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Agreement between dementia patient report and proxy reports using the Nottingham Health Profile
- Authors:
- BOYER F., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(11), November 2004, pp.1026-1034.
- Publisher:
- Wiley
The aim of the study was to examine the agreement between patient reports and their proxy reports (family and care provider proxies) on Health Status in a sample of patients with dementia. Completion rates for the different NHP dimensions ranged from 78 to 90% for the dementia subjects. Inter-rater agreement between different proxies and subject was from moderate to good for physical assessment (ICCs from 0.54 to 0.78 for physical mobility scales). Patient/family proxy concordance was moderate to good for five out of six dimensions (physical mobility, social isolation, pain, energy, sleep) and poor for emotional reaction. Family proxies systematically reported lower functioning than did patients in the four subscales assessing: physical mobility (p < 0.0001), energy (p < 0.005), social isolation (p < 0.01) and sleep (p < 0.03). Care provider proxies only estimated physical mobility as lower (p < 0.0001). Age and physical status of the patient significantly affected agreement in patient-care provider proxy ratings. Thus, caution is appropriate when resorting to proxies to estimate the Health Status of a dementia patient.
Emotional support, negative interaction and DSM IV lifetime disorders among older African Americans: findings from the national survey of American life (NSAL)
- Authors:
- LINCOLN Karen D., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(6), June 2010, pp.612-621.
- Publisher:
- Wiley
While both emotional support and negative interaction (conflicts) with family members have been linked to mental health problems, few studies have examined the associations between emotional support and negative interaction and psychiatric disorders in late life. This study investigated the relationship between emotional support and negative interaction on lifetime incidence of mood and anxiety disorders among older African Americans. Data from the National Survey of American Life identified 786 African Americans aged 55 years and older to be included in the study. The DSM-IV World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to assess mental disorders, and three dependent variables were examined: the prevalence of lifetime mood disorders; the prevalence of lifetime anxiety; and the prevalence of lifetime mood and anxiety disorders. Findings showed that emotional support was not associated with any of the three dependent variables. Negative interaction was significantly and positively associated with the chances of having a lifetime mood disorder, a lifetime anxiety disorder and the number of lifetime mood and anxiety disorders, with 23% of respondents reporting at least one mental disorder over their lifetime. The authors conclude that this study’s finding can alert clinicians to the potential negative impacts of family involvement and their implications for psychiatric disorders.
Beyond the global score of the Zarit Burden Interview: useful dimensions for clinicians
- Authors:
- ANKRI Joel, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(3), March 2005, pp.254-260.
- Publisher:
- Wiley
The purpose of this study was to explore the structure of the Zarit Burden Interview (ZBI) for informal caregivers of patients suffering from AD or related disorders, and to examine the relations of the dimensions found with functional disabilities and other patient health indicators. Caregiver burden was measured by the 22-item ZBI. Caregivers' and care recipients' characteristics were collected with the MDS (Minimum Data Set) of the RAI (Resident Assessment Instrument) Home Care instrument. Data on dementia (diagnosis, severity, MMSE) were also obtained. Burden data were analysed by principal component analysis (PCA) with varimax rotation. Relationships between scores on PCA factors and care recipients' health indicators were studied with inferential statistical tests. Three dimensions of burden were found: effect on the social and personal life of caregivers, psychological burden and feelings of guilt. Some health variables were linked to these dimensions. Spouses and children perceived burden differently. Spouse caregivers emphasized the deterioration of their personal and social life. Children, less involved in daily care, were more prone to feel guilt that they were not doing enough for their parent.
Object naming and semantic fluency among individuals with genetic risk for Alzheimer's disease
- Authors:
- MILLER Karen J., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(2), February 2005, pp.128-136.
- Publisher:
- Wiley
This study longitudinally examined the object naming and semantic fluency of individuals who are at risk for developing Alzheimer's disease (AD) by virtue of having APOE-4 or a family history of AD. A total of 108 participants (40 with a family history of AD and 43 with APOE-4) completed the Boston Naming Test and the Animal Naming task at initial assessment and after two years. At baseline, object naming was significantly lower for those with both risk factors, but those with either risk factor had significantly lower scores at follow-up. Semantic fluency (animal naming) was reduced among subjects with the APOE-4 allele at baseline, but it was not associated with either risk factor at follow-up. These deficits may be associated with a prodromal risk for AD and may serve as pre-symptomatic markers for the development of AD.
Competence to consent to treatment of geriatric patients: judgements of physicians, family members and the vignette method
- Authors:
- VELLINGA A., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(7), July 2004, pp.645-654.
- Publisher:
- Wiley
In absence of a gold standard of methods to assess competence, three judgements of competency of geriatric patients are evaluated: the judgements of a physician, the judgement of a family member, and the judgement of an instrument. Competence of 80 geriatric patients was judged both by a physician and a family member. Decision making capacity was assessed with a vignette. A vignette describes a treatment choice, after which the following abilities are evaluated: evidencing a choice, understanding, reasoning and appreciating a situation. Cognitive functioning was measured with the Mini-Mental State Examination. Most of the geriatric patients were judged competent by all three methods. Disagreement between the three judgements was found for 25 patients. Agreement about incompetence was only reached for one patient. Physicians appeared to be most lenient in their incompetency judgement: only three patients were judged incompetent. These patients scored significantly lower than competent patients on cognitive functioning, the decisional ability of understanding, and the total vignette score. Family members appeared to be most stringent in their judgement: they considered 22 patients incompetent. Incompetent patients scored significantly lower than competent patients on cognitive functioning, reasoning and the total vignette score. The disagreement between the judgements suggests a difference in factors given emphasis by the three methods. The finding that both the judgement of physicians and family members are associated with the assessment of the vignette, suggests that the vignette method has more than a legal theoretical base and is associated with daily life experience and knowledge as well. Physicians can be helped to assess competence by the vignette method to evaluate decisional abilities and by family members who can provide more information about patients' values.
