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Identifying changeable barriers to family involvement in the nursing home for cognitively impaired residents
- Author:
- PORT Cynthia Lindman
- Journal article citation:
- Gerontologist, 44(6), December 2004, pp.770-778.
- Publisher:
- Oxford University Press
Barriers to family involvement in the US nursing home with the potential for change through intervention were examined, including transportation, caregiver health, relationships with staff, and resident characteristics. Data were collected for 93 family caregiver–resident pairs by means of telephone interviews and chart review. Regression modelling was used to identify relationships between involvement (caregiver visit frequency) and the changeable barriers after the known variables of distance, kinship, payment source, length of stay and cognitive function were taken into account. Lower visit frequency was found for caregivers reporting problems with transportation, poor relationships with staff and a smaller network of supportive family and friends. Higher caregiver anxiety was related to higher visit frequency. Several barriers to family involvement are shown to be as or more influential than ones identified in previous research, thus providing empirical support for interventions currently used as well as suggesting new areas for intervention.
Prevalence of major and minor depression in elderly persons with mild cognitive impairment - MADRS factor analysis
- Authors:
- GABRYELEWICZ T., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(12), December 2004, pp.1168-1172.
- Publisher:
- Wiley
The aim of the study was to detect the prevalence of depressive syndromes and symptoms in the sample of elderly persons with Mild Cognitive Impairment (MCI), and to analyse Montgomery-Asberg Depression Rating (MADRS) item scores. The subjects of the study were 102 consecutive out-patients with MCI. All subjects were assessed by an experienced psychiatrist and MADRS was applied. Major and minor depressive episodes were defined according to DSM-IV criteria. Factor analysis was used to analyse baseline MADRS item scores. Three patient groups emerged according to the depressive symptoms distribution and severity scores basis: those with major depression constituted 19.6% (n = 20), with minor depression 26.5% (n = 27), and with very few depressive symptoms 53.9% (n = 55). Three interpretable MADRS factors were identified, using the factor analysis with Varimax rotation: the first consisting of apparent and reported sadness, inability to feel, pessimistic thoughts, the second consisting of inner tension, reduced sleep, reduced appetite, suicidal thoughts, and the third with concentration difficulties and lassitude. It was concluded that both major and minor depression is common in MCI. Three MADRS factors were identified and labelled as anhedonia-pessimism, anxiety-vegetative, and cognitive-inhibition.
Cognitive status and analgesic provision in nursing home residents
- Authors:
- CLOSS S. Jose, BARR Bridget, BRIGGS Michelle
- Journal article citation:
- British Journal of General Practice, 54(509), December 2004, pp.919-921.
- Publisher:
- Royal College of General Practitioners
Although it is becoming acknowledged that pain management is generally poor for older people, little is known about pain management for nursing home residents in the UK, and the specific problems for those with cognitive impairments. This study explored analgesic prescription and administration according to nursing home residents' cognitive status using a survey of residents and medication documentation. The sample included 113 residents from 15 homes in large city in northern England. Cognitive status was assessed using the mini-mental state examination (MMSE). Pain was measured with a 4-point verbal rating scale and a 10-point horizontal numeric rating scale. Medications (name, dose, frequency) were noted, and provision within the previous 24 hours. There were no statistically significant differences in pain scores according to level of cognitive impairment. Prescription and administration of opioid and non-opioid analgesics were highest for residents with low cognitive impairment, decreasing as impairment increased. Those prescribed neither opioid nor non-opioid analgesics had significantly lower MMSE scores than those who were. A low MMSE score indicates high cognitive impairment. It is not clear why those with greater impairment received fewer analgesics. More research is needed into relationships between pain assessment, pain experience, cognitive impairment and analgesic provision. It is likely that improvements in carers' knowledge of pain assessment and the risks and benefits of commonly used analgesics could improve analgesic provision.
Duration of stay and outcome for inpatients on an basement ward for elderly patients with cognitive impairment
- Authors:
- BALL Sue, et al
- Journal article citation:
- Quality in Ageing, 5(2), October 2004, pp.12-20.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
Reports a prospective study of a consecutive group of 101 patients who died on or were discharged from an acute assessment ward for elderly patients with cognitive impairment. Clinical characteristics were recorded according to an in-patient dementia care pathway, including mini-MOUSEPAD, Crichton activities of daily living, Mini-Mental State Examination and the Burvill physical health score evaluations. Outcome measures were duration of stay, destination on discharge or death on the ward. Mean duration of stay was 7.9 weeks. Self-funding status and lack of behaviourial and psychological complications were associated with reduced duration of. Discharge home was strongly predicted by having a spouse at home, and the need for nursing home other than residential care was related to severity of cognitive impairment. Concludes that patients can expect to stay in hospital for 8 weeks but 2 areas of concern are highlighted: the importance of community rehabilitation funding for patients with memory disorders and the importance of a spouse at home to look after the patient.
