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Psychological distress as a key component of psychosocial functioning in community-dwelling older people
- Authors:
- SCHNITTGER Rebecca I. B., et al
- Journal article citation:
- Aging and Mental Health, 16(1-2), January 2012, pp.199-207.
- Publisher:
- Taylor and Francis
Psychological distress is a critical issue affecting the quality of life in older adults with implications for both mental and physical health. The aim of this study was to explore the key components of psychosocial functioning in older adults with a focus on identifying the constituents of psychological distress. Another aim was to examine the relationship between these components and health outcomes such as frailty. The study was conducted at the Technology Research for Independent Living Clinic, a comprehensive geriatric assessment facility in Dublin. As part of a structured clinical assessment, 579 participants completed 9 primary psychosocial measures as well as a broad range of health and demographic secondary assessments. Principal factor analysis identified 3 core dimensions of the construct of psychosocial functioning. The first is related to a core internal component of psychological distress. The 2 other components are related to external and physiological functioning, specifically social support networks and sleep. These components, particularly psychological distress, were found to be associated with health outcomes associated with frailty.
Development of a delirium risk screening tool for long-term care facilities
- Authors:
- McCUSKER Jane, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(10), October 2012, pp.999-1007.
- Publisher:
- Wiley
Delirium is a frequent and serious problem in long-term care (LTC) and post acute care facilities. The aim of this study was to develop a brief risk screening tool that would facilitate the targeting of interventions to high risk patients in LTC. The study involved residents aged 65 years and over, without delirium at baseline, living in seven LTC facilities in Montreal and Quebec City. Incident delirium was diagnosed using multiple data sources during the 6-month follow-up. Six risk factors were evaluated: sociodemographic, medical, cognitive status, physical function, agitated behaviour, and symptoms of depression. Among the cohort of 206 residents there were 69 cases of incident delirium (rate 7.6 per 100 person weeks). The best-performing screening tool comprised five items, with an overall area under the curve of 0.82. These items included brief measures of cognitive status, physical function, behavioural, and emotional problems. Using cut-points of 2 (or 3) over 5, the scale had a sensitivity of 90% (63%), specificity of 59% (85%), and positive predictive value of 52% (66%). The authors conclude that this brief screening tool allows nurses to identify LTC residents at increased risk for delirium.
Communicating with older people about positive mental health
- Authors:
- PETTIGREW Simone, et al
- Journal article citation:
- Journal of Public Mental Health, 11(2), 2012, pp.65-76.
- Publisher:
- Emerald
The aim of this study was to identify aspects of mental health messages that may be particularly effective with older audiences, as population ageing is expected to increase the incidence of age-related mental illness. Individual interviews and focus groups were conducted with 111 Western Australians aged 40 years and older about their preferences for the delivery of mental health information, to inform future mental health promotion campaigns. The article describes the background to the study, the methods used and the findings, with illustrative quotations from study participants. It reports that there was a low level of knowledge about mental health and mental illness issues, and a lack of familiarity with the concept of positive mental health. It discusses participants' perceptions of mental health and mental illness and their views about appropriate spokespeople for physical and mental health messages. The authors conclude that there is considerable scope to educate the public about the importance of staying mentally healthy and how this outcome can be achieved.
The impact of the custodial setting on the mental health of older prisoners: a biopsychosocial perspective
- Author:
- CAIE Jude
- Journal article citation:
- Prison Service Journal, 202, 2012, pp.31-37.
- Publisher:
- Her Majesty's Prison Service of England and Wales
The aim of this paper is to highlight biopsychosocial factors which impact on the mental health of older male prisoners (those aged 50 years and over). It is based on a literature review. It discusses biological factors (physical health and wellbeing in custody and beyond), psychological factors (psychiatric morbidity, suicidality and risk), and social factors (isolation, social exclusion and reduced social capital). The author finds that biological, psychological and social factors are interconnected in the onset or worsening of primary mental health problems among older male prisoners. The article discusses practice, policy and research implications, noting that the elderly are the fastest growing group in the prison population. It suggest that there is a need to examine the effectiveness of biopsychosocial interventions in the care and treatment of mental health problems in the older prison population.
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.
The prevalence, incidence and risk factors for delirium in Dutch nursing homes and residential care homes
- Authors:
- BOORSMA Marijke, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(7), July 2012, pp.709-715.
