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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.
Features and challenges of personality disorders in late life
- Authors:
- ALPHEN S.P.J van, et al
- Journal article citation:
- Aging and Mental Health, 16(7), September 2012, pp.805-810.
- Publisher:
- Taylor and Francis
A personality disorder is an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture and leads to distress and impairment. The prevalence of personality disorder in older people is reported as lying between 2.8% and 13%. Being able to identify and accurately diagnose personality disorder in older adults has critical clinical importance both for providers and settings responsible for their care. This article discusses the expression of personality disorder in old age, the process of diagnosis and assessment, and presents treatment options available.
Hidden crisis: why millions keep quiet about hearing loss
- Author:
- ECHALIER Melissa
- Publisher:
- Royal National Institute for Deaf People
- Publication year:
- 2012
- Pagination:
- 38p.
- Place of publication:
- London
Hearing loss affects 1 in 7 of the adult UK population, and 55% of people over 60 years. Previous research has suggested that people may wait up to 15 years between the onset of hearing loss and seeking medical advice about it. This delay is problematic because it is important that people start wearing hearing aids as soon as possible in order to adjust to the amplified sound. This study comprised qualitative interviews with 24 hearing aid users (11 aged over 60 years and 13 aged under 60 years) throughout the UK. The aim was to gain a better understanding of people’s decision-making around diagnosis of their hearing loss, particularly identifying the factors that lead patients to consult their GP or a private hearing aid dispenser, and those factors that act as barriers to consultation. The research also aimed to explore the factors that influence whether hearing aid users gain the utmost benefit from their hearing aid, as well as other related factors that have an impact on their ability to live a full life. The findings are presented under the following themes: patients’ journey to diagnosis; experiences of health services; impact of hearing loss on relationships, family and social life; and support and equipment. Recommendations are provided in relation to all of these themes.
A world of silence: the case for tackling hearing loss in care homes
- Author:
- ECHALIER Melissa
- Publisher:
- Action on Hearing Loss
- Publication year:
- 2012
- Pagination:
- 49
- Place of publication:
- London
Drawing of findings from visits to three care homes in England, this report explores carers’ and residents’ attitudes to hearing loss and how they manage it. Attributes particular to this setting, such as high levels of dementia and low levels of conversation, can work against residents recognising and taking action on their hearing loss. At the same time, the high incidence of other conditions, such as sight loss and dementia, mean that it’s extremely important that hearing loss is managed in these settings, as unmanaged hearing loss can make difficulties caused by such conditions much worse. Interviews and focus groups were carried out, and residents’ hearing screened to gauge how many people had hearing loss but had never been properly diagnosed. The research demonstrates that if care home residents’ hearing loss is managed effectively, there is a real chance of improving their quality of life but also identifies the worrying trend of hearing loss not being diagnosed and managed properly. The report sets out three major recommendations: intervene earlier in hearing loss; meet communication needs in care homes; and improve hearing aid use and management in care homes. (Edited publisher abstract)
A qualitative investigation of the impact of multimorbidity on GP diagnosis and treatment of depression in Australia
- Authors:
- STANNERS Melinda N., et al
- Journal article citation:
- Aging and Mental Health, 16(8), November 2012, pp.1058-1064.
- Publisher:
- Taylor and Francis
The detection of depression in patients in primary care with multiple chronic conditions is often challenging for GPs. In this study, eight GPs engaged in a semi-structured interview to discuss the impact of multimorbidity on the diagnosis and detection of depression in older people. Participants described multimorbidity as obscuring symptom causation, but also creating time to investigate causation and negotiate the depression diagnosis with the patient, and generating relationship through frequent presentations. Knowledge of the patient impacted on intervention recommendations, and trust facilitated patient receptivity. Treatment was affected by a range of variables, and included medical and social interventions. GP process for multimorbid patients is similar to that of patients with chronic illness. Further research is needed to know whether different processes or diagnostic categories are warranted where multiple chronic illnesses are present. Also, GPs recommend social interventions where medical interventions are perceived as inappropriate, but further research into the efficacy of social interventions is required.
The rich picture on older people with cancer
- Author:
- MACMILLAN CANCER SUPPORT
- Publisher:
- Macmillan Cancer Support
- Publication year:
- 2012
- Pagination:
- 68p.
- Place of publication:
- London
The ‘Rich Pictures’ are evidence-based summaries of the numbers, needs and experiences of different groupings within the 2 million people living with cancer in the UK. They contain a range of evidence and insight including how many people are within the group, what their survival rates are, and what their typical needs and experiences are. This document provides information on older people living with cancer. The greatest risk factor for cancer is age, and over 60% of everyone living with cancer is aged 65 years and over. Around 1.3 million (13%) people aged 65 years and over are living with or beyond cancer. The document summarises what is known about the needs and experiences of older people at different stages of the cancer journey (diagnosis, treatment, survivorship, and progressive illness and end of life), and also what is known about their lifestyle and perceptions. It considers 4 types of needs: physical and medical needs; financial needs; practical and information needs; and emotional and psychological needs.
