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Prevalence of pseudobulbar affect symptoms and clinical correlates in nursing home residents
- Authors:
- FOLEY Kevin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 31(7), 2016, pp.694-701.
- Publisher:
- Wiley
Objective: Pseudobulbar affect (PBA) is a neurological disorder of emotional expression, characterised by uncontrollable episodes of crying or laughing in patients with certain neurological disorders affecting the brain. The purposes of this study were to estimate the prevalence of PBA in US nursing home residents and examine the relationship between PBA symptoms and other clinical correlates, including the use of psychopharmacological medications. Methods: A retrospective study was conducted between 2013 and 2014 with a convenience sample of residents from nine Michigan nursing homes. Chronic-care residents were included in the “predisposed population” if they had a neurological disorder affecting the brain and no evidence of psychosis, delirium, or disruptive behavior (per chart review). Residents were screened for PBA symptoms by a geropsychologist using the Center for Neurologic Study-Lability Scale (CNS-LS). Additional clinical information was collected using a diagnostic evaluation checklist and the most recent Minimum Data Set 3.0 assessment. Results: Of 811 residents screened, complete data were available for 804, and 412 (51%) met the criteria for the “predisposed population.” PBA symptom prevalence, based on having a CNS-LS score ≥13, was 17.5% in the predisposed population and 9.0% among all nursing home residents. Those with PBA symptoms were more likely to have a documented mood disorder and be using a psychopharmacological medication, including antipsychotics, than those without PBA symptoms. Conclusions: Pseudobulbar affect symptoms were present in 17.5% of nursing home residents with neurological conditions, and 9.0% of residents overall. Increasing awareness and improving diagnostic accuracy of PBA may help optimise treatment. (Edited publisher abstract)
Content validity analysis of ISD-1: an instrument for social diagnosis in care homes for older persons
- Authors:
- CURY Silvia Patricia, ASTRAY Andres Arias, GOMEZ Jose Luis Palacios
- Journal article citation:
- European Journal of Social Work, 22(3), 2019, pp.526-540.
- Publisher:
- Taylor and Francis
This article presents the validity study for ISD-1 (Instrument for Social Diagnosis), designed to be used in the specialist field of intervention in care homes for older persons. The study has focused on the evidence regarding the validity of its content. The definition of the operative area of ISD-1 (social diagnosis in care homes), and its representativeness and relevance, are decisive aspects for its validity. Two validation procedures were used, with the participation of two independent groups of experts. Both procedures had the objective of obtaining a quantitative measure assessing the representation of the area and of the degree of association between the dimensions and the items of the instrument. This study suggests that there is a sufficient degree of evidence for the representativeness, relevance and usefulness of the content of ISD-1, meaning it may be considered a suitable instrument for the formulation of social diagnoses in care homes for older persons. (Edited publisher abstract)
Beside the Geriatric Depression Scale: the WHO-Five Well-being Index as a valid screening tool for depression in nursing homes
- Authors:
- ALLGAIER Antje-Kathrin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 28(11), 2013, pp.1197-1204.
- Publisher:
- Wiley
The aim of the study was to compare criterion validities of the WHO-Five Well-being Index (WHO-5) and the Geriatric Depression Scale 15-item version (GDS-15) and 4-item version (GDS-4) as screening instruments for depression in nursing home residents. Data from 92 residents aged 65–97 years without severe cognitive impairment (Mini Mental State Examination ≥15) were analysed. Criterion validities of the WHO-5, the GDS-15 and the GDS-4 were assessed against diagnoses of major and minor depression provided by the Structured Clinical Interview for DSM-IV. Subanalyses were performed for major and minor depression. Areas under the receiver operating curve (AUCs) as well as sensitivities and specificities at optimal cut-off points were computed. Prevalence of depressive disorder was 28.3%. The AUC value of the WHO-5 (0.90) was similar to that of the GDS-15 (0.82). Sensitivity of the WHO-5 at its optimal cut-off of ≤12 was significantly higher than that of the GDS-15 at its optimal cut-off of ≥7. The WHO-5 was equally sensitive for the subgroups of major and minor depression, whereas the GDS-15 was sensitive only for major depression, but not for minor depression. For specificity, there was no significant difference between WHO-5 and GDS-15, but both instruments outperformed the GDS-4. The WHO-5 demonstrated high sensitivity for major and minor depression. Being shorter than the GDS-15 and superior to the GDS-4, the WHO-5 is a promising screening tool that could help physicians improve low recognition rates of depression in nursing home residents. (Edited publisher abstract)
Comparison of the diagnostic accuracy of the Cognitive Performance Scale (Minimum Data Set) and the Mini-Mental State Exam for the detection of cognitive impairment in nursing home residents
- Authors:
- PAGUAY Louis, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(4), April 2007, pp.286-293.
