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High prevalence of central nervous system medications in community-dwelling older adults with dementia over a three-year period
- Authors:
- FICK D., KOLANOWSKI A., WALLER J.
- Journal article citation:
- Aging and Mental Health, 11(5), September 2007, pp.588-595.
- Publisher:
- Taylor and Francis
Few recent studies have investigated the prevalence and outcomes for central nervous system (CNS)-active medication use in older persons with dementia (PWD) who live in the community. Thus, the purpose of this study was to describe the health outcomes and patterns of use of CNS-active drugs in PWD living in the community. Using a retrospective study design from a southeastern managed care organization (MCO), claims data were collected for three years on all identified cases with dementia and included age, gender, medical diagnoses for each claim (International Classification of Disease [ICD-9 code]) and prescription drugs (National Drug Code [NDC]). Individuals (N = 960) were selected who were continuously enrolled and had prescription drug coverage. Over 79% of PWD in this sample were on a CNS-active medication during the three-year period and 35% were on a benzodiazepine. The highest number of drug-related problems (DRPs) within 45 days after receiving a CNS drug prescription were for syncope, fatigue, altered level of consciousness, delirium, constipation, falls and fractures. This study illustrates the need to further examine inappropriate CNS-active medication use in PWD and to test non-pharmacologic therapies for the clinical problems that initiate their use in PWD.
High score on the Relative Stress Scale, a marker of possible psychiatric disorder in family carers of patients with dementia
- Authors:
- ULSTEIN Ingun, WYLLER Torgier, ENGEDAL Knut
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(3), March 2007, pp.195-202.
- Publisher:
- Wiley
Compares the scores on the Relative Stress Scale (RSS) with those on the General Health Questionnaire (GHQ) and the Geriatric Depression Scale (GDS), and to establish a cut-off score for RSS in order to distinguish carers with symptoms of psychiatric disorders from those without. One hundred and ninety-four carers of 194 patients suffering from dementia according to ICD-10 were included in the study. Burden of care was assessed by the 15-items RSS, and psychiatric symptoms by means of the GHQ-30 and the 30-items GDS. A case score above 5 on GHQ and above 13 on GDS were used to define carers with probable psychiatric morbidity. Sensitivity (SS), specificity (SP), accuracy and likelihood ratio for a positive test (LR+) were calculated for different cut-points of the RSS. Fifty-six percent of the carers had a GHQ score above 5, and 22% had a GDS score above 13. A two-step cluster analysis using 192 of the 194 carers, identified three groups of carers; a low risk group for psychiatric morbidity (LRG), 82 carers with GHQ 5 and GDS 13; a medium risk group (MRG), 69 carers with GHQ > 5 and GDS 13; and a high-risk group (HRG), 40 carers with GHQ > 5 and GDS > 13. The optimal RSS cut-off to distinguish between the LRG and the others was > 23, whereas the optimal cut-off to separate the HRG from the others was >30. The RSS is a useful instrument to stratify carers according to their risk of psychiatric morbidity.
Depression and dementia: coexistence and differentiation
- Author:
- WARRINGTON Jill
- Publisher:
- University of Stirling. Dementia Services Development Centre
- Publication year:
- 1996
- Pagination:
- 37p.,bibliog.
- Place of publication:
- Stirling
This report reviews the complex relationship between these two conditions and gives guidance on the recognition and management of depression in older people. Contents include: defining depression and dementia; how common are depression and dementia in the elderly?; what causes depression; how do depression and dementia relate to each other?; depressive dementia (pseudodementia); depression as a secondary condition to dementia.
Assessing older people with dementia living in the community: practice issues for social and health services
- Author:
- GREAT BRITAIN. Department of Health. Social Services Inspectorate
- Publisher:
- Great Britain. Department of Health. Social Services Inspectorate
- Publication year:
- 1996
- Pagination:
- 1p.
