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The prevalence and recognition of major depression among low-level aged care residents with and without cognitive impairment
- Authors:
- DAVISON T. E., et al
- Journal article citation:
- Aging and Mental Health, 11(1), January 2007, pp.82-88.
- Publisher:
- Taylor and Francis
Previous research has demonstrated a high level of depression in nursing homes. The current study was designed to determine the prevalence of depression, using a structured diagnostic interview, among older people with and without mild-moderate cognitive impairment residing in low-level care facilities. The results demonstrated that, consistent with previous research in nursing homes, 16.9% of older people were diagnosed with major depressive disorder. Less than half of these cases had been detected or treated. Individuals with moderate cognitive impairment were more likely to be depressed, but cognitive impairment did not appear to act as a strong impediment to the detection of depression by general practitioners. A low awareness of their use of antidepressant medications was demonstrated among older people prescribed this treatment, including those with normal cognitive function. Reasons for the poor recognition of depression among older people are discussed.
Hospital discharge of older people with cognitive impairment to care homes
- Author:
- BRITISH GERIATRICS SOCIETY
- Publisher:
- British Geriatrics Society
- Publication year:
- 2006
- Pagination:
- 2p.
The scope of this document is confined to the safe and appropriate discharge of older people with cognitive impairment from hospital to a care home. It is a given, within the context of this document, that discharge to any other care setting has been deemed inappropriate as the result of a comprehensive geriatric assessment (CGA). A separate British Geriatrics Society (BGS) compendium document deals with the wider context of hospital discharge of frail older people.
Delirium: a missing piece in the COVID-19 pandemic puzzle
- Authors:
- O’HANLON Shane, INOUYE Sharon K.
- Journal article citation:
- Age and Ageing, 49(4), 2020, pp.497-498.
- Publisher:
- Oxford University Press
This editorial argues that delirium is an important missing component in the assessment and management of older people for COVID-19. Guidelines should include delirium as a presenting feature, screening should be a standard of care, and non-pharmacological approaches for delirium prevention and management need to be implemented as early and often as possible. Resources to assist healthcare providers should be built into electronic medical records, order sets and protocols. Key points raised in this paper include: older people are most vulnerable to severe COVID-19 infections and mortality; current guidance for diagnosis does not routinely include delirium, which may lead to under-detection of COVID-19; the care home population is particularly at risk, as failure to promptly detect COVID-19 may lead to outbreaks; non-pharmacological approaches to management of delirium may be more difficult to implement but remain the priority. (Edited publisher abstract)
Resource use and its association to cognitive impairment, ADL functions, and behavior in residents of Swedish nursing homes: results from the U‐Age program (SWENIS study)
- Authors:
- SKOLDUNGER Anders, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 34(1), 2019, pp.130-136.
- Publisher:
- Wiley
Objectives: To investigate resource use and its association to cognitive impairment, activities of daily living, and neuropsychiatric symptoms in residents of Swedish nursing homes. Methods: Data were collected in 2014 from a Swedish national sample of nursing home residents (n = 4831) and were collected by staff in the facility. The sample consists of all nursing homes in 35 of 60 randomly selected Swedish municipalities. Demographic data and data on resource use, cognitive and physical function as well as neuropsychiatric symptoms were collected through proxies. Descriptive statistics and regression modeling were used to investigate this association. Results: Cognitive impairment, activities of daily living, and neuropsychiatric symptoms were associated with 23 hours per week increase in total resource use versus cognitively intact persons. This was also the case for being dependent in activities of daily living. Being totally dependent increased the amount of resource use by 25 hours per week. The sex of a resident did not influence the resource use. Annual costs of resource use with no functional dependency were 359 685 SEK, and in severely cognitive impaired resident, the cost was 825 081 SEK. Conclusion: Being cognitively impaired as well as functionally dependent increases the resource use significantly in nursing homes. This has implications for differentiation of costs in institutional settings in health economic evaluations. (Edited publisher abstract)
Disagreement in preference for residential care between family caregivers and elders is greater among cognitive impaired elders group than cognitively intact elders group
- Authors:
- CHAU Pui Hing, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(1), January 2010, pp.46-54.
