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Should dementia patients be informed about their diagnosis?
- Author:
- BIERNACKI Claire
- Journal article citation:
- Professional Nurse, 19(4), December 2003, pp.198-202.
- Publisher:
- Emap Healthcare
Current government policy encourages service users to be involved as equal members of the interprofessional care team. This goal is compromised in the care of people with dementia if they are not informed of their diagnosis. This article looks at recent research both for and against disclosure, and argues in favour of breaking the news in a supportive way.
Alcohol use disorders in elderly people: redefining an age old problem in old age
- Authors:
- O'CONNELL Henry, et al
- Journal article citation:
- British Medical Journal, 20.9.03, 2003, pp.664-667.
- Publisher:
- British Medical Association
Looks at alcohol misuse in older people; reasons for underdetection and misdiagnosis; the health effects and treatment of alcohol misuse in older people.
Stagnation in mortality decline among elders in the Netherlands
- Authors:
- JANSSEN Fanny, et al
- Journal article citation:
- Gerontologist, 43(5), October 2003, pp.722-734.
- Publisher:
- Oxford University Press
This study assesses whether the stagnation of old-age (80+) mortality decline observed in The Netherlands in the 1980s continued in the 1990s and determines which factors contributed to this stagnation. Emphasis is on the role of smoking. Poisson regression analysis with linear splines was applied to total and cause-specific mortality data by age, year of death (1950-1999), and sex. An age-period-cohort analysis was carried out to determine whether the trends followed period or cohort patterns. ICD revisions were bridged by use of a concordance table. A sudden reversal in old-age mortality decline occurred around 1980, leading to a stagnation of the decline and even increases in mortality thereafter. Smoking-related cancers, chronic obstructive pulmonary disease, and diseases specifically related to old age contributed to this stagnation. Trends in smoking-related cancers and chronic obstructive pulmonary disease showed a cohort pattern-especially for men. When these smoking-related diseases were excluded, the trends in old-age mortality in The Netherlands showed an increasing stagnation for both sexes. Smoking behaviour can only partly explain the stagnation of mortality. Other factors such as increased frailty and changes in medical and social services for elderly people probably played a more decisive role in the recent stagnation.
The forgetting
- Author:
- SHENK David
- Publisher:
- Flamingo
- Publication year:
- 2003
- Pagination:
- 290p.,bibliog.
- Place of publication:
- London
As lifespans continue to expand, dementia has reached epidemic proportions. Today Alzheimer's afflicts one in twenty over the age of sixty-five. There are currently around twelve million sufferers worldwide, and this number is rising fast. Poignant and hopeful this claims to be the first book to record the history and explain the future of this difficult disease.
The role of depressive symptoms in recovery from injuries to the extremities in older persons. a prospective study
- Authors:
- KEMPEN Gertrudis I. J. M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(1), January 2003, pp.14-22.
- Publisher:
- Wiley
Previous research suggests that depressive symptoms play a role in recovery after hip fracture. However none of these studies were prospective and included only patients with hip fractures. Depressive symptoms at baseline were not predictive for disability after the injury when covariates were taken into account. However, depressive symptoms 8 weeks after the fall were significantly related to disability at 8 weeks, 5 months and even 12 months after the injury. In addition, disability levels before the injury were highly predictive for recovery later on. Severity of injury was particularly predictive for disability at 8 weeks while age (which may generally represent the amount of physiological reserve) predicted disability at 5 and 12 months after the injury. Cognitive functioning 8 weeks post-injury was, in contrast to previous research, not predictive for recovery when covariates were taken into account.
How can we help older people not fall again?: implementing the Older People's NSF Falls Standard; support for commissioning good services
- Author:
- GREAT BRITAIN. Department of Health
- Publisher:
- Great Britain. Department of Health
- Publication year:
- 2003
- Pagination:
- 72p.
- Place of publication:
- London
The negative impact of falls and related injuries on older people and health and social care systems is clear. The NSF for Older People Standard 6 aims to prevent falls and reduce their impacts. This document provides guidance, primarily for commissioners, on how to implement that standard and achieve benefits for older people and health and social care systems. ree key elements of good practice in commissioning services to address falls and their impacts were identified: cost benefit analyses that make the case for investment; strategic commissioning is in itself a valuable tool in developing and sustaining effective services; interventions are most beneficial when targeted on those at risk, based on agreed assessment processes, and integrated in a falls strategy developed with the full range of local services.
Baseline experience with Modified Mini Mental State Exam: The Women's Health Initiative Memory Study (WHIMS)
- Authors:
- RAPP S. R., et al
- Journal article citation:
- Aging and Mental Health, 7(3), May 2003, pp.217-223.
