Search results for ‘Subject term:"older people"’ Sort:
Results 1 - 10 of 11
Early response as predictor of final remission in elderly depressed patients
- Authors:
- KOK Rob M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(11), November 2009, pp.1299-1303.
- Publisher:
- Wiley
Several studies have attempted to predict the final response or remission based on improvement during the early course of treatment of major depression, but there is variation in the cut offs used to define early response and in the best week to predict final results. This study aimed to compare different cut-offs at different time points early in the treatment of elderly depressed patients, using a 12 week randomised controlled trial in 81 elderly inpatients with major depression comparing venlafaxine with nortriptyline. The results showed that in elderly in patients, prediction of final remission is possible as early as week 3. In conclusion the researchers suggested that, combining the results from this study and other studies addressing this issue, treatment should be changed in the elderly if after 3-4 weeks less than 30% improvement in depression score has been achieved.
Delirium subtype identification and the validation of the Delirium Rating Scale - Revised-98 (Dutch version) in hospitalized elderly patients
- Authors:
- DE ROOIJ Sophia E., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(9), September 2006, pp.876-882.
- Publisher:
- Wiley
Delirium is the most common acute neuropsychiatric disorder in hospitalized elderly. The Dutch version of the Delirium Rating Scale - Revised-98 (DRS-R-98) appears to be a reliable method to classify delirium. The aim of this study was to determine the validity and reliability of the DRS-R-98 and to study clinical subtypes of delirium using the DRS-R-98. Patients received the Dutch version of the DRS-R-98, the Mini-Mental State Examination, the Confusion Assessment Method, and a clinical diagnosis of delirium according to DSM-IV criteria, and their relatives the Informant Questionnaire Cognitive Decline in the Elderly. The DRS-R-98 validation cohort (n = 65) consisted of 23 patients with delirium, 22 patients with dementia, and 20 non-psychiatric comparison patients. For the delirium subtype study, a second cohort comprising 54 delirious patients was investigated. Median DRS-R-98 scores significantly distinguished delirium from dementia and no psychiatric disorder. Inter-rater reliability (intra-class correlation 0.97) and internal consistency (Crohnbach's alpha 0.94) were high. Positive scores of DRS-R-98 item 4 (affect liability) and item 7 (motor agitation) predicted the presence of non-hypoactive delirium, with a specificity of 89% and a sensitivity of 57%. The results show that the Dutch version of the DRS-R-98 is a valid and reliable measure of delirium severity and distinguishes patients with delirium from patients with dementia and comparison patients.
Depressive disorders in caregivers of dementia patients: a systematic review
- Author:
- CUIJPERS P.
- Journal article citation:
- Aging and Mental Health, 9(4), July 2005, pp.325-330.
- Publisher:
- Taylor and Francis
Although depressive symptomatology has been well studied in caregivers of patients with dementia, depressive disorders have been examined much less. We conducted a systematic literature search in major bibliographical databases (Medline, Psychinfo, Dissertation Abstracts), and included studies examining caregivers of dementia patients that reported the prevalence of major depressive disorder, according to diagnostic criteria as assessed with a standardized psychiatric diagnostic interview. Ten studies with a total of 790 caregivers were identified (sample sizes: 22–147). In only one of the studies, a representative community sample was used. A total of 176 subjects (22.3%) had a depressive disorder (prevalence range from 0.15–0.32). In the three studies reporting differential prevalence rates for men and women somewhat smaller prevalence rates were found for men than for women. In six studies caregivers were compared to a (mostly matched) control group. The relative risks of having a depressive disorder in caregivers ranged from 2.80–38.68 (all RR's were significant). In the three prospective studies relatively high incidence rates were found (0.48). This study made it clear that prevalence and incidence of depressive disorders are increased in caregivers of dementia patients. More research is clearly needed in this population.
Primary care management of major depression in patients aged ≥55 years: outcome of a randomised clinical trial
- Authors:
- van MARWIJK Harm W.J., et al
- Journal article citation:
- British Journal of General Practice, 58(555), October 2008, pp.680-687.
- Publisher:
- Royal College of General Practitioners
Late-life depression is associated with chronic illness, disability, and a poor prognosis. Primary care management may be in need of improvement. This study compares the effects of an intervention programme that aims to improve the identification, diagnosis, and treatment of depression in patients aged ≥55 years with the effects of usual care. A cluster randomised controlled trial in general practices in the Netherlands was used. Trained GPs performed the intervention and their practice assistants conducted the screenings. Patients were screened with the 15-item Geriatric Depression Scale (GDS-15) and given a consultation with the GP who diagnosed depression with the mood module of the Primary Care Evaluation of Mental Disorders (PRIME-MD). Antidepressant treatment was proposed. Primary outcomes were measured with the Montgomery Åsberg Depression Rating Scale (MÅDRS). Trained independent research assistants performed independent evaluations in both arms. Eighteen practices (23 GPs) were allocated to the intervention and 16 practices (20 GPs) to usual care. From June 2000 to September 2002, 3937 patients were screened; 579 patients had a positive score on the GDS-15, 178 had major depression, of whom 145 participated in the trial. MÅDRS scores for the intervention group dropped from 21.66 at baseline to 9.23 at 6 months, and the usual care group from 20.94 at baseline to 11.45 at 6 months. MÅDRS scores decreased during the year in both arms. For the intervention group, these scores increased between 6 and 12 months. The programme resulted in lower MÅDRS scores in the intervention group than in the usual care group, but only at the end of the intervention, at 6 months after baseline.
How can occupational therapy improve the daily performance and communication of an older patient with dementia and his primary caregiver?
- Authors:
- GRAFF Maud J. L., et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 5(4), November 2006, pp.503-532.
