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From the 60s to their sixties. Baby boomers - challenges and choices for public mental health
- Author:
- WILLIAMSON Toby
- Journal article citation:
- Journal of Public Mental Health, 7(1), August 2008, pp.4-8.
- Publisher:
- Emerald
This commentary considers the demographic 'bulge' of the so-called 'baby boomer' generation and the public mental health challenge that this group will represent as they move into old age. It is argued that now is the time to start a debate with the aim of identifying long-term solutions to these new challenges.
A comparison of small and large assisted living facilities for the diagnosis and care of dementia: the Maryland Assisted Living Study
- Authors:
- LEROI Iracema, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(3), March 2007, pp.224-232.
- Publisher:
- Wiley
This study's objective was to compare the demographic, clinical, and psychiatric characteristics of residents living in small (15 beds) and large assisted living (AL) facilities in the United States. One hundred and ninety-eight residents in 10 large and 12 small assisted living facilities were comprehensively assessed as part of the Maryland Assisted Living Study (MD-AL). The presence or absence of dementia and psychiatric disturbances and the facilities' recognition and management of these disorders were compared across the two types of AL. Aspects of care delivery were also compared. Small facilities had a higher prevalence of dementia (81%) compared to larger facilities (63%) and the mean Mini-Mental State Examination (MMSE) across all residents in small facilities was than in large facilities. Almost all (98%) of the residents of small homes carried a diagnosis of a dementia or other psychiatric diagnosis, compared to 74% of residents in large facilities. Psychosis in particular was more prevalent in the smaller homes and the mean Neuropsychiatric Inventory score, a measure of neuropsychiatric symptoms, was higher compared to large homes. Falls were more common in larger homes despite a greater number of personal care hours per week. The use of safety devices and restraints was significantly less common in large facilities compared to smaller homes, where geri-chair and bedrails were more often used. Rates of dementia and psychiatric disorder differ in assisted living facilities depending on size of facility.
The criterion validity of the Center for Epidemiological Studies Depression Scale (CES-D) in a sample of self-referred elders with depressive symptomatology
- Authors:
- HARINGSMA R., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(6), June 2004, pp.558-563.
- Publisher:
- Wiley
The criterion validity of the Center for Epidemiological Studies Depression scale (CES-D) was assessed in a group of elderly Dutch community-residents who were self-referred to a prevention programme for depression. Paper-and-pencil administration of the CES-D to 318 elders (55-85 years). Criterion validity was evaluated with the Mini International Neuropsychiatric Interview (MINI), a clinical diagnostic interview based on DSM-IV. Sensitivity and specificity for various cut-off scores of CES-D were compared with the DSM-IV major depressive disorder (MDD) and with clinically relevant depression (CRD), a composite diagnosis of MDD, subthreshold depression or dysthymia. Furthermore the characteristics of true versus false positives were analyzed. For MDD, the optimal cut-off score was 25, (sensitivity 85%, specificity 64%, and positive predicted value of 63%). For CRD, the optimal cut-off was 22 (sensitivity 84%, specificity 60%, and positive predicted value 77%). True positives, MDD and CRD, reported significantly more anxiety symptomatology and more co-morbid anxiety disorders, false positives reported more previous depressive episodes. The criterion validity of the CES-D for MDD and CRD was satisfactory in this semi-clinical sample of elders. Subjects scoring 25 constitute a target group for further diagnostic assessment in order to determine appropriate treatment.
Screening for late life depression: cut-off scores for the Geriatric Depression Scale and the Cornell Scale for Depression in Dementia among Japanese subjects
- Authors:
- SCHREINER Andrea S., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(6), June 2003, pp.498-505.
- Publisher:
- Wiley
Proper screening of depression among older adults depends on accurate cut-off scores. Recent articles have recommended the Geriatric Depression Scale (GDS) and the Cornell Scale for Depression in Dementia (CSDD) for this screening. However, there has been no investigation of the sensitivity and specificity of either scale using Japanese subjects. The purpose of the present study was to identify appropriate GDS and CSDD cut-offs for Japanese older adults. The GDS and the CSDD were interview-administered to nondepressed Japanese older adults (n = 74) and to Japanese older adults with a SCID-IV diagnosis of major or minor depression (n = 37). Depressed subjects were also administered the Hamilton Depression Rating Scale (HDRS). Data were also collected on demographic variables, mental status, health status, and medication use. ROC curve analysis identified a cut-off score of 6 for the GDS which had a sensitivity of 0.973, a specificity of 0.959, a False Positive Rate (FPR) of 0.894, and a False Negative Rate (FNR) of 0. A cutoff score of 5 for the CSDD yielded a sensitivity of 1, a specificity of 0.919, a FPR of 0.942, and a FNR of 0. Comparisons indicate current HDRS cut-offs may overlook subthreshold depression. The GDS cut-off score identified among Japanese subjects was the same as that reported for Western subjects. Due to the substantial prevalence of psychiatric disorders found in false-negative subjects, the above cut-off scores were chosen to optimize the potential for true positives. These scores are recommended for alerting physicians and other caregivers as to when more intensive depression evaluation is needed.