- Publisher:
- Taylor and Francis
The Modified Mini Mental State Exam (3MS) is widely used for screening global cognitive functioning, however little is known about its performance in clinical trials. The authors report the distribution of 3MS scores among women enrolled in the Women's Health Initiative Memory Study (WHIMS) and describe differences in these scores associated with age, education, and ethnicity. The 3MS exams were administered to 7,480 women aged 65-80 who had volunteered for and were eligible for a clinical trial on postmenopausal hormone therapy. General linear models were used to describe demographic differences among scores. Factor analysis was used to characterize the correlational structure of exam subscales. The distribution of 3MS scores at baseline was compressed in WHIMS compared to population-based data. Mean 3MS scores (overall 95.1) tended to decrease with age and increase with education, however these associations varied among ethnic groups ( p < 0.0001) even after adjustment for health, physical disability and occupation attainment. Four factors accounted for 37% of the total variance. Each varied with education and ethnicity; the two most prominent factors also varied with age. Despite relatively narrow distributions in WHIMS, baseline 3MS scores retained associations with age and education. These associations varied among ethnic groups, so that care must be taken in comparing data across populations.
The use of Sections 2 and 3 of the Mental Health Act (1983) with older people: a prospective study
- Authors:
- McPHERSON A., JONES G.
- Journal article citation:
- Aging and Mental Health, 7(2), March 2003, pp.153-157.
- Publisher:
- Taylor and Francis
The use of the UK Mental Health Act (MHA) is under scrutiny with older people, especially in those with dementia and other organic mental disorder. Whilst research into use of the MHA with this group has been sparse, the small body of existing research suggests that the MHA is applied differently to older adults (i.e. those over 65 years). This multi-centre study identified all MHA assessments conducted over a prospective three-month period, and obtained detailed data on the circumstances behind assessment. The findings highlighted that older people assessed under the MHA tend to exhibit different behaviour patterns, circumstances and core characteristics to those under 65; older people were more likely to be detained because of self neglect and physical illness and also more often had a diagnosis of an organic mental disorder. Younger people were unlikely to have a diagnosis of organic mental disorder and were more likely to be judged as a risk to other people. Risk of suicide was particularly highlighted with the under 65 age group. Implications for legislative reform are discussed.
Nursing home suicides: a psychological autopsy study
- Authors:
- SOUMINEN Kirsi, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(12), December 2003, pp.1095-1101.
- Publisher:
- Wiley
Older adults comprise a fifth of all suicides. Elders are the fastest growing part of the population, thus the number of persons needing nursing home care will increase dramatically in the near future. Little information has been available about suicides in nursing homes. The present study described all suicides among older adults in nursing homes in Finland during a 12-month period emphasizing the factors that have been found to be associated with suicide in the general elderly population. Drawing on data from a psychological autopsy study of all suicides (n=1397) in Finland during one year, all suicides committed by patients in nursing homes were identified. Retrospective DSM-IV consensus diagnoses were assigned. Twelve elderly (aged 60 years or more) nursing home residents who died by suicide, 0.9% of all suicides, were identified. The primary finding of the present study was that nursing home residents who died by suicide had suffered from highly comorbid somatopsychiatric disorders. One or more diagnoses on Axis I were made for all who died by suicide in nursing home. Depressive syndrome was diagnosed in three-quarters of subjects. Only a third of these were identified to have suffered from depressive symptoms before their death. Early recognition and adequate treatment of both somatic diseases and mental disorders, particularly depression, as well as early recognition of suicide risk among nursing home residents, are needed in order to prevent suicide.
Family carers' responses to behavioural and psychological symptoms of dementia
- Authors:
- WARD Sandy, OPIE Janet, O'CONNOR Daniel W.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(11), November 2003, pp.1007-1012.
- Publisher:
- Wiley
Thirty family carers of people with dementia were identified in a survey of mental disorder in general practice. Another 20 were referred by local aged mental health services. Carers were interviewed using the Manchester and Oxford University Scale for the Psychopathological Assessment of Dementia (MOUSEPAD) which rates behavioural and psychological disturbances. Carers' customary responses to current symptoms were recorded verbatim and categorised using a structured typology. Symptom frequency increased in line with dementia severity. Disturbances were generally well tolerated. Most were ignored where possible, except for wandering from home. Other common responses included avoiding triggers, providing reassurance, reality orientation, diversion, and collusion with false beliefs. Restrictive or punitive responses were uncommon. Few carers articulated clear strategies to deal with behavioural and psychological symptoms. For most, tolerance proved more effective and less distressing than arguments and reprimands. Carers' responses are likely to be influenced by social and cultural factors and may differ in other settings.