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Clock drawing test in screening for Alzheimer's dementia and mild cognitive impairment in clinical practice
- Authors:
- VYHNALEK Martin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(9), 2017, pp.933-939.
- Publisher:
- Wiley
Objectives: The clock drawing test (CDT) is a commonly used brief cognitive measure. The authors evaluated diagnostic accuracy of subjective ratings of CDT by physicians (with/without specialty in cognitive neurology) and neuropsychologists in discriminating amnestic mild cognitive impairment (aMCI), Alzheimer's dementia (AD) and cognitively healthy older adults. They further compared the diagnostic accuracy of subjective categorical ratings with complex scoring of CDT. Methods: Three cognitive neurologists, three neuropsychologists and six neurology residents without experience in cognitive neurology blinded to the diagnosis rated 187 CDTs (50 mild AD, 49 aMCI and 88 cognitively healthy older adults) using a “yes” (abnormal) versus “suspected” versus “no” (normal) classification. The rating suspected was combined with yes or no to obtain two sets of sensitivity estimates. The authors also used a 17-point CDT rating system. Results: When using the categorical rating, neuropsychologists had highest sensitivity (89%) in differentiating patients with mild AD (yes/suspected versus no), followed by neurologic residents (80%) and cognitive neurologists (79%). When differentiating patients with aMCI (yes/suspected versus no), the sensitivity was 84% for neuropsychologists, 64% for cognitive neurologists and 62% for residents. The sensitivity using the complex scoring system was 92% in patients with mild AD and 69% in patients with aMCI. Conclusions: A categorical rating of CDT shows high sensitivity for mild AD even in non-experienced raters. Neuropsychologists outperformed physicians in differentiating patients with aMCI from cognitively healthy older adults (specificity), which was counterbalanced by the lower specificity of their ratings. The diagnostic accuracy was not substantially improved by using complex scoring system. (Edited publisher abstract)
Using clinical signs of neglect to identify elder neglect cases
- Authors:
- FRIEDMAN Lee S., et al
- Journal article citation:
- Journal of Elder Abuse and Neglect, 29(4), 2017, pp.270-287.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Elder neglect is the one of the most pervasive forms of mistreatment, and often the only place outside of the individual’s residence to identify and assist neglected individuals is in a medical setting. However, elder neglect cases treated in hospitals do not present with a single diagnosis or clinical sign, but rather involve a complex constellation of clinical signs. Currently, there is a lack of comprehensive guidelines on which clinical signs to use in screening tools for neglect among patients treated in hospitals. Using the DELPHI method, a group of experts developed and tested a scale to be used as a pre-screener that conceptually could be integrated into electronic health record systems so that it could identify potential neglect cases in an automated manner. By applying the scale as a pre-screener for neglect, the tool would reduce the pool of at-risk patients who would benefit from in-depth screening for elder neglect by 95%. (Publisher abstract)
Potential of mobile technologies and applications in the detection of mild cognitive impairment among older generation groups
- Authors:
- KLIMOVA Blanka, VALIS Martin, KUCA Kamil
- Journal article citation:
- Social Work in Health Care, 56(7), 2017, pp.588-599.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
At present, demographic changes result in the growing number of older people. This trend inevitably brings about serious social and economic issues, as well as occurrence of ageing diseases. The purpose of this study is to discuss the potential of using mobile technologies and applications in the detection of ageing disorders such as mild cognitive impairment. The methods used for this review study include a literature search in the world’s acknowledged databases. The findings of this study indicate that mobile applications can serve as appropriate diagnostic tools for ageing disorders such as mild cognitive impairment because they seem to provide better, faster, and less costly care for older people. (Publisher abstract)
The influence of thoughts of death and suicidal ideation on the course of depression in older depressed patients
- Authors:
- BOGERS Ista C.H.M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(8), 2017, pp.882-891.