- Place of publication:
- London
Letter accompanying the action checklist for the document 'Assessing older people with dementia living in the community.'
Assessing older people with dementia living in the community: practice issues for social and health services: report of the SSI workshop and visits May-June 1995
- Author:
- GREAT BRITAIN. Department of Health. Social Services Inspectorate
- Publisher:
- Great Britain. Department of Health. Social Services Inspectorate
- Publication year:
- 1996
- Pagination:
- 36p.,bibliog.
- Place of publication:
- London
Report of an exploratory project undertaken by the SSI to consider the assessment of older people with dementia who need support to live in the community. The study focused in particular on health needs and multidisciplinary work. Includes an action checklist.
Meeting the private sector housing condition and adaptation needs of older people: responses from London’s environmental health and allied services
- Author:
- STEWART Jill
- Journal article citation:
- Housing Care and Support, 25(1), 2022, pp.1-12.
- Publisher:
- Emerald
Purpose: This study aims to explore the environmental health role in meeting the housing condition, adaptation and associated needs of older people living in private sector housing in London, including those living with and at risk of dementia. Design/methodology/approach: A multi-method approach was adopted. First, relevant public-facing websites in London were scrutinised. Second, a Qualtrics online survey was designed and circulated to capture relevant information around relevant services offered. Third, seven face-to-face interviews were conducted with front-line practitioners involved in providing housing services to private sector owners and tenants. These were transcribed verbatim and analysed using NVivo software before categorising into themes arising. Findings: An erratic picture emerged around the meaning of “older people” and the services offered. A mixture of organisational arrangements and types of assistance available was reported, with different ways of access and referral to services, with a range of discretionary grants offered including for dementia. Some local authorities offered minimal specialist services, with others providing highly integrated and client-led, flexible interventions to meet a range of needs. Limited inclusion of research, evidence and evaluation of the effectiveness of interventions was reported overall, although client feedback was noted as good where services were provided. Originality/value: There is very little published around environmental health work in supporting older people living in London and their housing, health and social care needs. This paper captures a snapshot of current and proposed services offered across London for owner-occupiers and private sector tenants, as a basis for further research for evidence-based, effective front-line services going forward. (Edited publisher abstract)
Met and unmet care needs of older people with dementia living at home: personal and informal carers’ perspectives
- Authors:
- MAZUREK Justyna, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 18(6), 2019, pp.1963-1975.
- Publisher:
- Sage
In Poland, there are few reports of the holistic approach to caring for older people with dementia. The aim of this study was to assess the needs of people with dementia living at home. This was done by evaluating the perspective of people with dementia themselves and that of their carers. The study included 47 people diagnosed with mild to moderate dementia and 41 informal carers, all living in Wroclaw in Poland, involved in the MeetingDem project. The needs were assessed using the CANE. Other scales used were: the MMSE, the GDS and the QOL-AD. The carers reported significantly more needs, both met and unmet, than the people with dementia themselves. The most frequent reported unmet needs both by the people with dementia and their carers included activities of daily living, psychological distress and the need for company. Based on this study’s findings, tailored multidisciplinary treatment, adjusted to their needs and wishes, can be offered thus creating integrated and individualised support. (Edited publisher abstract)
The relationship between frailty, functional dependence, and healthcare needs among community‐dwelling people with moderate to severe dementia
- Authors:
- ABREU Wilson, et al
- Journal article citation:
- Health and Social Care in the Community, 27(3), 2019, pp.642-653.
