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The diagnosis gap
- Author:
- STOKES Graham
- Journal article citation:
- Journal of Dementia Care, 20(3), May 2012, pp.18-20.
- Publisher:
- Hawker
An objective of the National Dementia Strategy (NDS) for England (2009) is the provision of good quality early diagnosis and early intervention services for all on a nationwide basis. It is expected that all people with suspected dementia will have access to a pathway of care that delivers a rapid and competent specialist assessment that results in an accurate sensitively communicated diagnosis with the appropriate treatment, care and support provided as needed thereafter. Yet, 3 years after the publication of the NDS, under-diagnosis remains the prevailing norm, with an average diagnosis rate in England of around 42%. This article considers the reasons for this low diagnostic rate. These reasons are: the myth that becoming ‘absent minded’ is a normal part of ageing; the stigma attached to dementia; the isolation of many older people; the existence of co-morbidities; and the belief that a diagnosis of dementia may harm the patient. For those patients who are diagnosed, management of care may be disjointed and ineffective, and even, for many with early diagnosis, completely non-existent. The article argues that a failure to deal with these problems leads to costly repeat emergency hospital admissions and premature entry to care homes, as well as being responsible for the unacceptable suffering of patients and their families.
Discharge diagnosis and comorbidity profile in hospitalized older patients with dementia
- Authors:
- ZULIANI Giovanni, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(3), March 2012, pp.313-320.
- Publisher:
- Wiley
Dementia is known to be present in a significant proportion of hospitalised older patients, and may be associated with different pathologies and longer stays in hospital. The aim of this study was to investigate the prevalence of dementia in a large sample of hospitalised older individuals, and to analyse principal discharge diagnosis and related comorbidity in the patients affected by dementia. Data from 51,838 consecutive computerised discharge records of individuals aged 60 years and over from a hospital in Ferrara, Italy were analysed. The number of admissions, length of stay in hospital, primary and secondary discharge diagnosis, number of procedures, and possible death were evaluated. The findings showed that demented patients represented 8.6% of the sample and were older and more likely to be female patients. They were characterised by higher number of admissions to hospital, instrumental clinical investigations, secondary diagnoses, and mortality rate. Among the primary diagnoses, a higher prevalence of cerebrovascular disease, pneumonia, and hip fracture was observed in demented patients. Furthermore, pulmonary embolism, renal failure, septicaemia, and urinary infections were frequently reported in demented patients, but not in controls. As regards secondary diagnoses, dementia was associated with an increased risk of delirium, muscular atrophy and immobilisation, dehydration, cystitis, and pressure ulcers, whereas the risk for other conditions, including cancer, was reduced.
Medical comorbidity in late-life depression
- Authors:
- TAYLOR Warren D., McQUOID Douglas R., KRISHNAN Ranga Rama
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(10), October 2004, pp.935-943.
- Publisher:
- Wiley
Medical comorbidity is common in elderly patients with depression, however the difference between depressed and non-depressed elderly populations is not well established. Additionally, differences between subgroups of depressed populations, including those with MRI-defined vascular depression and those with late-onset compared with early-onset depression are not well described. The authors compared self-report of medical disorders between 370 depressed elders and 157 non-depressed control subjects. Subjects were additionally dichotomized based on presence or absence of subcortical MRI lesions and age of onset. Medical comorbidity was assessed by self report only, and depressed subjects were additionally assessed by the clinician-rated Cumulative Illness Rating Scale. When compared with the non-depressed group, depressed subjects were significantly more likely to report the presence of hypertension, heart disease, gastrointestinal ulcers, and hardening of the arteries. Analyses of subjects with subcortical disease demonstrated they were significantly older, more likely to have depression, and more likely to report the presence of hypertension. Finally, the depressed cohort with late-onset depression (occurring after age 50 years) had more male subjects, exhibited greater CIRS scores, and greater prevalence of hypertension, but these did not reach a level of statistical significance after applying a Bonferroni correction. Vascular comorbidities are common in depressed elders. The differences in the report of hypertension supports past work investigating a vascular contribution to late-life depression. Given the association between depression and poor medical outcomes of cardiac disease, this population deserves clinical scrutiny and further research.
Health care utilization in dementia patients with psychiatric comorbidity
- Authors:
- KUNIK Mark E., et al
- Journal article citation:
- Gerontologist, 43(1), February 2003, pp.92-98.
- Publisher:
- Oxford University Press
The purpose of this research was to determine if differences in service use exist between dementia patients with and without psychiatric comorbidity. Examination of 2-year health service use revealed that, after adjusting for demographic and medical comorbidity differences, dementia patients with psychiatric comorbidity had increased medical and psychiatric inpatient days of care and more psychiatric outpatient visits compared with patients without psychiatric comorbidity. A coordinated system of care with interdisciplinary teamwork may provide both cost-effective and optimal treatment for dementia patients.
Comorbidity with depression in older people: the Islington Study
- Authors:
- KATONA C.L.E., MANELA M.V., LIVINGSTON G.A.
- Journal article citation:
- Aging and Mental Health, 1(1), February 1997, pp.57-61.
- Publisher:
- Taylor and Francis
Discusses the results of a research study into comorbidity and other associations of depression in a community sample of older adults in the inner London borough of Islington. Results found that older people who were depressed were likely to have other comorbid physical and psychiatric pathology, namely general anxiety, phobic anxiety, physical disability, somatic symptoms, sleep disturbance and subjective memory impairment. The overwhelming majority of older people with depression were not receiving pharmacological treatment. Concludes that while the majority of elderly people are psychiatrically well and do not require day to day help, those who are depressed have a significant rate of comorbidity and that health workers treating elderly people with depression should look for other physical and psychiatric conditions routinely.
The TAPS project. 21: functional and organic comorbidity and the effect of cognitive and behavioural disability on the placement of elderly psychiatric inpatients - a whole hospital survey
- Authors:
- ANDERSON Jeremy, TRIEMAN Noam
- Journal article citation:
- International Journal of Geriatric Psychiatry, 10(11), November 1995, pp.959-966.
- Publisher:
- Wiley
Reports a survey by the Team for the Assessment of Psychiatric Services (TAPS) of all inpatients aged 70 years or more resident in Clayburn Hospital, London, for more than 12 months. Of 189 inpatients who completed the assessments, 142 (75%) showed unequivocal, severe cognitive disability. After controlling for age, sex and total length of inpatient stay, patients with a severe degree of reported behavioural problems were almost 23 times more likely to receive specialized psychogeriatric care than other patients. Issues related to measurement of cognitive disability across the disparate diagnosis groups are discussed.