Neuropsychological characteristics of mild vascular cognitive impairment and dementia after stroke
- Authors:
- STEPHENS S., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(11), November 2004, pp.1053-1057.
- Publisher:
- Wiley
Post-stroke cognitive impairment is frequent, with characteristic impairments of attentional and executive performance. The study aims to determine whether the profile and severity of impairment in vascular Cognitive Impairment No Dementia (vascular CIND) is intermediate between that seen in stroke patients without significant cognitive impairment and patients with post-stroke dementia and thus to establish if the potential value of vascular CIND is a useful concept for predicting further cognitive decline and dementia in stroke patients. Stroke patients (n = 381) > 75 were recruited from representative hospital-based stroke registers in Tyneside and Wearside, UK. Sixty six age matched controls were also recruited. A detailed battery of neuropsychological assessments was completed 3 months post stroke. Deficits of attention (z = 5.7; p < 0.0001) and executive function (z = 5.9; p < 0.0001) were seen even in stroke patients without vascular CIND, compared to controls. However, stroke patients with CIND were significantly more impaired again on tests of executive function (z = 10.3; p < 0.0001) compared to those not meeting CIND criteria; and also had greater impairments of memory (z = 10.4; p < 0.0001) and language expression (z = 10.1; p < 0.0001). A similar overall profile of deficits was evident in the CIND and the dementia group, but specific deficits were significantly more pronounced in those with dementia, particularly in orientation (z = 7.2; p < 0.0001) and memory (z = 5.8; p < 0.0001). The current study indicates that attentional and executive impairments are frequent in stroke patients, but deficits of memory, orientation and language are more indicative of CIND and dementia. Further longitudinal studies are required to clarify the relationship between specific lesions and the progression of specific cognitive deficits in post-stroke patients.
Smell identification test as an indicator for cognitive impairment in Alzheimer's disease
- Authors:
- SUZYKI Y., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(8), August 2004, pp.727-733.
- Publisher:
- Wiley
The aim of the present study was to assess olfactory dysfunction in patients with Alzheimer's disease (AD) and to compare utility of the olfactory tests as possible clinical markers. Two olfactory identification tests (The Cross-Cultural Smell Identification Test [CC-SIT] and the Picture-based Smell Identification Test [P-SIT]) and the Mini Mental State Examination (MMSE) were administered to patients with AD and age-matched controls. Apolipoprotein E (Apo E) genotypes of patients with AD were identified. Patients with AD had significantly lower olfactory identification scores than age-matched non-demented elderly subjects in both olfactory assessments. In the AD group, the coefficient of correlation between the MMSE scores and the P-SIT scores was higher than that between the MMSE scores and the CC-SIT scores. Receiver operating curve (ROC) analyses for both tests indicated that the P-SIT discriminated AD patients from controls more reliably than did the CC-SIT. Within AD patients, those who were carrying one or two ApoE 4 alleles had a higher coefficient of correlation between the MMSE scores and the P-SIT scores than patients without the ApoE 4 allele. The results suggest that a short and simple non-lexical olfactory identification test can be useful as a clinical marker of AD appropriate for Japanese elderly population
The utility of the Visual Analogue Scale for the assessment of depressive mood in cognitively impaired patients
- Authors:
- KERTZMAN Semion, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(8), August 2004, pp.789-796.
- Publisher:
- Wiley
Early detection of depression in elderly demented patients may assist in adequate treatment. The aim of this study was to evaluate the utility of Visual Analogue Scale for depression among demented and mild cognitively impaired elderly patients. 157 Patients, aged from 65 to 92 years, in a memory clinic were divided into two groups according to scores on the Mini Mental State Examination (MMSE): Demented group (62 patients) with MMSE scores from 16 to 23, and Mild Cognitively Impaired group (MCI-95 patients) with MMSE scores from 24 to 29. Subjects were diagnosed for depression according to DSM-IV criteria, using Hamilton Depression Rating Scale (HDRS) and a comprehensive clinical evaluation. All were administered a Visual Analogue Scale (VAS) for depression. In the demented group, 25 subjects were diagnosed as depressive. In the MCI group, 46 subjects were diagnosed as depressive. Mean VAS scores for the demented and MCI groups were similar, both for depressive and non-depressive patients. Correlations between VAS scores with HDRS scores and with the clinical diagnosis were high, although somewhat lower for the demented group. Analyzing data with ROC curve technique yielded significantly different ROC curves. Optimal cutoff point for the demented group was VAS value of 60, and 50 for the MCI group. VAS seems to be a useful tool for evaluation of depression among cognitively impaired patients. Severity of cognitive decline in the elderly may influence the cutoff points on VAS for detecting depression. Further large-scale studies are needed to substantiate our observation.