- Publisher:
- Wiley
This paper examines the healthcare needs of community‐dwelling older people living in Porto, Portugal, diagnosed with moderate or severe dementia, linked to functional dependency, cognitive decline, limitations in the activities of daily life, and frailty levels. A sample of 83 participants was recruited. Data were collected between 2013 and 2017. A sociodemographic questionnaire, the Clinical Dementia Rating (CDR), the Barthel Index (BI), the Lawton and Brody Instrumental Activities of Daily Living (IADL) Scale, and the Edmonton Frail Scale (EFS) were used. A set of 26 healthcare needs was defined to support the assessment. The Pearson chi‐square or Fisher's exact test (as appropriate) was used to examine the association of the needs (unmet and met) with the levels of dementia and frailty. Participants were diagnosed previously with moderate or severe dementia and benefited from a structured home‐care program. There was a high number rated as “severe dementia,” “fully dependent,” “severely or fully dependent in the activities of daily living (ADL),” and “severe frailty.” There were statistically significant differences among needs identified in people with moderate or severe dementia and moderate or severe frailty. The most prevalent healthcare needs in the sample were food preparation, medication/taking pills, looking after their home, toilet use, sensory problems, communication/interaction, bladder, bowels, eating and drinking, memory, sleeping, and falls prevention. In particular, the study identifies a set of needs that are present simultaneously in both frailty and dementia stages. This study underlines that despite well‐structured home‐care programs for people with dementia, unmet health needs remain. Timely healthcare needs assessment may help professionals to avoid fragmented care and to tailor quality‐integrated interventions, including the emotional and psychological balance of the caregiver. (Edited publisher abstract)
Hearing their voice: a systematic review of dementia family caregivers’ needs
- Authors:
- MCCABE Marita, YOU Emily (Chuanmei), TATANGELO Gemma
- Journal article citation:
- Gerontologist, 56(5), 2016, pp.e70-e88.
- Publisher:
- Oxford University Press
Purpose: The number of Australians living with dementia is expected to increase from currently 332,000 to 900,000 by 2050. Around 200,000 unpaid caregivers are caring for community-dwelling people living with dementia, and therefore, supporting the caregivers’ needs is of paramount importance. The aim of this systematic review was to understand the perceived needs of immediate family caregivers of community-dwelling older adults with dementia. Design and methods: The authors examined qualitative studies that reported on the self-perceived needs of partner and/or offspring caregivers who were caring for community-dwelling older adults with dementia. Results: Two themes were developed from 12 studies: caregiver needs related to the management of older people with dementia and caregivers’ personal needs. The first theme further included four subthemes: information and knowledge needs; activities of daily living, instrumental activities of daily living and Behavioural and Psychological Symptoms of Dementia support needs; formal care support needs; and informal care support needs. The second theme consisted of two subthemes: the need to address caregivers’ physical and psychological health and the need to manage caregivers’ own lives. Implications: The findings have important implications for the development of interventions that comprehensively address caregivers’ individual needs. Caregivers’ unmet needs highlight key areas for improvement in policy and service provision. The findings demonstrate the need for more rigorous qualitative studies exploring the perceived needs of partner and offspring caregivers respectively. Furthermore, examining the underlying relationships between different caregiver needs is warranted. (Edited publisher abstract)
Report of the community led research project focussing on: the needs of Chinese older people with dementia and their carers
- Authors:
- CHAN Nancy, et al
- Publisher:
- National Institute for Mental Health in England
- Publication year:
- 2007
- Pagination:
- 121p.
- Place of publication:
- Leeds
The aim of this research project was to investigate the needs of older Chinese people with dementia and their carers in the Greater Manchester area. The particular areas of interest relate to understanding and awareness of dementia and the support needs among Chinese older people and carers. Data was collected by means of questionnaires which were completed by 72 respondents (28 males and 44 females). All of the respondents were born outside the UK, and almost 75% had lived in the UK for over 20 years, 75% of them had come from Hong Kong. The findings from the different sections of the questionnaires are presented: profiles of the respondents; dementia awareness; services from the family doctor; and health and social care needs. The findings demonstrate in particular that the respondents had a lack of awareness and understanding of dementia and of how to access mental health services. The report concludes that it is important to provide individual and family support for the people with dementia and their carers, and to develop services which are culturally appropriate for Chinese older people. Some key recommendations are provided.