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The case for specialist home care for people with dementia
- Author:
- CHILVERS Dominic
- Journal article citation:
- Journal of Dementia Care, 11(1), January 2003, pp.20-21.
- Publisher:
- Hawker
Discusses the case for specialist home care for people with dementia, and highlights a specialist homecare service operating in Poole.
Getting old is not for cowards: comfortable, healthy ageing
- Authors:
- REED Jan, et al
- Publisher:
- Joseph Rowntree Foundation
- Publication year:
- 2003
- Pagination:
- 70p.
- Place of publication:
- York
The project reported on here was commissioned by the Joseph Rowntree Foundation as a way of exploring different ideas about health for older people, alternatives to medical models that defined health simply as the absence of disease. In these medical models, with their emphasis on physiology and cure, growing old becomes a process of experiencing increasing deficits and problems, and the goals of intervention are to prevent or treat these problems. Much medical research and the resources to support it therefore concentrate on these deficits, and define ‘healthy ageing’ as avoiding or escaping them. Partly in response to this deficit model, a movement has developed which seeks to promote the idea of growing older as positive experience. If services are based on ideas of health that have developed in professional and policy debates, then they run the risk of being, at best, irrelevant to the needs of older people and, at worst, dismissive of their views and damaging to them. Services that are designed to promote health for older people, therefore, need to take into account the ideas and wishes of older people themselves.
Extra care housing: getting the facts straight and improving practice
- Authors:
- RISEBOROUGH Moyra, PORTEUS Jeremy
- Journal article citation:
- Housing Care and Support, 6(4), November 2003, pp.22-28.
- Publisher:
- Emerald
Presents an overview on what extra care housing is (sometimes called very sheltered housing) and makes a few points on what really helps improve commissioning. Also draws on innovative and up-to-date material developed for the Department of Health's Housing Learning and Improvement Network by Moyra Riseborough from CURS at the University of Birmingham and Peter Fletcher of Peter Fletcher Associates.
A three-factor analytic model of the MADRS in geriatric depression
- Authors:
- PARKER R. D., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(1), January 2003, pp.73-77.
- Publisher:
- Wiley
Major depression is a heterogeneous disorder, perhaps comprising several clinical subtypes or subgroups of symptoms. This study examined whether items on the Montgomery-Åsberg Depression Rating Scale (MADRS) form distinct symptom subgroups among geriatric depressive patients that might form the basis of new outcome measures for tracking treatment effects. The study examined a sample of 225 adults age 59 and older diagnosed with major depression. Three distinct interpretable factors were obtained. The first factor, dysphoric apathy/retardation, comprised five items: apparent sadness, reported sadness, lassitude, reduced concentration, and inability to feel. Psychic anxiety, the second factor, included three items: inner tension, pessimistic thoughts, and suicidal thoughts. The third factor, vegetative symptoms, resulted from items involving sleep and appetite.
Baseline experience with Modified Mini Mental State Exam: The Women's Health Initiative Memory Study (WHIMS)
- Authors:
- RAPP S. R., et al
- Journal article citation:
- Aging and Mental Health, 7(3), May 2003, pp.217-223.
- Publisher:
- Taylor and Francis
The Modified Mini Mental State Exam (3MS) is widely used for screening global cognitive functioning, however little is known about its performance in clinical trials. The authors report the distribution of 3MS scores among women enrolled in the Women's Health Initiative Memory Study (WHIMS) and describe differences in these scores associated with age, education, and ethnicity. The 3MS exams were administered to 7,480 women aged 65-80 who had volunteered for and were eligible for a clinical trial on postmenopausal hormone therapy. General linear models were used to describe demographic differences among scores. Factor analysis was used to characterize the correlational structure of exam subscales. The distribution of 3MS scores at baseline was compressed in WHIMS compared to population-based data. Mean 3MS scores (overall 95.1) tended to decrease with age and increase with education, however these associations varied among ethnic groups ( p < 0.0001) even after adjustment for health, physical disability and occupation attainment. Four factors accounted for 37% of the total variance. Each varied with education and ethnicity; the two most prominent factors also varied with age. Despite relatively narrow distributions in WHIMS, baseline 3MS scores retained associations with age and education. These associations varied among ethnic groups, so that care must be taken in comparing data across populations.
Evaluating a practice-oriented service model to increase the use of respite services among minorities and rural caregivers
- Authors:
- MONTORO-RODRIGUEZ Julian, et al
- Journal article citation:
- Gerontologist, 43(6), December 2003, pp.918-924.