- Publisher:
- Wiley
Objective: Thoughts of death are not regularly included in diagnostic instruments and rarely examined separately from thoughts of suicide. This exploratory study examined whether thoughts of death and thoughts of suicide affect the course of late-life depressive disorders. Methods: In 378 depressed older persons, thoughts of death and thoughts of suicide were assessed using questions from the Composite International Diagnostic Interview. After 2 years, the presence of a DSM-IV-TR diagnosis of minor or major depression or dysthymia was assessed with the Composite International Diagnostic Interview. The Inventory of Depressive Symptomatology was administered every 6 months up till 3-year follow-up. Results: Multinomial logistic regression showed that thoughts of death as well as thoughts of suicide predicted double depression at follow-up (OR = 2.14 [95% CI: 1.04–4.40] and OR = 6.47 [95% CI: 2.22–3.02], respectively), compared with patients without these thoughts. Results became non-significant when adjusted for baseline depression severity (OR = 1.17 [95% CI: 0.52–2.63] and OR = 2.57 [95% CI: 0.79–8.84], respectively). Mixed linear models showed that severity of depression was lowest in the reference group, while symptoms decreased more over time in those with either thoughts of death or suicide. Conclusions: Patients with thoughts of death or with thoughts of suicide were more severely depressed at baseline and follow-up, with the highest risk of being depressed at follow-up for patients with thoughts of suicide. These associations could be explained by baseline depression severity. The results suggest that thoughts of death and thoughts of suicide are important risk markers in predicting the course of depression. (Publisher abstract)
Mental health first aid for the elderly: a pilot study of a training program adapted for helping elderly people
- Authors:
- SVENSSON Bengt, HANSSON Lars
- Journal article citation:
- Aging and Mental Health, 21(6), 2017, pp.595-601.
- Publisher:
- Taylor and Francis
Objectives: Epidemiological studies have shown a high prevalence of mental illness among the elderly. Clinical data however indicate both insufficient detection and treatment of illnesses. Suggested barriers to treatment include conceptions that mental health symptoms belong to normal ageing and lack of competence among staff in elderly care in detecting mental illness. A Mental Health First Aid (MHFA) training programme for the elderly was developed and provided to staff in elderly care. The aim of this study was to investigate changes in knowledge in mental illness, confidence in helping a person, readiness to give help and attitudes towards persons with mental illness. Method: Single group pre-test–post-test design. Results: The study group included staff in elderly care from different places in Sweden (n = 139). Significant improvements in knowledge, confidence in helping an elderly person with mental illness and attitudes towards persons with mental illness are shown. Skills acquired during the course have been practiced during the follow-up. Conclusions: The adaption of MHFA training for staff working in elderly care gives promising results. Improvements in self-reported confidence in giving help, attitudes towards persons with mental illness and actual help given to persons with mental illness are shown. However, the study design allows no firm conclusions and a randomised controlled trail is needed to investigate the effectiveness of the programme. Outcomes should include if the detection and treatment of mental illness among the elderly actually improved. (Edited publisher abstract)
Elder abuse screening tools: a systematic review
- Authors:
- McCARTHY Louise, CAMPBELL Susan, PENHALE Bridget
- Journal article citation:
- Journal of Adult Protection, 19(6), 2017, pp.368-379.