- Publisher:
- Wiley
For this study examining the predictive factors of preference for residential care in cognitively intact and impaired elders and their family caregivers, a survey was conducted with a sample of 707 community dwelling elders aged 65 and above and 705 family caregivers in Hong Kong. The main finding of the study was that there was significant disagreement between elders with cognitive impairment and their family caregivers in the preference for residential care - from the elders' perspective, less preference for residential care was associated with cognitive impairment whereas greater preference was associated with depression (for those cognitively intact), more usage of community service and functional impairment; from the caregivers' perspective, greater preference for residential care was associated with greater caregiver burden, or care recipients having cognitive or functional impairment, or more usage of community services. The authors concluded that cognitively intact elders were more likely to indicate preference for residential care than cognitively impaired elders and both cognitively intact and impaired elders were less likely than their caregivers to indicate preference for residential care, and that disagreement in preference for residential care between the elders and their caregivers was larger for the cognitively impaired group.
Detrimental effects of confinement and isolation on the cognitive and psychological health of people living with dementia during COVID-19: emerging evidence
- Author:
- SUAREZ-GONZALEZ Aida
- Publisher:
- International Long Term Care Policy Network
- Publication year:
- 2020
- Pagination:
- 11
- Place of publication:
- London
This report contains a short review of the emerging evidence on the impact of COVID-19 on the cognitive and psychological health of people living with dementia and the reported mitigating measures. Three papers describing the effects of lockdown on people with dementia living in the community show a worsening of functional independence and cognitive symptoms during the first month of lockdown (31% of people surveyed) and also exacerbated agitation, apathy and depression (54%), along with the deterioration of health status (40%) and increased used of antipsychotics or related drugs (7%). People with frontotemporal dementia (FTD) and their family caregivers seem to be particularly struggling to comply with protective measures. Only 2 case studies reporting strategies to support people with dementia in care homes have been produced so far. One describes a quarantine care plan for a person with FTD and the other, a mitigating strategy to ease the distress experienced by a man when his family stopped visiting during the pandemic. People living with dementia in care homes have experienced a particularly harsh version of lockdown – the ban on visits from spouses and partners in care is believed to be causing a significant deterioration in the health and wellbeing of residents with dementia. It is worth noting that a study involving 26 care homes proved that it is possible to implement successful infection control measures at the same time that visits are permitted. Learnings from this first COVID-19 wave can help the home care and day care sector prepare to minimise the disruption of their services in future waves so support can continue for people with dementia in the community. In care homes, evidence-based compassionate protocols should contribute to mitigating the detrimental effects of isolation and quarantine in residents with dementia (and their families). (Edited publisher abstract)
The Cognitive Daisy – a novel method for recognising the cognitive status of older adults in residential care: innovative practice
- Authors:
- HUDSON John M., POLLUX Petra
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 18(5), 2019, pp.1948-1958.
- Publisher:
- Sage
The Cognitive Daisy is an innovative assessment system created to provide healthcare staff with an instant snapshot of the cognitive status of older adults in residential care. The Cognitive Daisy comprises a flower head consisting of 15 colour coded petals depicting information about: visual-spatial perception, comprehension, communication, memory and attention. This study confirmed the practicality of the Cognitive Daisy protocol for assessing cognition in a sample of 33 older adults living in residential care and endorsed the use of the Cognitive Daisy as a tool for recognising the cognitive status of care home residents. (Edited publisher abstract)
Cognitive functioning and quality of life: Diverging views of older adults with Alzheimer and professional care staff
- Authors:
- DEWITTE Laura, VANDENBULCKE Mathieu, DEZUTTER Jessie
- Journal article citation:
- International Journal of Geriatric Psychiatry, 33(8), 2018, pp.1074-1081.