- Publisher:
- Oxford University Press
The goal of this study was to evaluate the practice-oriented model of service use relative to the more widely used behavioural model in its ability to explain the use of respite services by caregivers of Alzheimer's patients. Unlike the behavioural model, which focuses primarily on characteristics of the service user, the practice-oriented model focuses primarily on characteristics of the service. Interview data from 1,158 caregivers participating in the Alzheimer's Disease Demonstration Grants to States programme were analyzed. Separate regression models were estimated for adult day care and in-home respite, using the full information maximum likelihood procedure described by Arbuckle, and ordinary least squares regression with listwise deletion of missing data. The findings indicate that the factors related to respite use tapped by the practice-oriented model add significantly to explanatory models of service use over models that use only the factors typically represented by the behavioural model. Additional analyses, including a set of interactions with ethnicity, indicated that this improvement occurs primarily for White and Hispanic caregivers, and less so for African Americans.
Home and away: home from hospital, progress and prospects
- Authors:
- WADDINGTON Eileen, HENWOOD Melanie
- Journal article citation:
- Journal of Integrated Care, 11(6), December 2003, pp.40-42.
- Publisher:
- Emerald
Home from Hospital schemes run in the UK by the British Red Cross meet and match intermediate care policy's objectives. This article compares a review of 55 schemes operating in 2003. It suggests that such schemes are addressing needs and have the potential to develop work in prevention of hospital admission and to improve health generally. The service provides emotional and practical help by linking trained volunteers with individuals and developing flexible support packages.
Intermediate care: it's place in a whole-systems approach
- Authors:
- ASTHANA Sheena, HALLIDAY Joyce
- Journal article citation:
- Journal of Integrated Care, 11(6), December 2003, pp.15-24.
- Publisher:
- Emerald
Considers intermediate care as part of a whole-systems approach to care. It argues that this perspective allows a wider appreciation of the potential benefits of intermediate care, and that this would also be a welcome feature in future research studies. Draws on an evaluation of intermediate care in Cornwall and outlines the central role of intermediate care co-ordination in the whole system. The example of residential rehabilitation is then used to examine how an individual service relates to the system as a whole. Finally, factors that may also influence local systems such as partnership working and rurality are considered; these are seen as important considerations for any other authorities which might seek to replicate the Cornwall approach to intermediate care.
Models for individuals with Alzheimer disease: beyond the special care framework
- Authors:
- HOLMES Douglas, RAMIREZ Mildred
- Journal article citation:
- Journal of Social Work in Long-Term Care, 2(1/2), 2003, pp.175-181.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
For the past two decades much attention has been given to the definition and evaluation of special care units for nursing home residents with dementia. Beyond their potential as a marketing device, the controversy rages regarding the qualities, qualifications and benefits of special care. Inasmuch as 80-90% of nursing home residents suffer from some form of cognitive impairment, the debate would be better focussed on the quality of care and living for all residents. In that regard a fundamental restructuring of all nursing home care and life is a more appropriate direction than the continued debate on this more narrow theme.
Modelling late-life depression
- Authors:
- PARKER Gordon, SNOWDON John, PARKER Kay
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(12), December 2003, pp.1102-1109.
- Publisher:
- Wiley
This article seeks to find support for a three-class depression sub-typing model (and identify differentiating constituent clinical features) in a sample of elderly depressed patients. Depression is currently modelled dimensionally, with little concession to descriptive psychopathology and distinction of meaningful clinical depressive sub-types. The authors proposed a three-class hierarchical specificity model for sub-typing the depressive disorders (comprising psychotic, melancholic and non-melancholic depression), with specificity referring to two clinical features (psychotic symptoms and psychomotor disturbance or PMD) separating the first two classes from a residual non-melancholic class. Subjects were aged 65 years or more, non-demented and being treated for depression. Extensive clinical assessment was undertaken, while several standardised measures were administered. Bottom up analyses were data driven, while top down analyses respected DSM-III-R decision rules. Dimensional and categorical multivariate analyses sought to identify features differentiating psychotic depression (PD), melancholic depression (MEL) and a residual non-melancholic (NON-MEL) class. Of the 123 referred patients (having a mean age of 75.6 years), 46 had DSM-defined PD, 46 had MEL and 31 were assigned as NON-MEL. Mean total CORE scores (measuring PMD) more clearly distinguished the groups than scores on two depression severity measures. Psychotic depression was best distinguished from melancholic depression by psychotic features, as well as more severe PMD and anhedonia. Melancholic depression was best distinguished from non-melancholic depression by PMD, terminal insomnia and pathological guilt. The specificity of PMD to the definition of the psychotic and melancholic depression was confirmed in our elderly depressed sample. Clinical features identified as distinguishing psychotic, melancholic and non-melancholic depression were broadly consistent with findings from our previous studies involving younger subjects and with our three-class hierarchical model.