% of the patients with a major depression were treated with antidepressants. Depression in older GP attendees is a very common health problem. Further research should focus on identifying those groups of patients with high risk of persistence of depression. This could help to focus the limited resources available in general practice to those patients in whom treatment is most urgently needed.
Creative reminiscence as an early intervention for depression: results of a pilot project
- Authors:
- BOHLMEIJER E., et al
- Journal article citation:
- Aging and Mental Health, 9(4), July 2005, pp.302-304.
- Publisher:
- Taylor and Francis
Reminiscence may help in resolving conflicts from the past and making up the balance of one's life. Life-review may be further enhanced by the creative expression of memories in stories, poems or drawings. In this way people are encouraged to create and discover metaphors, images and stories that symbolically represent the subjective and inner meaning of their lives. In this article, a new intervention, which combines reminiscence and creative expression aimed at early treatment of depression, is described. A pilot project showed that the intervention Searching for the meaning in life may generate small-sized effects in reducing depression. Additionally, it appears to generate effects of medium size in enhancing mastery. Several possible ways to improve the effectiveness of the intervention are described.
Depressive disorders in caregivers of dementia patients: a systematic review
- Author:
- CUIJPERS P.
- Journal article citation:
- Aging and Mental Health, 9(4), July 2005, pp.325-330.
- Publisher:
- Taylor and Francis
Although depressive symptomatology has been well studied in caregivers of patients with dementia, depressive disorders have been examined much less. We conducted a systematic literature search in major bibliographical databases (Medline, Psychinfo, Dissertation Abstracts), and included studies examining caregivers of dementia patients that reported the prevalence of major depressive disorder, according to diagnostic criteria as assessed with a standardized psychiatric diagnostic interview. Ten studies with a total of 790 caregivers were identified (sample sizes: 22–147). In only one of the studies, a representative community sample was used. A total of 176 subjects (22.3%) had a depressive disorder (prevalence range from 0.15–0.32). In the three studies reporting differential prevalence rates for men and women somewhat smaller prevalence rates were found for men than for women. In six studies caregivers were compared to a (mostly matched) control group. The relative risks of having a depressive disorder in caregivers ranged from 2.80–38.68 (all RR's were significant). In the three prospective studies relatively high incidence rates were found (0.48). This study made it clear that prevalence and incidence of depressive disorders are increased in caregivers of dementia patients. More research is clearly needed in this population.
The sensitivity of somatic symptoms in post-stroke depression: a discriminant analytic approach
- Authors:
- DE COSTER Liesbeth, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(4), April 2005, pp.358-362.
- Publisher:
- Wiley
Somatic and neurocognitive symptoms of depression may overlap with the physical symptoms of stroke, and thus make the diagnosis of post-stroke depression difficult. The aim was to assess the sensitivity of individual depressive symptoms and their contribution to the diagnosis of post-stroke depression. Two hundred and six patients with first-ever stroke, participating in a longitudinal study, were administered the Structured Clinical Interview for DSM-IV and the Hamilton Depression Rating Scale (HAM-D). In a discriminant analysis the relative contribution of the individual HAM-D items to the diagnosis of major depressive disorder was evaluated. The cumulative incidence of post-stroke major depressive disorder was 32%. The discriminant model based on HAM-D item scores was highly significant (p<0.001) and classified 88.3% of patients correctly as depressed or nondepressed. As expected, depressed mood discriminated best between depressed and non-depressed stroke patients. Reduced interests had a relatively low sensitivity and may in part reflect apathy, which often is considered a separate construct. With the exception of suicidal thoughts, most psychological symptoms, such as hypochondriasis, lack of insight and feelings of guilt, were not very sensitive. Some somatic symptoms, such as reduced appetite, psychomotor retardation, and fatigue had high discriminative properties. Psychological, neurocognitive and somatic symptoms of depression differ among themselves in terms of diagnostic sensitivity, and should be considered individually. Some somatic symptoms are highly sensitive for depression and should not be neglected by following an exclusive or attributional approach to the diagnosis of PSD.