Influence of cognitive impairment, functional impairment and care setting on Dementia Care Mapping results
- Authors:
- EDELMAN P., KUHN D., FULTON B.R.
- Journal article citation:
- Aging and Mental Health, 8(6), November 2004, pp.514-523.
- Publisher:
- Taylor and Francis
Quality of life (QOL) for people with dementia has become a major focus over the past decade. Dementia care mapping (DCM) is an observational measure of quality of care given by staff in formal care settings, as well as a measure of QOL that has been used in many studies of people with dementia in residential care settings. However, the method itself has not been rigorously studied in a scientific manner. For this report, mapping data were collected for 166 persons with dementia in three types of care settings: special care facilities that are licensed nursing homes, assisted living facilities, and adult day centers in the Chicago area. The relationships between DCM and several independent variables including cognitive status, functional status, care setting, depression, length of stay, and co-morbid illnesses were assessed. Both cognitive status and functional status were found to be associated with DCM scores. Moreover, DCM was sensitive in differentiating among persons with four levels of cognitive impairment. Implications for practice are discussed.
No association between subjective memory complaints and apolipoprotein E genotype in cognitively intact elderly
- Authors:
- HARWOOD Dylan G., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(12), December 2004, pp.1131-1139.
- Publisher:
- Wiley
This cross-sectional study examined the relationship between subjective memory complaints and the apolipoprotein epsilon 4 allele (4), a genetic risk factor for Alzheimer's disease (AD), among cognitively normal subjects identified from a community memory screening. The sample comprised 232 consecutive white non-Hispanic older adults who presented to a free community-based memory-screening program at a University affiliated memory disorders center. Participants were classified as cognitively normal based on scores on the age and educated adjusted Folstein Mini-Mental Status Exam (MMSAdj) and a brief Delayed Verbal Recall Test (DRT). Subjects were assessed for APOE genotype, subjective memory complaints (Memory Questionnaire, MQ), depressive symptoms (Hamilton Depression Rating Scale, HDRS), and history of four major medical conditions that have been associated with memory loss (stroke/transient ischemic attack [TIA], atherosclerotic heart disease, hypertension, and diabetes). A hierarchical regression analysis was performed to examine the association between APOE genotype and memory complaints after controlling for a host of potential confounding factors. The APOE 4 allele frequency for cognitively normal subjects was 0.13. Subjective memory complaints were predicted by depressive symptoms and a history of stroke/TIA. They were not associated with APOE genotype, MMSAdj score, DRT score, age, education, gender, and reported history of atherosclerotic heart disease, hypertension, or diabetes. The results did not suggest an association between subjective memory complaints and the APOE 4 allele in this sample of cognitively intact subjects. This indicates that memory complaints may confer risk for future dementia through pathways independent of APOE genotype. The results also show that older adults with memory complaints are at increased risk for underlying depression
Selective memory impairment on an adapted Mini-Mental State Examination increases risk of future dementia
- Authors:
- GLAZARIN J., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(12), December 2004, pp.1173-1180.
- Publisher:
- Wiley
The aim was to determine whether selective memory impairment (SMI) on an adapted Mini-Mental State Examination (aMMSE) test increases risk of future dementia in a population-based survey of central Spain. SMI is a strong predictor of dementia in the elderly. However, most approaches have used extensive memory batteries, which are not always suitable for screening purposes. The basal cohort consisted of 2982 poorly educated individuals aged 65 or over. Dementia, stroke and parkinsonism cases were previously excluded. At entry, participants received a structured interview including an aMMSE. Two groups were created according to basal cognitive performance, namely: (1) aMMSE > 23 and no word remembered on the aMMSE delayed-recall task (SMI group); and (2) aMMSE > 23 and at least one word remembered on the delayed-recall task (control group). In a three-year follow-up wave, conversion rate to dementia was calculated and logistic regression was performed. Of a total of 2507 subjects who completed the two evaluations, 280 qualified for SMI at entry. In the SMI group, 25 subjects (8.9%) developed dementia vs 26 subjects (1.2%) in the control group. Taking the two groups together, and once demographic and medical variables had been controlled, a low delayed-recall score increased dementia conversion rate (OR 0.47, 95% CI 0.34-0.64). Alzheimer's disease was the main cause of dementia (79.8%). Memory impairment is a risk factor for future dementia in the neurologically-healthy elderly. This can be observed in a subgroup of subjects with SMI defined on the aMMSE delayed-recall subscore. Some other measurements should be added to the SMI construct to improve its predictive validity.