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The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes
- Authors:
- SALBAEK Geir, KIRKEVOLD Oyvind, ENGEDAL Knut
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(9), September 2007, pp.843-849.
- Publisher:
- Wiley
Psychiatric and behavioural symptoms in dementia are associated with a range of negative outcomes, including institutional placement and the widespread use of psychotropic drugs in spite of limited evidence for their efficacy. The aim was to determine the prevalence of psychiatric and behavioural symptoms and the pattern of psychotropic drug prescription in patients with various degrees of dementia. A sample of 1,163 non-selected nursing home patients were assessed by means of the Neuropsychiatric Inventory, the Clinical Dementia Rating scale and Lawton's activities of daily living scale. In addition, information was collected from the patients' records. Dementia was found in 81% of the patients and 72% of them had clinically significant psychiatric and behavioural symptoms. The frequencies of symptoms increased with the severity of the dementia. Psychotropic medication was being prescribed to 75% of patients with dementia. There was a significant relationship between the type of drug and the symptom for which it had been dispensed. Psychiatric and behavioural symptoms are frequent in nursing homes and the rate increases with the progression of the dementia. Systematic programmes are needed for disseminating skills and providing guidance regarding the evaluation and treatment of these symptoms in nursing homes.
Forgetful but not forgotten: assessment and aspects of treatment of people with dementia by a specialist old age psychiatry service
- Author:
- ROYAL COLLEGE OF PSYCHIATRISTS
- Publisher:
- Royal College of Psychiatrists
- Publication year:
- 2005
- Pagination:
- 94p., bibliog.
- Place of publication:
- London
The report represents a consensus statement from an Expert Working Group of the Faculty of the Psychiatry of Old Age, and has been produced in collaboration with the Alzheimer's Society and with representation from primary care. It describes good practice, with particular attention focused on working with primary care and with carers. In preparing the report, the Working Group has used systematic summaries of published evidence.
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.
A pilot study examining the effectiveness of maintenance Cognitive Stimulation Therapy (MCST) for people with dementia
- Authors:
- PRRELL Martin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(5), May 2005, pp.446-451.
- Publisher:
- Wiley
A recent randomised controlled trial on Cognitive Stimulation Therapy (CST) identified the need to evaluate its more long-term benefits for people with dementia. This study evaluates the effectiveness of a weekly maintenance CST programme for people with dementia in residential care. Thirty-five people with dementia were included, following on from a seven-week twice-weekly study of CST. The maintenance CST sessions ran in two residential homes using a once a week programme of CST over an additional 16 weeks. Two control homes did not receive the maintenance intervention. Using repeated measures ANOVAS, there was a continuous, significant improvement in cognitive function (MMSE) for those receiving MCST (CST+maintenance CST sessions) as compared to CST alone or no treatment (p = 0.012). There were no effects on quality of life, behaviour or communication following maintenance sessions. The initial cognitive improvements following CST were only sustained at follow-up when followed by the programme of maintenance CST sessions. The cognitive benefits of CST can be maintained by weekly sessions for around 6 months. A large-scale, multi-centre maintenance CST trial is required to clarify potential longer-term benefits of maintenance CST for dementia.
Mortality from dementia in a community-dwelling Brazilian population
- Authors:
- NITRINI Ricardo, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(3), March 2005, pp.247-253.
- Publisher:
- Wiley
The influence of dementia on mortality has not yet been reported for a Latin American country. The aim was to evaluate the influence of dementia on mortality of a community-dwelling elderly population in Brazil, and to verify the extent to which the diagnosis of dementia is reported on death certificates. A cohort of 1,656 individuals, aged 65 and over, was screened for dementia at their domiciles, in 1997. The same population was re-evaluated in 2000, and information on deaths was obtained from relatives and from the municipal obituary service. Kaplan-Meier curves were used for the survival analysis, and the mortality risk ratio (MMR) was calculated using Cox proportional hazards models. We obtained data from 1,393 subjects, corresponding to 84.1% of the target population. The number of deaths was 58 (51.3%) among the patients with dementia and 163 (12.7%) among those without dementia in 1997 (p < 0.0001). Dementia and Alzheimer's disease (AD) decreased survival, with hazards ratios of 5.16 [95% Confidence Interval (CI): 3.74-7.12] for dementia and 4.76 (95% CI: 3.16-7.18) for AD. The Cox proportional hazards model identified dementia (MMR = 3.92, 95% CI: 2.80-5.48) as the most significant predictor of death, followed by age, history of stroke, complaints of visual impairment and heart failure and by severe arterial hypertension in the baseline evaluation. Dementia and/or AD were mentioned in only 12.5% of the death certificates of individuals with dementia. Dementia causes a significant decrease in survival, and the diagnosis of dementia is rarely reported on death certificates in Brazil.
International Journal of Geriatric Psychiatry
- Publisher:
- Wiley
The International Journal of Geriatric Psychiatry provides an international perspective on the of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services. This journal is indexed and abstracted selectively on Social Care Online.
Alzheimer's Disease and dementia
- Author:
- ROYAL COLLEGE OF PSYCHIATRISTS
- Publisher:
- Royal College of Psychiatrists
- Publication year:
- 1999
- Pagination:
- 10p.
- Place of publication:
- London
Part of a series of booklets describing a range of mental health problems, aiming to make people more understanding of what these are and of the people who suffer from them. This pamphlet looks at Alzheimer's Disease and dementia, particularly in older people.
The natural history of mental disorder on old age. Martin Roth, Journal of Medical Science (1955) 101, 281-301
- Author:
- BURNS Alistair
- Journal article citation:
- International Journal of Geriatric Psychiatry, 11(1), January 1996, pp.7-14.
- Publisher:
- Wiley
This article is part of a series in which key papers in old age psychiatry are presented with an introduction, commentary by the original author and current update by someone working in the field. The paper was the first attempt to differentiate the features of clinical psychiatric illness in later life and has been comprehensively summarized. The salient findings of the paper are presented and discussed.
The prevalence and phenomenology of psychotic symptoms in dementia sufferers
- Authors:
- BALLARD C.G., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 10(6), June 1995, pp.477-485.
- Publisher:
- Wiley
One hundred patients referred to old age psychiatry services in the West Midlands and 25 patients referred to a memory clinic in Bristol with mild to moderate dementia were assessed using the GMS/HAS schedule together with a detailed inventory to assess their psychotic symptoms. On careful evaluation one patient did not have dementia. Eighty-three of the other 124 patients (66%) had a least one psychotic symptom. The frequencies of individual psychotic symptoms are described in the text.
Assessing fitness to drive in dementia and other psychiatric conditions: a higher training learning opportunity at a driving assessment centre
- Author:
- SHERIDAN Matthew P.
- Journal article citation:
- Psychiatrist (The), 36(3), March 2012, pp.113-116.
- Publisher:
- Royal College of Psychiatrists
Doctors have a professional obligation to identify patients who are unsafe to drive, and in cases of dementia this decision is often complex. The Scottish Driving Assessment Service is one of 17 centres across the UK which carries out specialist driving assessments for people with medical conditions that may affect their on-road performance. In this article the author describes the work of the Scottish Driving Assessment Service in Edinburgh and the assessment process, and reflects on the experience of spending a day at the centre and shadowing 3 driving assessments for people with dementia. The assessment includes a full clinical history, sight check, examination of higher cognitive function, static assessment test and on-road test of safe driving ability. The article concludes that visiting a local driving assessment centre can be a valuable learning opportunity for psychiatrists in training, particularly those working with older adults, to improve their knowledge of driving assessment.