Self-Injurious behaviour in nursing home residents with dementia
- Authors:
- de JONGHE-ROULEAU Adrienne P., POT Anne Margriet, de JONGHE Jos. F.M.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(7), July 2005, pp.651-657.
- Publisher:
- Wiley
This study used a cross-sectional study of 110 nursing home patients with dementia in the West of the Netherlands. Nurses' ratings of SIB and other behavioural disturbances were compared to independent resident physician ratings of medical charts data pertaining to dementia type, dementia severity, prescribed psychotropic drugs, immobility and measures to restrain the patient. Instruments used were the Overt Aggression Scale (OAS, modified), Behaviour Rating Scale for Psychogeriatric Inpatients (GIP), Rating scale for Older Patients (BOP). SIB was observed in 22% of the dementia patients. Pinching or scratching oneself and banging one's fist against objects were most frequently reported. Five patients showed a combination of two types of SIB. As expected, SIB was modestly related to Aimless repetitive behaviour and Aggression and no association was found between SIB and Apathy. Correlates of SIB were prescribed psychotropics (i.e. benzodiazepines), immobility and measures to restrain the patient. This preliminary data suggest that SIB is a specific psychopathological phenomenon that is highly prevalent in nursing home patients with dementia. Future research should focus on the aetiology and treatment of SIB.
Look for what you can do, not for what you cannot: an international study of working across boundaries in the care of older people
- Author:
- EDWARDS Amanda
- Publisher:
- University of Leicester
- Publication year:
- 2005
- Pagination:
- 163p.,bibliog.
- Place of publication:
- Leicester
"The subject of this study is managing boundaries in the care of older people; within and between organisations, between different levels of government [and] between professions and disciplines" - from the introduction. Countries visited were: Germany; Denmark; United States; Italy; Netherlands; and Australia.
Understanding obstacles to the recognition of and response to dementia in different European countries: a modified focus group approach using multinational, multi-disciplinary expert groups
- Authors:
- ILIFFE S., et al
- Journal article citation:
- Aging and Mental Health, 9(1), January 2005, pp.1-6.
- Publisher:
- Taylor and Francis
Experts from eight European countries (Belgium, France, The Netherlands, Ireland, Italy, Portugal, Spain and the United Kingdom) and the disciplines of clinical psychology, general practice, geriatric medicine, old age psychiatry, medical sociology, nursing and voluntary body organisation met in 2003 to explore obstacles to recognition of and response to dementia in general practice within Europe. A modified focus group methodology was used in this exploratory process. Groups were conducted over a two-day period, with five sessions lasting 1-1.5 hours each. An adapted nominal group method was used to record themes arising from the group discussion, and these themes were used in a grounded theory approach to generate explanations for delayed recognition of and response to dementia. The overarching theme that arose from the focus groups was movement, which had three different expressions. These were: population movement and its consequences for localities, services and professional experience; the journey of the person with dementia along the disease process; and the referral pathway to access services and support. Change is the core issue in dementia care, with multiple pathways of change that need to be understood at clinical and organisational levels. Practitioners and people with dementia are engaged in managing emotional, social and physical risks, making explicit risk management a potentially important component of dementia care. The boundary between generalist and specialist services is a particular problem, with great potential for dysfunctionality. Stigma and ageism are variably distributed phenomena both within and between countries.
The last 3 months of life: care, transitions and the place of death of older people
- Authors:
- KLINKENBERG Marianne, et al
- Journal article citation:
- Health and Social Care in the Community, 13(5), September 2005, pp.420-430.
- Publisher:
- Wiley
This study investigated the care received by older people in the last 3 months of their life, the transitions in care and the predictors of place of death. In this population-based study, interviews were held with 270 proxy respondents to obtain data on 342 deceased participants (79 percent response rate) in the Longitudinal Aging Study Amsterdam. In the last 3 months of life, the utilisation of formal care increased. Half of the community-dwelling older people and their families were confronted with transitions to institutional care, in most cases to hospitals. Women relied less often on informal care only, and were more dependent than men on institutional care. For people who only received informal care, the odds of dying in a hospital were 3.68 times the odds for those who received a combination of formal and informal home care. The chance of dying in a hospital was also related to the geographical region.