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Examination of cognitive and instrumental functional performance as indicators for driving cessation risk across 3 years
- Authors:
- ACKERMAN Michelle, et al
- Journal article citation:
- Gerontologist, 48(6), December 2008, pp.802-810.
- Publisher:
- Oxford University Press
The purpose of this study was to prospectively examine the role of cognitive and instrumental functional performance in driving cessation while simultaneously accounting for any contributions of demographics, vision, physical performance, and health among a sample of older adults without dementia. Included in the analyses were 1,838 participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study who were drivers at baseline and completed the third-year assessment. Participants completed baseline assessments of sociodemographic characteristics, health, sensory function, physical function, cognitive abilities, instrumental functional performance, and depressive symptoms. Driving status was again ascertained 3 years later. Cox proportional hazard analyses to examine prospective predictors of driving cessation over a 3-year period. The final model indicated four significant risk factors for driving cessation: older age, poorer balance as measured by the Turn 360° test, slower cognitive speed of processing as measured by the Useful Field of View test, and poorer instrumental functional performance as assessed by the Everyday Problems Test. Although vision, health, and physical abilities are commonly considered when determining driving capacity, cognitive speed of processing and instrumental functional performance may be better indicators of subsequent likelihood of driving cessation across 3 years among older adults. Poor health and vision may only impact driving cessation to the extent that cognitive speed of processing and instrumental functioning are affected.
Guidance on: the assessment of pain in older people
- Authors:
- BRITISH PAIN SOCIETY, BRITISH GERIATRICS SOCIETY
- Publishers:
- British Pain Society, British Geriatrics Society
- Publication year:
- 2008
- Pagination:
- 36p.
- Place of publication:
- London
The British Pain Society has worked with the British Geriatrics Society and the Royal College of Physicians to produce new concise guidance on 'The assessment of pain in older people'. The guidelines have been developed to provide: recommendations in simple and clear terms for assessing pain in all older people; several types of scales that can be photocopied and used to assist in assessments, to monitor progress and evaluate the effect of treatment; and an algorithm for simple implementation of the guidance.
A semi-structured interview to assess visual hallucinations in older people
- Authors:
- MOSIMANN Urs Peter, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(7), July 2008, pp.712-718.
- Publisher:
- Wiley
Visual hallucinations are under-reported by patients and are often undiscovered by health professionals. There is no gold standard available to assess hallucinations. The authors' objective was to develop a reliable, valid semi-structured interview for identifying and assessing visual hallucinations in older people with eye disease and cognitive impairment. They piloted the North-East Visual Hallucinations Interview (NEVHI) in 80 older people with visual and/or cognitive impairment (patient group) and 34 older people without known risks of hallucinations (control group). The informants of 11 patients were interviewed separately. They established face validity, content validity, criterion validity, inter-rater agreement and the internal consistency of the NEVHI and assessed the factor structure for questions evaluating emotions, cognitions, and behaviours associated with hallucinations. Recurrent visual hallucinations were common in the patient group (68.8%) and absent in controls (0%). The criterion, face and content validities were good and the internal consistency of screening questions for hallucinations was high (Cronbach alpha: 0.71). The inter-rater agreements for simple and complex hallucinations were good (Kappa 0.72 and 0.83, respectively). Four factors associated with experiencing hallucinations (perceived control, pleasantness, distress and awareness) were identified and explained a total variance of 73%. Informants gave more don't know answers than patients throughout the interview, especially to questions evaluating cognitions and emotions associated with hallucinations. It was concluded that NEVHI is a comprehensive assessment tool, helpful to identify the presence of visual hallucinations and to quantify cognitions, emotions and behaviours associated with hallucinations.
The usability of the Northern Ireland single assessment tool for the health and social care of older people
- Author:
- MCCORMACK B.
- Publisher:
- Northern Ireland. Department of Health, Social Services and Public Safety
- Publication year:
- 2008
- Pagination:
- 30p., bibliog.
- Place of publication:
- Belfast
The Northern Ireland Single Assessment Tool (NISAT) was developed for the National Service Framework for Older People. This comprised of three stands (Contact Screening, Core and Complex Assessment) supported by a number of specialists assessments (such as G.P assessment, Carers assessment, Specialist Assessment Summary). The NISAT was developed through a participatory process of engagement with front-line staff, and had acceptable psychometric properties. This study examined users options regarding the usability of the three components of the NISAT and invited comments on how best to implement training across the province. Assessors were given the opportunity to use the NISAT with a purposive sample of older people. The findings informed discussion with assessors regarding training, its structure, contents and format.
The reliability of the core element of the Northern Ireland single assessment tool (NISAT) for the health and social care of older people
- Authors:
- MCCORMACK B.G., et al
- Publisher:
- Northern Ireland. Department of Health, Social Services and Public Safety
- Publication year:
- 2008
- Pagination:
- 26p., bibliog.
- Place of publication:
- Belfast
The Northern Ireland Single Assessment Tool (NISAT) was developed to address the assessment process as highlighted in the NSF for Older People. The NISAT consists of three main parts: the Contact Screening; the Core NISAT; and the Complex NISAT. The Core assessment consists of eight domains covering all areas of the older people's life - mental health; communication and sensory functioning; personal care and daily tasks; mobility and movement; awareness and decision making; accommodation and living arrangements; employment, finance and leisure; and physical health and medication. This study used case studies with a purposive sample of trained assessors to determine the inter-rater reliability of the Core NISAT. The study aimed to: determine the reliability (percentage agreement) of quantitative measures between assessors; determine the statistical significance of the quantitative measures; and determine the overall reliability of the Core NISAT. A sample of twenty seven assessors participated in the study. The quantitative findings from each of the 27 completed assessments for each case study were analysed. Overall there was a high level of inter-rater reliability on the quantitative measures contained in the core NISAT. This high inter-rater reliability was consistent across each domain and in each case study. It can be concluded from the findings that the core NISAT is reliable as a measure of older peoples’ needs and abilities.
