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Major depression as a risk factor for early institutionalization of dementia patients living in the community
- Authors:
- DORENLOT Pascale, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(5), May 2005, pp.471-478.
- Publisher:
- Wiley
Although depression is known to be frequently associated with dementia, it is nonetheless under-diagnosed and under-treated among this patient population. Its effect on outcome for dementia patients is thought to be substantial, because depression appears to induce higher than normal rates of disability as well as supplementary cognitive decline. The aim of this study was to measure the impact of major depression on the institutionalization rate of community-dwelling dementia patients. Three-hundred forty-eight consecutive dementia outpatients of a geriatric clinic (mean age: 81 years, 69.8% women, 65.5% dementia of Alzheimer's type, mean baseline MMSE score: 20.5), followed between 1997 and 2002 (mean follow-up: 20.5 months). Twenty-five percent of the patients met the criteria of major depression at baseline, and only 30.3% of these received antidepressant medication. Major depression at baseline was independently associated with nursing home admission within one year of the baseline assessment. Antidepressant medication tended to protect against this outcome, but not to a statistically significant extent. Major depression at baseline is an independent risk factor for early institutionalization of dementia sufferers. Early institutionalization is defined in this study as nursing home placement within a year of diagnosis with dementia at our specialized outpatient center. The study highlights the need for better management of depression among dementia outpatients. Further investigation is needed to evaluate the protective effect of antidepressant medication (and/or non-pharmacological therapies) on the institutionalization rate.
Ageing and employment policies: France
- Author:
- ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT
- Publisher:
- Organisation for Economic Co-operation and Development
- Publication year:
- 2005
- Pagination:
- 165p., bibliog.
- Place of publication:
- Paris
In the face of rapid population ageing and the trend towards early retirement, there is a need to promote better employment opportunities for older people. Much has been said about the need for reform of old-age pensions and early retirement schemes but this may not be sufficient to raise employment rates for older people significantly or to reduce the future risk of labour shortages. Both governments and firms will need to take active measures to adapt wage-setting practices to ageing workforces, to address the extent to which other welfare schemes act as pathways to early retirement, to tackle age discrimination and to improve the job skills and working conditions of older workers. In addition, older workers will need to change their own attitudes towards working longer and acquiring new skills. Little is known about what countries have been doing or should be doing in these areas. This report on France is part of a series of around 20 OECD country reports that are intended to fill this gap. Each report contains a survey of the main barriers to employment for older workers, an assessment of the adequacy and effectiveness of existing measures to overcome these barriers and a set of policy recommendations for further action by the public authorities and social partners.
Cost-benefit analysis in social care for elderly people
- Author:
- DUTRENIT Jean-Marc
- Journal article citation:
- Evaluation Review, 29(5), October 2005, pp.389-406.
- Publisher:
- Sage
Social care at home for elderly people is now growing rapidly in France. The research presented here, and made for the Comity of Lille Employment Area with cooperation of the Caisse Primaire d’Assurance Maladiede Lille (the local board of the national social security system), attempts to discover 'What kind of social activities could stimulate good health for elderly people measured by lower cost of pharmacy expenditures?'. The results found that ceteris paribus, cultural activities - in a group or at home - versus others appear to produce more interest for elderly, professional caregivers, and the rest of society.
Dignity and older people
- Authors:
- ARINO-BLASCO Sergio, TADD Win, BOIX-FERRER Josep Antoni
- Journal article citation:
- Quality in Ageing, 6(1), June 2005, pp.30-36.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
This article deals with professionals' views concerning the importance of dignity for older people and how this can best be maintained. Overall, participants painted a negative picture of the lives of older people, although clear distinctions were drawn between fit and frail older people. Indignities associated with old age arose from ill health, dependency, vulnerability, frailty and loss of competence. It was considered that technological advances made older people seem left behind. However, many described working with this age group as an enjoyable experience. Professionals identified the following factors as essential to dignified care: promotion of autonomy and independence,; a person-centred and holistic approach; maintenance of identity and encouragement of involvement; participation and empowerment; effective communication and respect. Undignified care was associated with invisibility, de-personalisation, abuse, humiliation and narrow and mechanistic approaches to care.