- Publisher:
- Wiley
Delirium is characterised by acute onset, fluctuating course and disturbances of consciousness, attention and perception. Its fluctuating course presents challenges to staff. This study compares the prevalence and incidence of delirium and its risk factors in residents of Dutch nursing and residential care homes. Data were drawn from a study involving a total of 3627 residents using the Long-Term Care Facility (inter RAI-LTCF) version of the Resident Assessment Instrument. Of the residents, 828 residents were from six nursing homes and 1365 from 23 residential homes. Delirium was defined as a positive score on the adjusted Nursing Home–Confusion Assessment Method. The prevalence of delirium was 8.9% in the nursing homes and 8.2% in the residential homes. The incidence was highest in the nursing homes; 20.7 versus 14.6 per 100 person-years. Multivariate tests of risk factors for delirium included chair restraints (OR 2.3); dementia (OR 3.3) and Parkinson's disease (OR 2.3) in nursing homes, and dementia (OR 1.8 and falls (OR 1.7) in residential care homes. The authors that conclude delirium is an important clinical problem in both settings. They suggest there is a need for greater focus on the modifiable risk factors revealed in the analyses.
Listening to older adult parents of adult children with mental illness
- Author:
- SMITH Judith R.
- Journal article citation:
- Journal of Family Social Work, 15(2), March 2012, pp.126-140.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Current knowledge about the conflicts of older parents with dependent children is underdeveloped. This qualitative study investigated the experience of women age 55 and older who were parents caring for adult children with mental illness. All participants were from Rockland County, New York. Analysis of the women's stories about parenting in later life suggested that they had two sets of feelings – wanting to be free from the responsibility of caregiving and feeling responsible to continue the support and protection of their adult vulnerable children. The women's conflicts were considerable and were founded in the ideational themes of the narratives, as well as the structure of how the narratives were spoken. A discussion details the relevance of the theory of ambivalence for clinical practice when working with older women who are caregivers for their adult dependent children.
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.
An examination of the needs of older patients with chronic mental illness in public mental health services
- Authors:
- FUTERAN Shuli, DRAPER Brian M.
- Journal article citation:
- Aging and Mental Health, 16(3), April 2012, pp.327-334.
- Publisher:
- Taylor and Francis
Meeting the needs of patients is likely to influence their experienced quality of life. The aim of this study was to describe the needs of patients aged 50 years and over with chronic mental illness being case managed within a public mental health service, and to determine factors that influence these needs. The participants were 97 patients recruited from community-based Adult Mental Health (AMH) teams and Specialist Mental Health Services for Older People (SMHSOP) teams. Eligibility criteria included a diagnosis of schizophrenia or mood disorder. Patient, carer and key worker interviews were carried out using the Camberwell Assessment of Need for the Elderly (CANE). The findings showed that patients self-rated fewer needs overall on the CANE than their key workers or the researcher, and also rated a higher proportion of their needs being met (83%) than the key worker (77%) or researcher (76%). From each perspective, over 80% of psychiatric and around 95% of identified medical needs were being met. The majority of social needs were unmet, with patients reporting only 42%, and key workers only 33%, met needs. The key unmet social needs were company, daily activities and having a close confidant. The article concludes that the social needs of older patients with chronic mental illness require greater attention by public mental health services.
Instruments for comprehensive needs assessment in individuals with cognitive complaints, mild cognitive impairment or dementia: a systematic review
- Authors:
- SCHMID Roger, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(4), April 2012, pp.329-341.
- Publisher:
- Wiley
The authors begin their paper by discussing the importance of appropriate and appropriately applied needs assessment in cognitive impairment from both the patient’s and practitioner’s perspectives. It has become more common to complement the objective assessment of symptoms with an assessment of individual needs patterns as created by the individual pattern of symptoms. However, relatively little is known about needs patterns in individuals with subjective cognitive impairment, mild cognitive impairment and dementia. Based on an analysis of the development of needs in the course of cognitive decline, the authors provide an overview of the existing needs assessment instruments with respect to their feasibility, validity and reliability. A literature search included publications to September 2009 in PsycINFO and PubMed. Seventeen needs assessment instruments for older individuals with mental disorders, cognitive impairment or dementia were identified. A wide range of needs indicators within different subgroups were discovered. Validity and reliability ranged between moderate and good. The authors conclude that even though a wide range of needs assessment instruments is available, most assess individual needs on a general rather than on a more concrete level that may serve better to inform interventions for this growing population. They suggest basing the development of instruments on an adequate theoretical framework and standardise procedural guidelines.