Developing multidisciplinary assessment - exploring the evidence from a social care perspective
- Authors:
- SUTCLIFFE Caroline, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(12), December 2008, pp.1297-1305.
- Publisher:
- Wiley
This paper provides an initial evaluation of the impact of the Single Assessment Process (SAP) in England upon practice regarding multidisciplinary assessment. The objectives were to investigate changes in recorded health needs of older people and in the number of multidisciplinary assessments undertaken using social care agencies' case files. Also to examine differences in approaches to the use of multidisciplinary assessment for older people with different health needs. An audit of case files of older people living in the community in receipt of social care in three areas carried out at two time periods before and after implementation of the SAP in 2004. Information extracted from files covered a number of domains including evidence of multidisciplinary assessments, and presence of mental and physical health problems. Data from 144 files at Time 1 were compared with 145 files from Time 2. Little evidence emerged that older people at Time 2 were more dependent. However, significantly more multidisciplinary assessments were undertaken following the introduction of the SAP, in particular by occupational therapists and secondary health care teams. Cognitive impairment was a significant predictor of multidisciplinary assessment at both time periods. The impact of the introduction of the SAP has been mediated by the influence of other policies in England: intermediate care and integrated health and social care provision. Nevertheless, the data suggest that consideration be given to more effective targeting of multidisciplinary assessments on the grounds of both cost and more accurate identification of those who will benefit from the process.
An in-home geriatric programme for vulnerable community-dwelling older people improves the detection of dementia in primary care
- Authors:
- PERRY M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(12), December 2008, pp.1312-1319.
- Publisher:
- Wiley
Dementia is under-diagnosed in primary care. This study investigated whether an in-home geriatric assessment and management programme could improve the identification of patients with dementia in primary care. A secondary analysis was performed, using data of a randomised controlled trial that studied the effects of an in-home geriatric evaluation and management programme compared with usual care. In this trial, 151 vulnerable community-dwelling patients, aged 70 years and older, living in the Netherlands participated: 86 in the intervention group and 66 in the control group. The effect of the programme on the dementia detection rate was determined by comparing the number of new dementia diagnoses in both study arms at 6 months follow-up. Of all 151 participants, 38 (25%) had a registered dementia diagnosis at baseline. During follow-up, 23 of 113 patients without a registered dementia diagnosis at baseline were identified as suffering from dementia. The difference between the numbers of new dementia diagnoses in the intervention group (19 of 66 patients) and the control group (4 of 47 patients) was significant. (p = 0.02). An in-home geriatric assessment and management programme for vulnerable older patients improves the detection of dementia and can therefore contribute to overcoming of under-diagnosis of dementia.
Real lessons of Ethel the unreal
- Author:
- CARLISLE Daloni
- Journal article citation:
- Health Service Journal, 4.12.08, 2008, pp.24-25.
- Publisher:
- Emap Healthcare
Describes how Bedfordshire PCT used the case of a fictitious patient was used to help it rethink how it delivered out of hours care. The case of 'Ethel', a fictitious 82-year-old who likes a drink or two, stumbles out of bed and falls, was used to test how older people, and particularly those who have falls access the service. It resulted in the development of '1call', which provides a single access number to provide an initial assessment.
Predictors of discharge destination for 234 patients admitted to a combined geriatric medicine/old age psychiatry unit
- Authors:
- ASTELL Arlene J., CLARK Stella A., HARTLEY Nicholas T.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(9), September 2008, pp.903-908.
- Publisher:
- Wiley
This study examines the factors that predicted discharge destinations of all patients admitted to a combined geriatric medicine/old age psychiatry unit in Scotland over a 4-year period. Data regarding discharge destinations, active medical problems and demographics of 234 patients admitted to the unit were analysed using non-parametric bivariate correlation and logistic regression analysis. Independence for activities of daily living (ADL) was the key predictor of discharge destination. In combination with the number of active medical problems and dementia severity, independence for activities of daily living (ADL) defined three distinct groups: patients discharged home, patients discharged to a nursing home and patients who died in hospital. The findings suggest that although the key precipitants of admission to joint geriatric medicine/old age psychiatric care are behavioural and psychiatric, these factors are intercurrent, can be successfully treated in an appropriate environment, and do not play a major role in determining discharge outcome. These findings confirm the broad spectrum of need among older patients admitted to acute medical care identified in previous research and support the case for specialised joint provision to address their physical and mental health needs.
The significance of dyslexia screening for the assessment of dementia in older people
- Author:
- METZLER-BADDELEY Claudia
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(7), July 2008, pp.766-768.
- Publisher:
- Wiley
Dyslexia and Dementia are disorders that share cognitive impairments in attention, language, and working memory. It is therefore possible that the presence of dyslexia may influence the assessment of the severity of dementia and potentially lead to the development of atypical forms of dementia. The present study investigated the prevalence of problems suggestive of dyslexia with a brief self-report questionnaire in a sample of 195 older adults referred to a Memory Clinic for dementia assessment. Ten percent reported problems suggestive of dyslexia consistent with the estimated prevalence in the general population. This group performed significantly lower in a number of attention and language related tests but not in other cognitive domains. These results highlight the importance of dyslexia screening for the assessment of dementia, not least because the choice of treatment is guided by the outcome of the assessment of the severity and the type of dementia.