Dignity and older Europeans: methodology
- Authors:
- CALNAN Michael, TADD Win
- Journal article citation:
- Quality in Ageing, 6(1), June 2005, pp.10-16.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
Describes the methods used within the Dignity and Older Europeans (DOE) Project and in particular the approach involved in developing the bibliographical database, the philosophical methods used in creating the theoretical model of dignity, together with the empirical methods involved in data collection with older people, health and social care practitioners and the younger and middle-aged adults. The article attempts to provide the reasoning for the chosen methods and highlight some of the difficulties involved in carrying out comparative cross-cultural research.
Dignity: the voice of older people
- Authors:
- BAYER Tony, TADD Win, KRAJCIK Stefan
- Journal article citation:
- Quality in Ageing, 6(1), June 2005, pp.22-29.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
Reports on the findings of 89 focus group and individual interviews, involving 391 people aged 61plus in six European countries. The study was carried out with the aim of exploring how older people view human dignity in their lives. It was seen as highly relevant and important concept, enhancing self-esteem, self-worth and wellbeing. Three major themes were identified: respect and recognition; participant and involvement; and dignity in care. The empirical data reflected the theoretical model of human dignity in that it considered the dignity of personal identity as of importance and relevance. In conclusion, the authors assert that for the dignity of older people to be enhanced, communication issues, privacy, personal identity and feelings of vulnerability need to be addressed.
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.
Policies for the ageing society: report of a seminar held at Church House, London 15 June 2005
- Author:
- JOHNSON Christopher
- Publisher:
- Franco British Council
- Publication year:
- 2005
- Pagination:
- 16p.
- Place of publication:
- London
The ageing society has become a major topic of research, discussion and policy-making. The report focuses on two broad topics: the work-life balance, and the welfare of older people. Society needs to change its attitude towards older people, seeing them as a potential resource rather than a burden. Governments have an important role to play, but a wider dialogue involving employers, trade unions, and non-governmental organizations is needed as well. Greater flexibility is needed in finding the right work-life balance for each individual, on the part of employers as well as employees, allowing part-time work or self-employment after pension age. Later retirement should be encouraged by stronger financial incentives than at present. Products and services should be adapted to benefit people of all age groups, for example domestic appliances. Mobility is a key factor in health and welfare for older people. Traffic lights with longer crossing times and more user-friendly public transport should be introduced. Housing policy in both countries needs to provide for a big increase in the number of households skewed towards older people. Older people could help each other or the younger generations as carers, educators and mentors.
Dignity and older people: the voice of society
- Authors:
- STRATTON David, TADD Win
- Journal article citation:
- Quality in Ageing, 6(1), June 2005, pp.37-45.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
This article describes the findings of a focus group study designed to discover young and middle aged attitudes towards the subject of age and dignity. 89 focus groups were carried out with 505 participants aged between 13 and 59 years from the UK, Ireland, Spain, France, Slovakia and Sweden. The results confirmed that dignity was important to people of all ages but particularly to older people. Being treated as an individual was critical for the maintenance of dignity. In the participating countries older people were generally treated negatively and undervalued and seen as vulnerable, second-class citizens. Old age was seen as a time for physical and mental deterioration, poverty and dependency. Suggestions for enhancing dignity included greater public awareness about dignity for older people and existing care and support services. Health policies should also tackle ageism in service provision and the developments of standards in health and social care.
Older patients undergoing dialysis treatment: cognitive functioning, depressive mood and health-related quality of life
- Authors:
- TYRRELL J., et al
- Journal article citation:
- Aging and Mental Health, 9(4), July 2005, pp.374-379.
- Publisher:
- Taylor and Francis
An increasing number of older patients receive dialysis treatment to compensate for deficient kidneys due to end-stage renal disease (ESRD). Ethical questions arise about the benefits of dialysis when a patient appears unwilling or unable to comply with this treatment procedure. Such attitudes and behaviour may be due to psychological factors, but these are not routinely assessed. The purpose of this study was to evaluate levels of cognitive impairment, depressive mood and self-reported quality of life in older dialysis patients (>70 years). A total of 51 outpatients receiving dialysis were assessed by psychologists, using a depression scale (MADRS), two cognitive tests (MMSE and BEC 96), and a quality of life questionnaire (NHP). Sixty percent of the patients were depressed, and between 30–47% had cognitive impairment. Almost half of the depressed patients were also cognitively impaired. The scores for self-reported quality of life varied widely within the sample. Cognitive impairment and depressive mood are often overlooked and underestimated in this population. Regular assessments of depressive mood, cognitive ability and quality of life are recommended, given the prevalence of problems in these domains for older dialysis patients. The information obtained should assist staff as they reflect on individual cases where the benefits of continuing treatment are being examined.