- Publisher:
- Wiley
This study aimed to compare the diagnostic accuracy of an outcome measurement scale of the Minimum Data Set of the Resident Assessment Instrument for nursing homes (MDS/RAI-NH), the Cognitive Performance Scale (CPS) and the Mini-Mental State Exam (MMSE) for the detection of cognitive impairment. The Cambridge Examination for Mental Disorders of the Elderly - Revised (CAMDEX-R) was used as the reference standard. This study was part of a larger prospective study (QUALIDEM) involving a diagnostic procedure and two-year follow-up on the quality of primary care for demented patients. CAMDEX-R and MDS/RAI-NH were administered to 198 residents, aged 65 or more, living in 42 low and high care institutions for older people in Belgium. Main outcome measures used were indicators of diagnostic accuracy: sensitivity, specificity, predictive values, likelihood ratios, odds ratio and area under receiver operating characteristics curve (AUC). The CAMDEX-based prevalence of cognitive impairment was 75%. The results found that CPS and MMSE demonstrated similar performance to detect cognitive impairment in nursing home residents.
Down and drowsy?: do apathetic nursing home residents experience low quality of life?
- Authors:
- GERRITSEN D. L., et al
- Journal article citation:
- Aging and Mental Health, 9(2), March 2005, pp.135-141.
- Publisher:
- Taylor and Francis
This cross-sectional study investigated the relationship between apathy and quality of life (QOL) in nursing home residents (n?=?227). In all, 92 residents could be assessed with the Mini Mental State Examination (MMSE), the Geriatric Depression Scale (GDS) and the Philadelphia Geriatric Centre Morale Scale (PGCMS), and were able to answer a question about overall subjective QOL. Apathetic behaviour and consciousness disorders were measured with the Behaviour Rating Scale for Psychogeriatric Inpatients (GIP). Linear regression analysis was first applied to study the association of cognition, depression and consciousness with apathy. It was then used to study the relationship between apathy and QOL, controlling for the constructs that were associated with apathy. The relationship between apathy and QOL appeared to vary with the cognitive functioning of the residents: In residents with a low level of cognitive functioning, apathetic behaviour was associated with high QOL; in residents with a higher level of cognitive functioning, apathetic behaviour was associated with low QOL. The necessity and nature of interventions aimed at stimulating apathetic residents may depend on the level of cognitive functioning of the residents. Further research is needed to determine if and when apathy interventions are appropriate.
Assessment of dementia in nursing home residents by nursing and assistants: criteria validity and determinants
- Authors:
- SORENSEN Lisbeth, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 16(6), June 2001, pp.615-621.
- Publisher:
- Wiley
The most prevalent psychiatric disorder among nursing home residents is dementia, which requires considerable medical attention, specialised care and psychological counselling to the relatives and staff. The nursing home staff play an important role in communication with general practitioners (GPs), consultants and other professionals working with the residents. The nursing home staff thus have considerable influence on the choice of treatment for problem behaviour among demented residents. The precision of staff assessment and perception of dementia is essential for the treatment of nursing home residents by any professional group and short comings in nursing home staff assessments may lead to decision errors. Little, however, is known about the validity of nursing home staff's assessment of dementia or about what symptoms and behaviours determine staff assessment of dementia in a resident. This Danish study describes the criterion validity of staff assessment of dementia compared with ICD-10 criteria, and to identify determinants of this assessment.
Design of ISD-1: an instrument for social diagnosis in care homes for older persons
- Authors:
- CURY Silvia Patricia, ASTRAY Andres Arias, GOMEZ Jose Luis Palacios
- Journal article citation:
- European Journal of Social Work, 22(3), 2019, pp.511-525.
- Publisher:
- Taylor and Francis
This article describes the design process and main features of an instrument developed for use in the specialist area of intervention in care homes for older persons. The essential aim of ISD-1 (instrument for social diagnosis) is to permit the correct formulation of social diagnoses and to standardise and define the professional language used by social workers. Its content has been organised into 4 dimensions of social diagnosis, divided into 15 sub-dimensions containing 83 diagnostic categories. This work was performed in Spain, in the 24 care homes of the Madrid Social Care Agency of the Community of Madrid, involving the participation of the 40 social workers practising in these centres. ISD-1 is an easily understood and used tool, of potential use for social workers practising in care homes for older persons and capable of being adapted for use in other institutional environments, as well as being capable of adaptation and translation for its application in other countries. (Edited publisher abstract)
Care staff training in detection of depression in residential homes for the elderly: randomised trial
- Authors:
- EISSES A. M.H, et al
- Journal article citation:
- British Journal of Psychiatry, 186(5), May 2005, pp.404-409.
