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The association between depression, anxiety, and cognitive function in the elderly general population - the Hordaland Health Study
- Authors:
- BIRINGER Eva, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(10), October 2005, pp.989-997.
- Publisher:
- Wiley
The participants in this study were 1,930 non-demented participants from the general population aged 72-74 years. Symptoms and caseness of depression and anxiety disorder were assessed using the Hospital Anxiety and Depression Scale (HADS). Cognitive function was assessed by the Digit Symbol Test (modified version), the Kendrick Object Learning Test, and the S-task from the Controlled Oral Word Association Test. The results found a significant association between depression and reduced cognitive function. The inverse association between anxiety and reduced cognitive performance was explained by adjustment for co-morbid depression. The inverse association between depressive symptoms and cognitive function was found to be close to linear, and was also present in the sub-clinical symptom range. Males were more affected cognitively by depressive symptoms than females. The inverse association between depression and cognitive function is not only a finding restricted to severely ill patient samples, but it can also be found in the elderly general population.
The role of voluntary organizations in the care of the elderly in Norway
- Author:
- AMOAKO-ADDO Yaw
- Journal article citation:
- Journal of Aging and Social Policy, 17(1), 2005, pp.83-102.
- Publisher:
- Routledge
- Place of publication:
- Philadelphia, USA
This paper describes the contributions of voluntary organizations to the provision of social services for the elderly in Norway. It presents data on the volume of social services provided by Norwegian voluntary organizations and discusses the recognition that the central government gives to such organizations, as well as the conditions for supporting voluntary organizations in the Norwegian welfare state. The analysis indicates the scope of the contributions made by these organizations in caring for older people. Though the size of contributions made by the voluntary organizations has been declining rapidly in recent years, the Norwegian government still recognizes their past contributions and the role they can play within the framework of the welfare state's social services for the aged. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580)
Are nursing home patients with dementia diagnosis at increased risk for inadequate pain treatment?
- Authors:
- NYGAARD Harald A., JARLAND Marit
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(8), August 2005, pp.730-737.
- Publisher:
- Wiley
Mentally impaired and demented nursing home patients are at increased risk of under-treatment for pain. This study examines pain assessment and complaints and pain treatment of nursing home patients according to mental state, and with special regard to treatment of patients with dementia diagnosis and cognitively impaired patients who did not have a dementia diagnosis. Cross sectional study from three nursing homes in Bergen, Norway including 125 persons (median age 84 years), living permanently in a nursing home was carried out. Diagnoses and prescribed and administered analgesic drugs were recorded. An experienced nurse interviewed nurses in charge and patients regarding presence of pain during the last week. Patients who were able to answer whether they had experienced pain during the last week were categorised as communicative. Cognitive function was assessed by means of the Abbreviated Mental Test. Seventeen percent of the patients were cognitively intact, 30% cognitively impaired and 54% had a dementia diagnosis. Forty-seven percent of communicative patients complained of pain, nurses reported pain in 67% patients. Twenty-nine percent of the patients had received scheduled analgesics during the last week, cognitively intact patients 38%, cognitively impaired 30%, demented 25%. Twenty percent were given analgesics PRN: cognitively intact patients 33%, cognitively impaired 27%, demented 12%. Logistic regression analyses revealed that patients with dementia diagnosis were less likely to receive PRN medication compared to mentally impaired patients. Regarding scheduled medication there was no difference between the groups. Nurses' opinion of pain was a significant factor for receiving analgesic drugs. The study concludes that a label of dementia may bias the interpretation of pain cues of demented patients, while complaints from cognitively impaired patients may be taken for granted. This may contribute to lower use of PRN medication in demented patients compared to cognitively impaired patients.
The Spielberger State-Trait Anxiety Inventory (STAI): the state scale in detecting mental disorders in geriatric patients
- Authors:
- KVAAL Kari, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(7), July 2005, pp.629-634.
- Publisher:
- Wiley
In geriatric psychiatry assessment scales are often used in clinical praxis in the diagnostic work-up of mental disorders. This study aimed to assess whether the state part of the STAI is useful as a case-finding instrument of mental disorders. Data came from 70 non demented geriatric in-patients in stable clinical condition. Mean age was 83.3 years (range 64-96), and 74.3% were women. The 20-item STAI state instrument was used to measure current anxiety symptoms. Without knowledge of the score on STAI state a psychiatrist examined all patients and set diagnosis according to DSM-IV-TR criteria, but hierarchical rules were not used. Sensitivity, specificity, Likelihood ratio and accuracy were calculated for different cut-points of the mean sumscore on the STAI state. The mean STAI sumscore in this group was 56.3 compared with 39.2 in the 59 patients without any psychiatric diagnosis. The authors concluded that the STAI state scale is a useful instrument for detecting a variety of mental disorders in older people and recommend that further studies should be carried out in different populations.
The effect of staff training on the use of restraint in dementia: a single-blind randomised controlled trial
- Authors:
- TESTAD L., AASLAND A.M., AARSLAND D.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(6), June 2005, pp.587-590.
- Publisher:
- Wiley
The aim of this study was to reduce problem behaviour and the use of restraint in demented patients using a staff training program as intervention. The study was a randomised single-blind controlled trial and took place in Stavanger, Norway. Four nursing homes were randomised to a control or an intervention group after stratification for size. The intervention consisted of a full day seminar, followed by a one-hour session of guidance per month over six months. The content of the educational program focused on the decision making process in the use of restraint and alternatives to restraint consistent with professional practice and quality care. The primary outcome measures were number of restraints per patient in the nursing homes in one week and agitation as measured with the Brief Agitation Rating Scale (BARS). These were rated before and immediately after the intervention was completed. The assessments were performed blind to design and randomisation group. Results found clinical and demographic variables did not differ between the intervention and control groups at baseline. After the intervention period, the number of restraints had declined by 54 percent in the treatment group, and increased by 18 percent in the control group. Although the level of agitated behaviour remained unchanged or increased slightly, the educational program led to a significant reduction of the use of restraint in institutionalised elderly with dementia. These results suggest that educational programs can improve the quality of care of people with dementia.