- Publisher:
- Emerald
Purpose: Elder abuse results in high rates of morbidity and mortality. It has longstanding physical and psychological effects and is difficult to detect. Due to fear or embarrassment, victims may make attempts to hide it rather than to disclose and professionals are often reluctant to report it as they may worry about worsening a situation. If detected early enough, serious harm can be prevented and lives saved. Screening and screening tools can assist health and social care practitioners to detect abuse. This review of screening tools was undertaken as part of an MSc in clinical research, funded by the National Institute for Health Research; the purpose of this paper is to report on the review and its findings. Design/methodology/approach: This was a systematic review with eligibility inclusion and exclusion criteria decided in advance. Keywords and their synonyms were combined and then used to search health and social care databases. Data items were collected from the included studies. The preferred reporting item for systematic reviews and meta-analysis was followed for the reporting of the results. A narrative synthesis approach was applied to the analysis. Findings: A total of 34 full text studies were downloaded, read and analysed. In all, 11 met the inclusion criteria and were included in the final analysis. Of these, three studies reported sensitivity and specificity, with the remainder reporting validity and reliability testing. In total, 12 tools of varying length and quality were found. The length and characteristics of tools affects the efficacy of their use. The clinical environment will determine choice of screening tool to be used. Screening tools should be used within an overall system of detection and management of abuse. Research limitations/implications: The synthesis of results was challenging due to the lack of homogeneity between the included studies. The variations in tool characteristics and qualities added to this challenge. A further limitation was the lack of a gold standard tool in elder abuse. Originality/value: This systematic review highlights a lack of robust evidence in the development and validation of screening tools to detect elder abuse. Though there is an increasing awareness and knowledge about elder abuse, its detection remains problematic and the lack of research in this area is worth emphasising. Specific tools, centred on the clinical setting in which they are used, are recommended (Publisher abstract)
Development of a caregiver-reported measure to support systematic assessment of people with dementia in long-term care: the Integrated Palliative care Outcome Scale for Dementia
- Authors:
- ELLIS-SMITH Clare, et al
- Journal article citation:
- Palliative Medicine, 31(7), 2017, pp.651-660.
- Publisher:
- Hodder Arnold
Background: Symptom burden is common for long-term care residents with dementia which if untreated compromises quality of life. Measurement tools can support assessment of symptoms and problems but are not widely used in long-term care settings. We developed the Integrated Palliative care Outcome Scale for Dementia derived from the Palliative care Outcome Scale, Palliative care Outcome Scale–Symptom and Integrated Palliative care Outcome Scale. Aim: To examine the content validity, acceptability and comprehension of Integrated Palliative care Outcome Scale for Dementia for routine use in long-term care settings for people with dementia and to refine Integrated Palliative care Outcome Scale for Dementia. Design: A multi-method qualitative study consisting of focus groups, semi-structured interviews and cognitive interviews. Setting/participants: Three residential long-term care settings in London, UK. Focus group and semi-structured interview participants included caregiver staff, family, general practitioners and district nurses. Caregiver staff were sampled purposively for cognitive interviews. Results: A total of 26 respondents participated in the focus groups (n = 21) or semi-structured interviews (n = 5) and 10 caregiver staff completed cognitive interviews. Additional symptoms and problems included agitation, wandering, sleep problems, communication problems and diarrhoea. Refinements or lay terms were required to improve comprehension and consistency of item response for nausea, drowsiness, delusions/hallucinations, agitation, loss of interest, communication problems and interaction. A video presentation was required to support comprehension of instructions and assessment of verbally compromised residents. Conclusion: Integrated Palliative care Outcome Scale for Dementia is a comprehensive and acceptable caregiver-reported measure to detect symptoms and problems in dementia. It is suitable for caregiver staff without professional training as it has been refined and tailored to maximise caregiver expertise, ready for further psychometric testing. (Publisher abstract)
Alzheimer's disease and the law: positive and negative consequences of structural stigma and labelling in the legal system
- Authors:
- WERNER Perla, DORON Israel (Issi)
- Journal article citation:
- Aging and Mental Health, 21(11), 2017, pp.1206-1213.
