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Phenomenology of depression in older compared with younger adults: meta-analysis
- Authors:
- HEGEMAN J. M., et al
- Journal article citation:
- British Journal of Psychiatry, 200(4), April 2012, pp.275-281.
- Publisher:
- Cambridge University Press
Late-life depression may present differently to early-life depression. Conceptual and methodological limitations and the inherent subjectivity of narrative reviews have made it difficult to draw firm conclusions. This study was designed to investigate the effect of age on the phenomenology of major depression. A systematic search was conducted in PubMed, Embase and PsycINFO for studies examining the relation between age and phenomenology of major depression according to RDC, DSM and ICD criteria. Inclusion criteria required age groups to be compared at the single-item level using the 17-, 21- or 24-item versions of the Hamilton Rating Scale. A meta-analysis was undertaken for each item of the 17-item scale. Eleven papers met the inclusion criteria. When compared with younger depressed adults, older adults demonstrated more agitation, hypochondriasis and general as well as gastrointestinal somatic symptoms, but less guilt and loss of sexual interest. The authors conclude that the experience of late-life depression differs only in part from that of early-life depression. Older people may have a more somatic presentation, whereas feelings of guilt and loss of sexual function may be more prevalent in younger people.
Personality changes in Alzheimer's disease: a systematic review
- Authors:
- WAHLIN Tarja-Brita Robins, BYRNE Gerald J.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(10), October 2011, pp.1019-1029.
- Publisher:
- Wiley
People with Alzheimer's disease (AD) commonly exhibit changes in personality that sometimes precedes other early clinical manifestations such as cognitive impairment and mood changes. Early identification of personality change might therefore assist with diagnosis of AD. The objective of this paper is to provide a systematic review of the literature to examine the nature and extent of change in personality in people with AD. Systematic searches of 5 databases to November 2009 were undertaken to identify studies of informant-rated personality traits in AD patients. Nine studies that mapped changes in traits from the 5-factor model of personality (neuroticism, extraversion, openness, agreeableness and conscientiousness) were selected for analysis. The change in each of these 5 traits was calculated as the mean difference in score before and after the diagnosis of AD. The findings showed a mean increase in neuroticism of 10–20 T scores, a decrease of the same magnitude in extraversion, consistently reduced openness and agreeableness, and a marked decrease in conscientiousness of about 20–30 T scores. These changes were systematic and consistent. The article concludes that conscientiousness and neuroticism are the personality traits that exhibit the most change in dementia, and that these traits might therefore be useful early markers of dementia.
Screening for dementia in general hospital inpatients: a systematic review and meta-analysis of available instruments
- Authors:
- JACKSON Thomas A., NAQVI Syeda Huma, SHEEHAN Bart
- Journal article citation:
- Age and Ageing, 42(6), 2013, pp.689-695.
- Publisher:
- Oxford University Press
Objective: Dementia is common and often undiagnosed. Improving rates of diagnosis has become a key part of current dementia guidelines. Older people admitted to hospital are a potential target population for screening for dementia. The objective was to report whether instruments advocated in screening for dementia had been validated in hospital inpatients and to make recommendations on evidence-based screening for dementia in this population. Design: A systematic review was performed by an initial electronic database search using three key search criteria. Studies were then selected in a systematic fashion using specific predetermined criteria. Pooled meta-analysis was performed. Inclusion criteria were studies where the study group were inpatients in general hospitals, including a clearly defined group of older people (60 or older), they used a recognised screening instrument compared with a reference standard, and included at least 10 cases of dementia. Demographic data as well as sensitivity and specificity were recorded from the selected studies. Results: In total nine studies describing validation of six discreet instruments satisfied all our criteria and we were able to perform meta-analysis with one instrument, the Abbreviated Mental Test Score (AMTS). With a cut-off of <7, pooled analysis of the AMTS showed a sensitivity of 81%, a specificity of 84% and an area under the curve (AUC) of 0.88. Conclusion: A small number of instruments have been validated for screening for dementia in general hospital. Understanding strengths and weaknesses of currently available instruments allows informed decisions about screening in this setting. (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)
Screening for geriatric depression in residential care facilities: a systematic narrative review
- Authors:
- AZULAI Anna, WALSH Christine A.
- Journal article citation:
- Journal of Gerontological Social Work, 58(1), 2015, pp.20-45.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Studies in residential care facilities suggest that routine screening can assist in the early detection of geriatric depression. However, the effectiveness of screening instruments in residential care in the US and Canada has not been adequately evaluated. The authors conducted a systematic narrative review of the English-language literature published between 2000 and 2010 on screening instruments used for depression detection in older adults living in residential care facilities. The review yielded nine scales and their modifications tested in residential care, which were evaluated. The authors provide specific recommendations for the use of effective scales and discuss implications for practice, policy and research. (Edited publisher abstract)
Dementia in older adults with intellectual disabilities: a report on the state of science on dementia in older adults with intellectual disabilities by the IASSID Special Interest Research Group on Ageing and Intellectual Disabilities
- Authors:
- STRYDOM Andre, et al
- Publisher:
- International Association for the Scientific Study of Intellectual Disabilities
- Publication year:
- 2009
- Pagination:
- 49p., bibliog.
- Place of publication:
- Canterbury
This systematic review summarises current knowledge on dementia in older people with learning disabilities. The review included papers published from 1997 to 2008. Findings are discussed in the areas of: epidemiology; presentation and symptoms; screening, assessment and diagnosis; non-pharmacological and pharmacological interventions and issues for carers.
Disclosing a diagnosis of dementia: a systematic review
- Authors:
- BAMFORD Claire, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(2), February 2004, pp.151-169.
- Publisher:
- Wiley
The issue of diagnostic disclosure in dementia has been debated extensively in professional journals, but empirical data concerning disclosure in dementia has not previously been systematically reviewed. Five electronic databases were searched up to September 2003 (Medline, Embase, Cinahl, Sociological Abstracts, Web of Science). Additional references were identified through hand searches of selected journals and bibliographies of relevant articles and books. The title and abstract of each identified paper were reviewed independently by two reviewers against pre-determined inclusion criteria: original data about disclosure were presented and the paper was in English. Any disagreements were resolved by discussion until consensus was reached. Data were extracted independently by two reviewers using a structured abstraction form. Data quality were not formally assessed although each study was critically reviewed in terms of methodology, sampling criteria, response rates and appropriateness of analysis. Fifty-nine papers met the inclusion criteria for detailed review. Many of the studies had methodological shortcomings. The studies reported wide variability in all areas of beliefs and attitudes to diagnostic disclosure and reported practice. Studies of the impact of disclosure indicate both negative and positive consequences of diagnostic disclosure for people with dementia and their carers. Existing evidence regarding diagnostic disclosure in dementia is both inconsistent and limited with the perspectives of people with dementia being largely neglected. This state of knowledge seems at variance with current guidance about disclosure.