- Publisher:
- Cambridge University Press
Many people with depression in residential care homes for the elderly do not receive treatment because their depression remains undetected. The aim was to determine the effects of staff training on the detection, treatment and outcome of depression in residents of ten homes. The authors conducted a randomised controlled trialin ten residential homes. The intervention consisted of a training programme for staff and collaborative evaluation by staff and a mental health specialist of residents with possible depression. Recognition of depression increased more in homes where staff received the training than in the control homes. Treatment rates also increased compared with control homes, but the increase was not significant. Residents with depressive symptoms had a more favourable course when staff had received training. Moreover, the prevalence of depressive symptoms decreased, but the decrease was not significant. Training of care staff results in the increased detection of depression in the elderly, a trend towards more treatment and better outcomes.
The minimum data set depression quality indicator: does it reflect differences in care processes?
- Authors:
- SIMMONS S. F., et al
- Journal article citation:
- Gerontologist, 44(4), August 2004, pp.554-564.
- Publisher:
- Oxford University Press
The objective of this work was to determine if nursing homes that score differently on prevalence of depression, according to the Minimum Data Set (MDS) quality indicator, also provide different processes of care related to depression. A cross-sectional study with 396 long-term residents in 14 skilled nursing facilities was conducted: 10 homes in the lower (25th percentile: low prevalence 0–2%) quartile and 4 homes in the upper (75th percentile: high prevalence 12–14%) quartile on the MDS depression quality indicator. Ten care processes related to depression were defined and operationalized into clinical indicators. Measurement of nursing home staff implementation of each care process and the assessment of depressive symptoms were conducted by trained research staff during 3 consecutive 12-hr days (7 a.m. to 7 p.m.), which included resident interviews (Geriatric Depression Scale), direct observations, and medical record review using standardized protocols. The prevalence of depressive symptoms according to independent assessments was significantly higher than prevalence based on the MDS quality indicator and comparable between homes reporting low versus high rates of depression (46% and 41%, respectively). Documentation of depressive symptoms was significantly more common in homes reporting a high prevalence rate; however, documentation of symptoms on the MDS did not result in better treatment or management of depression according to any care-process measure. Psychosocial prevention and intervention efforts, such as resident participation in organized social group activities, were not widely used within either group of homes. The MDS depression quality indicator underestimates the prevalence of depressive symptoms in all homes but, in particular, among those reporting low or nonexistent rates. The indicator may be more reflective of measurement processes related to detection of symptoms than of prevention, intervention, or management of depression outcomes. A depression quality indicator should not be eliminated from MDS reports because of the importance and prevalence of the condition. However, efforts to improve nursing home staff detection of depressive symptoms should be initiated prior to the use of any MDS-based depression indicator for improvement purposes. Homes that report a low prevalence of depression according to the nationally publicized MDS quality indicator should not be regarded as providing better care.
Predictors of circadian sleep-wake rhythm maintenance in elders with dementia
- Authors:
- SULLIVAN S. C., RICHARDS K. C.
- Journal article citation:
- Aging and Mental Health, 8(2), March 2004, pp.143-152.
- Publisher:
- Taylor and Francis
Minimal data exists to predict which elders with dementia in nursing homes will maintain circadian sleep-wake rhythms during senescence and which elders with dementia in nursing homes will experience sleep-wake rhythm deterioration. This circadian deterioration is one of the background factors identified in the Needs-driven Dementia-compromised Behavior Model. The objective of this study was to determine predictors of circadian sleep-wake rhythm maintenance in elders with dementia residing in nursing homes. This secondary analysis identifies predictors of maintaining circadian sleep-wake rhythm in a convenience sample of 171 elders with dementia residing in seven nursing homes in the Southern United States. An autocorrelogram of the circadian sleep-wake rhythm for each participant determined whether or not the rhythm had deteriorated. Using measures of depression, cognitive function, physical and psychosocial activity, medications, and sleep apnea, as well as demographic characteristics of the sample, logistic regression determined the best predictors of rhythm maintenance. The best predictors of circadian sleep-wake rhythm maintenance in elders with dementia residing in nursing homes were physical activity (p = 0.00) and psychosocial activity (p = 0.00). The interaction term between these variables was not significant (p = 0.24). These findings suggest that providing meaningful daytime physical and psychosocial activity may assist in maintaining circadian sleep-wake rhythmicity. Additional research is needed to determine if these interventions would improve circadian sleep-wake rhythm in elders with dementia residing in nursing homes.