Depression and dementia: coexistence and differentiation
- Author:
- WARRINGTON Jill
- Publisher:
- University of Stirling. Dementia Services Development Centre
- Publication year:
- 1996
- Pagination:
- 37p.,bibliog.
- Place of publication:
- Stirling
This report reviews the complex relationship between these two conditions and gives guidance on the recognition and management of depression in older people. Contents include: defining depression and dementia; how common are depression and dementia in the elderly?; what causes depression; how do depression and dementia relate to each other?; depressive dementia (pseudodementia); depression as a secondary condition to dementia.
Anxiety disorders in dementia sufferers
- Authors:
- BALLARD Clive, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 11(11), November 1996, pp.987-990.
- Publisher:
- Wiley
One hundred and fifty-eight consecutive patients attending a university memory clinic were assessed using variety of standardized instruments. Dementia was diagnosed according to DSM-III-R criteria. One hundred and nine patients had DSM-II-R dementia. None of the cognitive or demographic variables were significantly associated with the presence of anxiety symptoms. Three main categories of anxiety symptoms were evident - anxiety related to depression, anxiety related to psychosis and anxiety to interpersonal situations.
One hundred cases of suicide in elderly people
- Authors:
- CATTELL Howard, JOLLEY David J.
- Journal article citation:
- British Journal of Psychiatry, 166, April 1995, pp.451-457.
- Publisher:
- Cambridge University Press
The prevention of suicide is receiving public attention at present because the White Paper, The Health of the Nation specifically targets a reduction in suicide rate. Preventative strategies must be guided by an understanding of the demography and antecedents of suicide. These issues are examined in relation to suicide by older people in Manchester.
The Cambridge handbook of age and ageing
- Editors:
- JOHNSON Malcolm L., (ed.)
- Publisher:
- Cambridge University Press
- Publication year:
- 2005
- Pagination:
- 744p.
- Place of publication:
- Cambridge
This is a guide to the current body of knowledge, theory, policy and practice relevant to age researchers and gerontologists around the world. It contains almost 80 original chapters, commissioned and written by the world's leading gerontologists from 16 countries and 5 continents. The broad focus of the book is on the behavioural and social sciences but it also includes important contributions from the biological and medical sciences. It provides comprehensive, accessible and authoritative accounts of all the key topics in the field ranging from theories of ageing, to demography, physical aspects of ageing, mental processes and ageing, nursing and health care for older people, the social context of ageing, cross cultural perspectives, relationships, quality of life, gender, and financial and policy provision.
Taking the community into the home
- Authors:
- NOTTER Joy, SPIJKER Truus, STOMP Koos
- Journal article citation:
- Health and Social Care in the Community, 12(5), September 2004, pp.448-452.
- Publisher:
- Wiley
The changing demographics of the population are such that there is an increasing need for care for frail older people with both physical and mental health problems. At the same time, the increased migration of workers and their families means that care provision now has to embrace a range of cultures. The present paper explores how the concept of cultural safety has importance for those planning and providing care for older adults. The recognition that removing individuals with mental health problems from their own environment causes increased disorientation and confusion has led to some organisations trying to maintain the community aspects of life when independent living is no longer possible. The present paper focuses on two such organisations in the Netherlands, demonstrating how they have changed their practice to improve and enhance the quality of life of their clientele through 'taking the community into the home'. Whilst sharing the same goals and aspirations, each organisation, serves a different population, and therefore, has developed a unique approach.
Are the Health of the nation outcome scales (HoNOS) useful for measuring outcomes in older people's mental health services?
- Author:
- TURNER S.
- Journal article citation:
- Aging and Mental Health, 8(5), September 2004, pp.387-396.
- Publisher:
- Taylor and Francis
The Health of the Nation Outcome Scales (HoNOS) were developed to provide a single index in order to enable the government target 'to improve significantly the health and social functioning of mentally ill people' to be quantified. They were intended to be applicable to all adults (including older people), across a wide range of settings so that services in different localities could be compared and changes both within individuals and within services could be measured. In 1999 the HoNOS65+ was launched with a modified glossary for older people. The HoNOS has been formally adopted as the preferred outcome measure for adults of working age. There has been no such formal adoption of the HoNOS65+, or any other outcome measure, for mental health services for older people. This review summarises how the HoNOS was originally developed and validated. Studies with older people, which have used both the original definitions and those developed for the HoNOS65+ are reviewed focusing on data on the reliability and validity of the HoNOS and HoNOS65+ with older people. Finally the question of whether the HoNOS or HoNOS65+ is suitable as an outcome measure in routine clinical practice in services for older people is addressed.