Difficulties in disclosing the diagnosis of dementia: a qualitative study in general practice
- Authors:
- PHILLIPS Jill, et al
- Journal article citation:
- British Journal of General Practice, 62(601), August 2012, pp.415-416.
- Publisher:
- Royal College of General Practitioners
Dementia research indicates that GPs find communicating diagnosis problematic. Delays in diagnosis may impede optimal patient care. This study investigated GPs’ perceptions of barriers to disclosing the diagnosis of dementia. Semi-structured interviews were conducted with GPs from three capital cities and one regional centre in Australia. Findings revealed that GPs' lack of confidence in having a correct diagnosis, concern to act in patients' best interests, and the stigma associated with the ‘dementia’ label influenced the disclosure process. GPs found it challenging to identify dementia in the consultation context. It was difficult to raise the issue when both the patient and their carers were unaware of symptoms of cognitive decline. Referral to a specialist was favoured to confirm suspicions, although this did not always result in a definitive diagnosis. Opinions differed as to whether the GP or the specialist was better placed to deliver the diagnosis. GPs preferred disclosure to the patient with his/her family/carer(s) present; associated issues of confidentiality and the importance of offering hope emerged.
Making a name for dementia: a national challenge
- Author:
- LAKEY Louise
- Journal article citation:
- Mental Health Today, July 2012, pp.18-19.
- Publisher:
- Pavilion
- Place of publication:
- Hove
By 2021 it is estimated that there will be more than one million people living with dementia in the UK. Health and social care systems therefore need to be ready to support and provide for the growing number of people who are going to be affected by dementia. Only 43% of people living with dementia in the UK ever receive a diagnosis. Even when they do receive one, it often occurs only once they are at the moderate or late stages of dementia, which minimises the opportunities for the care and support that improves quality of life. Greater training is required for GPs in diseases affecting people in older age, including dementia. It is also important that there are adequate specialist dementia diagnostic services to perform the appropriate scans and tests to confirm a diagnosis of dementia. In addition, society needs to play a part in making the UK dementia friendly. People need to be aware of how dementia affects lives, and communities need to be able to support people who are living with dementia in their area. Another issue that needs to be tackled is the cost and the quality of the care that paid for by people with dementia and their families.
DSM-5 research: assessing the mental health needs of older adults from diverse ethnic backgrounds
- Authors:
- ROSE Alexis Lee, CHEUNG Monit
- Journal article citation:
- Journal of Ethnic and Cultural Diversity in Social Work, 21(2), April 2012, pp.144-167.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is being updated and expanded by the American Psychiatric Association, based on scientific criteria for developing comprehensive assessments and culturally appropriate interventions to meet the psychological and behavioural needs of individuals. As a clinical manual, it identifies appropriate care through diagnoses and classifications of mental and behavioural health needs. This article analyses current trends and limitations in the design of the DSM, focusing particularly on its application to older adults from diverse ethnic backgrounds. It is based on a literature review which identified 54 articles published between 2001 and 2011 discussing DSM and its applicability to assessing ethnically diverse older adults' mental health. 5 themes emerged from qualitative analysis of the material: assessment issues related to acculturation, limitations with culture elements, health disparities, evidence-based practice with dementia, and prevalence of anxiety and depression. The article discusses incorporation of additional considerations into the DSM in the light of the literature review findings.
Age differences in symptom expression in patients with major depression
- Authors:
- HYBELS Celia F., LANDERMAN Lawrence R., BLAZER Dan G.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(6), June 2012, pp.601-611.
- Publisher:
- Wiley
Symptom expression was compared in middle-aged (below 60) and older (60+) depressed patients to determine whether symptom profiles differed by age. Patients diagnosed with major depression (N=664) were screened using the Center for Epidemiologic Studies Depression scale and sections of the Diagnostic Interview Schedule. They were separated into homogeneous clusters based on symptom endorsement. Older patients were less likely to endorse crying spells, sadness, feeling fearful, being bothered, or feeling life a failure but were more likely to endorse poor appetite and loss of interest in sex. Older patients were also less likely to report enjoying life, feeling as good as others, feeling worthless, wanting to die, and thinking about suicide. Profiles supported heterogeneity in symptom expression. Clusters differed by age when other demographic, clinical, health, and social variables were controlled but did not support age-specific symptom profiles. Overall, older patients had later age of onset, had fewer lifetime spells, were more likely to have received electroconvulsive therapy (ECT), and were less likely to have comorbid anxiety. Older patients also had more cognitive impairment, health conditions, and mobility limitations but had higher levels of subjective social support and had experienced fewer stressful life events. It appears that there are age differences in symptom endorsement; however the data did not support a symptom profile unique to late-life depression.