Effect of combined support for people with dementia and carers versus regular day care on behaviour and mood of persons with dementia: results from a multi-centre implementation study
- Authors:
- DROES Rose-Marie, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(7), July 2004, pp.673-684.
- Publisher:
- Wiley
A previous study in Amsterdam showed that combined family support in the Meeting Centres Support Programme, in which dementia patients and their carers are both supported by one professional staff member, is more effective in influencing behaviour problems and mood of dementia patients living in the community than non-integrated support, such as day care only. A multi-centre implementation study tests if similar effects are achieved in other regions of The Netherlands. A pretest-posttest control group design was applied. 112 dementia patients who visited psychogeriatric day care in eight community centres across the country and in three nursing homes, and their carers participated in the study. The 89 patients in the experimental group received support from the Meeting Centres Support Programme together with their carers, while the 23 people in the control group received day care only. Behaviour problems (aggressive behaviour, inactivity, non-social behaviour) and mood (dissatisfaction, depressive behaviour) were assessed using standardized observation scales. Quality of life was assessed by interviewing the patients. After 7 months the Meeting Centres Support Programme, compared to regular day care, showed a moderately positive effect on the degree of total behaviour problems, especially on inactivity and non-social behaviour, a large effect on depressive behaviour and a moderate effect on self-esteem. Participation in the programme seems to have a positive effect on self-esteem, an important aspect of quality of life. These findings confirm the surplus value of the combined family support in the Meeting Centres Support Programme as compared to regular day care for people with mild to severe dementia.
Family functioning in the caregivers of patients with dementia
- Authors:
- HERU Alison M., RYAN Christine E., IQBAL Asma
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(6), June 2004, pp.533-537.
- Publisher:
- Wiley
Caregiver burden has been extensively studied in the dementia population. The marital relationship has been suggested as a mediational model through which variables influence the caregiver and contribute to the experience of burden or reward. This study examines family functioning, caregiver burden and reward and quality of life in 38 family members caring for a relative with dementia. Caregivers of out-patients with dementia completed self report questionnaires. 63% of caregivers were female with a mean age of 62 years. Patient mean age was 73 years. The average number of caregiving years was 3.1. Caregivers were more likely to be spouses (61%) than children (29%) or other relatives (11%). Despite the fact that caregivers reported that their relatives were moderately disabled, they perceived more reward than burden. Caregivers who reported poor family functioning had higher ratings of strain and burden. Family functioning in these caregivers was poorest in the dimensions of affective responsiveness, problem solving and communication but it was also impaired in roles and affective involvement.
Family carers' responses to behavioural and psychological symptoms of dementia
- Authors:
- WARD Sandy, OPIE Janet, O'CONNOR Daniel W.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(11), November 2003, pp.1007-1012.
- Publisher:
- Wiley
Thirty family carers of people with dementia were identified in a survey of mental disorder in general practice. Another 20 were referred by local aged mental health services. Carers were interviewed using the Manchester and Oxford University Scale for the Psychopathological Assessment of Dementia (MOUSEPAD) which rates behavioural and psychological disturbances. Carers' customary responses to current symptoms were recorded verbatim and categorised using a structured typology. Symptom frequency increased in line with dementia severity. Disturbances were generally well tolerated. Most were ignored where possible, except for wandering from home. Other common responses included avoiding triggers, providing reassurance, reality orientation, diversion, and collusion with false beliefs. Restrictive or punitive responses were uncommon. Few carers articulated clear strategies to deal with behavioural and psychological symptoms. For most, tolerance proved more effective and less distressing than arguments and reprimands. Carers' responses are likely to be influenced by social and cultural factors and may differ in other settings.
Memory for new information as a cognitive marker of liability to Alzheimer's disease in a high risk group
- Authors:
- RICE Frances, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(2), February 2003, pp.155-160.
- Publisher:
- Wiley
The development of Alzheimer's disease (AD) is often insidious and there is evidence that pre-morbid neuropsychological deficits exist. The purpose of this article was examine aspects of neuropsychological performance as cognitive markers in a group at high risk of developing AD. Memory for novel information and verbal fluency were examined in 33 unaffected biological siblings of patients who fulfilled criteria for probable AD, and 22 controls who reported no family history of dementia. Comparisons between siblings and controls revealed significant differences on overall memory performance. Detailed measures of memory performance may be clinically useful in groups at a high risk of developing AD.
Women who challenge: women offenders and mental health issues
- Author:
- KESTEVEN Sue
- Publisher:
- NACRO
- Publication year:
- 2002
- Pagination:
- 52p., bibliog.
- Place of publication:
- London
Mental health problems can contribute to women's offending and mat be exacerbated rather than addressed in prison. This can be extremely damaging both to the women themselves and their families. The aim of this book is to provide a comprehensive overview of the problems faced by women prisoners with mental health problems.