- Publisher:
- Wiley
Objective: Staff ratings of quality of life (QOL) in dementia are often lower and more strongly related to the cognitive functioning of the person with dementia than self‐ratings. However, cognition‐related items in QOL measures and limited cognitive screening measures hamper a clear understanding of the relationship, two issues addressed in the current study. Methods: The authors collected data of 88 pairs of older adults with Alzheimer disease and their professional caregivers in 9 residential care settings. Both self‐report and staff report of the QOL of residents were assessed with the Quality of Life in Alzheimer's Disease. Cognitive functioning was assessed with the Mini‐Mental State Examination and a battery of specific cognitive measures. Results: Intraclass correlations and a paired sample t test confirmed a discrepancy between self‐rating and staff rating, with staff significantly underestimating QOL as experienced by the resident. After removing the possibly confounding memory item of the Quality of Life in Alzheimer's Disease, Mini‐Mental State Examination score remained a significant predictor of staff ratings but not self‐ratings in regression analyses. Exploratory analyses of specific cognitive measures showed a significant contribution of a memory test of intentional visual association learning in the prediction of staff‐rated QOL. Conclusions: Staff reports cannot simply substitute reports of the subjective experience of residents with Alzheimer, so both judgments should be taken into account to form an adequate picture of QOL. Staff might be guided more strongly by a cognitive point of view when evaluating QOL of residents with Alzheimer disease, while the latter might have shifted their evaluation standards to cope adequately with the challenges posed by their disease. (Edited publisher abstract)
Characteristics of double care demanding patients in a mental health care setting and a nursing home setting: results from the SpeCIMeN study
- Authors:
- COLLET Janine, et al
- Journal article citation:
- Aging and Mental Health, 22(1), 2018, pp.333-39.
- Publisher:
- Taylor and Francis
Background: Older patients suffering from a combination of psychiatric disorders and physical illnesses and/or dementia are called Double Care Demanding patients (DCDs). Special wards for DCDs within Dutch nursing homes (NHs) and mental health care institutions (MHCIs) offer a unique opportunity to obtain insight into the characteristics and needs of this challenging population. Methods: This observational cross-sectional study collected data from 163 DCDs admitted to either a NH or a MHCI providing specialised care for DCDs. Similarities and differences between both DCD groups are described. Results: Neuropsychiatric symptoms were highly prevalent in all DCDs but significantly more in MHCI-DCDs. Cognitive disorders were far more present in NH-DCDs, while MHCI-DCDs often suffered from multiple psychiatric disorders. The severity of comorbidities and care dependency were equally high among all DCDs. NH-DCDs expressed more satisfaction in overall quality of life. Conclusions: The institutionalised elderly DCD population is very heterogeneous. Specific care arrangements are necessary because the severity of a patient's physical illness and the level of functional impairment seem to be equally important as the patient's behavioural, psychiatric and social problems. Further research should assess the adequacy of the setting assignment and the professional skills needed to provide adequate care for elderly DCDs. (Publisher abstract)
Diabetes, dignity and cognitive impairment
- Authors:
- PHILLIPS Stephen, PHILLIPS Anne
- Journal article citation:
- Nursing and Residential Care, 14(7), July 2012, pp.370-373.
- Publisher:
- MA Healthcare Ltd.
- Place of publication:
- London
Diabetes is common in older people and therefore the probability of caring for older people with diabetes and cognitive impairment, such as dementia, is increasingly likely. In addition, type 2 diabetes is associated with increased development of cognitive impairment, Alzheimer's disease and vascular dementia. This article reviews the consequences and requirements of care workers looking after people with diabetes and dementia, highlighting the potential risk and issues of which they need to be aware. Care home residents should receive initial and ongoing screening for both diabetes and dementia. The need to assess dental and nutritional status is vital in those with a confirmed diagnosis, and priorities for care need to be in place with regard to nutrition, dietary requirements and feeding assessment and ability. Parallel to this is the consideration of medication and its safe administration. Care planning and review needs to be in place so that individual’s needs are recognised, assessed and are met accordingly to ensure safety and dignity.