- Publisher:
- Taylor and Francis
Objective: To explore the meaning and consequences of labelling on structural stigma in the context of Alzheimer's disease (AD) in the legal system. Method: This qualitative study was made up of three focus groups including social workers and lawyers (n = 26). Participants were asked to report their experience in circumstances in which persons with AD and their family members engage with the legal system. Thematic analysis using the constant comparative method was used. Results: The discussions in the focus groups raised two overall themes. (1) The significance of the medical diagnostic labelling of AD in the legal system and (2) the consequences of labelling of AD within the legal system. This last theme included four sub-themes: (a) negative consequences of labelling; (b) reasons associated with negative consequences of labelling; (c) positive consequences of labelling; and (d) reasons associated with positive consequences of labelling. Conclusion: Findings of the study provide a first foundation for future research on the meaning and consequences of labelling in legal cases involving persons with AD. They suggest that increasing judges' knowledge about AD and reforming the existing ‘status-based’ legal capacity legislation might benefit by limiting the legal weight given today to the medical diagnosis. (Edited publisher abstract)
Taking a positive spin: preserved initiative and performance of everyday activities across mild Alzheimer's, vascular and mixed dementia
- Authors:
- GIEBEL Clarissa M., BURNS Alistair, CHALLIS David
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(9), 2017, pp.959-967.
- Publisher:
- Wiley
Objectives: The literature commonly evaluates those daily activities which are impaired in dementia. However, in the mild stages, people with dementia (PwD) are still able to initiate and perform many of those tasks. With a lack of research exploring variations between different dementia diagnoses, this study sought to investigate those daily activities with modest impairments in the mild stages and how these compare between Alzheimer's disease (AD), vascular dementia (VaD) and mixed dementia. Methods: Staff from memory assessment services from nine National Health Service trusts across England identified and approached informal carers of people with mild dementia. Carers completed the newly revised Interview for Deteriorations in Daily Living Activities in Dementia 2 assessing the PwD's initiative and performance of instrumental activities of daily living (IADLs). Data were analysed using analysis of variance and Chi-square tests to compare the maintenance of IADL functioning across AD, VaD, and mixed dementia. Results: A total of 160 carers returned the Interview for Deteriorations in Daily Living Activities in Dementia 2, of which 109, 21, and 30 cared for someone with AD, VaD, and mixed dementia, respectively. There were significant variations across subtypes, with AD showing better preserved initiative and performance than VaD for several IADLs. Overall, PwD showed greater preservation of performance than initiative, with tasks such as preparing a hot drink and dressing being best maintained. Conclusion: Findings can help classify dementia better into subtypes in order to receive bespoke support. It suggests that interventions should primarily address initiative to improve overall functioning. (Publisher abstract)
Emergency medical service, nursing, and physician providers' perspectives on delirium identification and management
- Authors:
- LaMANTIA Michael A., et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 16(3), 2017, pp.329-343.
- Publisher:
- Sage
Purpose of the study: The study objective was to understand providers' perceptions regarding identifying and treating older adults with delirium, a common complication of acute illness in persons with dementia, in the pre-hospital and emergency department environments. Design and methods: The authors conducted structured focus group interviews with separate groups of emergency medical services staff, emergency nurses, and emergency physicians. Recordings of each session were transcribed, coded, and analysed for themes with representative supporting quotations identified. Results: Providers shared that the busy emergency department environment was the largest challenge to delirium recognition and treatment. When describing delirium, participants frequently detailed hyperactive features of delirium, rather than hypoactive features. Participants shared that they employed no clear diagnostic strategy for identifying the condition and that they used heterogeneous approaches to treat the condition. To improve care for older adults with delirium, emergency nurses identified the need for more training around the management of the condition. Emergency medical services providers identified the need for more support in managing agitated patients when in transport to the hospital and more guidance from emergency physicians on what information to collect from the patient's home environment. Emergency physicians felt that delirium care would be improved if they could have baseline mental status data on their patients and if they had access to a simple, accurate diagnostic tool for the condition. Implications: Emergency medical services providers, emergency nurses, and emergency physicians frequently encounter delirious patients, but do not employ clear diagnostic strategies for identifying the condition and have varying levels of comfort in managing the condition. Clear steps should be taken to improve delirium care in the emergency department including the development of mechanisms to communicate patients' baseline mental status, the adoption of a systematised approach to recognising delirium, and the institution of a standardised method to treat the condition when identified. (Edited publisher abstract)