- Publisher:
- Sage
The aim was to enhance insight into the process of occupational therapy (OT) and the changes after OT, in an older patient with mild dementia and his primary caregiver. System-based OT at home using a guideline focusing on both patient's performance in daily activities and caregiver's cognition on patient behaviour and caregiver role and focusing on adaptation of the physical environment. Triangulation of results of qualitative content analysis and quantitative description using the following measures: Brief Cognitive Rating Scale (BCRS), Assessment of Motor and Process Skills (AMPS), Interview of Deterioration in Daily Activities in Dementia (IDDD), Canadian Occupational Performance Measurement (COPM), Dementia Quality of Life Instrument (DQOL), Sense of Competence Scale (SCQ) and the Mastery Scale. The global categories derived from content analysis were: daily performance and communication. The specific categories were the patient with dementia, his or her caregiver and the occupational therapist. Important themes derived from content analysis were: patient's capacity for pleasure, autonomy and appreciation in performing daily activities and caregiver's competence. Patient's changes reported after OT: more initiative, autonomy and pleasure in performing daily activities, increase of quality of life; caregiver's changes reported after OT: improved communication and supervision skills, changed cognition on patient behaviour and caregiver role, improved sense of competence. The quantitative results showed an improved daily performance (e.g. initiative, motor and process skills, need for assistance) and quality of life of the patient and improved sense of competence, quality of life and mastery of the situation of the caregiver after OT intervention. Thus the results of the qualitative content analysis were supported by the quantitative results. Additionally, based on the results of the content analysis an exploratory and system-based model has been developed connecting OT diagnosis and OT treatment at home for patients with dementia and their primary caregivers. This case study provides information on how occupational therapy can improve the daily performance, communication, sense of competence and quality of life of an older patient with dementia and his or her primary caregiver. A combination of education, setting feasible goals, using adaptations in physical environment, training compensatory skills, training supervision skills, and changing dysfunctional cognitions on patient behaviour and caregiver role seemed to be successful. A randomized controlled trial must provide information on the effects of OT at home for older patients with dementia and their primary caregivers.
The impact of depression and anxiety on well being, disability and use of health care services in nursing home patients
- Authors:
- SMALBRUGGE Martin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(4), April 2006, pp.325-332.
- Publisher:
- Wiley
The study-population consisted of 350 elderly nursing home patients from 14 nursing homes in the Netherlands. Well being, disability, use of health care services (i.e. assistance in ADL, paramedical care, number of medications) and depression and anxiety and other relevant characteristics (gender, age, education, marital status, urbanization, cognition, morbidity, social support) were measured cross-sectionally. Associations of well being, disability and use of health care services with independent baseline characteristics were assessed with bivariate and with multivariate analyses. Results found that the presence of depression and/or anxiety was associated with significantly less well being, but not with more disability. Presence of depression and/or anxiety was also significantly associated with four of the seven indicators of health care service use measured in this study: less assistance in ADL, more consultation of medical specialists, a higher mean number of medications and more use of antidepressants. It is concluded that presence of depression and/or anxiety has a statistically and clinically significant negative impact on well being, but not on disability. Future studies should focus on interventions for improving the detection, diagnosis and treatment of depression and/or anxiety in the nursing home.
Supported living in residential homes for the elderly: impact on patients and elder care workers
- Authors:
- DELPA M. F. I. A., et al
- Journal article citation:
- Aging and Mental Health, 8(5), September 2004, pp.460-468.
- Publisher:
- Taylor and Francis
To enable older people with severe and persistent mental illness to live in the community, the Dutch mental health sector has developed a program for supported living in residential homes for the elderly. It provides for the permanent stationing of mental health workers (MHWs) in elder care facilities to support both the resident patients and the elder care staff. The authors examined associations between the number of MHW staff and the degree to which (1) patients were integrated into the community and (2) elder care workers had developed effective working alliances with their patients. Participants included 110 patients participating in 18 supported living programs in the Netherlands. Community integration was assessed in face-to-face interviews with the patients about their perceived influence over daily life, involvement in social activities, and social network size. The quality of the worker-patient relationship was assessed using the Dutch Working Alliance Questionnaire for Community Care, completed by the elder care worker primarily responsible for each patient. After differentiation of the MHW staff into medically trained and nurse-trained professionals, associations with outcome measures were found only for the nurse-trained staff. The more hours of nurse-trained staff capacity per patient, the more influence perceived by the patients, and the more directiveness shown by the elder care workers in their contacts with patients. The impact of supported living programs in residential homes for the elderly appears to be determined in part by the caseloads of the on-site MHWs.
Is aggressive behaviour influenced by the use of a behaviour rating scale in patients in a psychogeriatric nursing home?
- Author:
- SIVAL Rob C.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 15(2), February 2000, pp.108-111.
- Publisher:
- Wiley
Examines the influence of the introduction of a behaviour rating scale on reported incidence and management of aggressive behaviours in patients in a psychogeriatric nursing home in the Netherlands. Concludes that the introduction of a behaviour rating scale does influence the reported incidence and management of aggressive behaviour. Prospective intervention studies should include a stabilization phase for measurements prior to any planned trial.
Ethical issues in research with dementia patients
- Authors:
- BERGHMANS Ron L.P., TER MEULEN Rudd H.J.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 10(8), 1995, pp.647-651.
- Publisher:
- Wiley
The conduct of scientific research involving dementia patients is an ethically complex issue. Increased insight into the causes and aetiology of this condition can be of paramount importance for future patients and society as a whole. However, the rights and interests of vulnerable and incompetent persons as subjects in research make ethical boundaries imperative. A distinction should be made between research that may directly be of benefit to the subject (therapeutic research) and research in which no direct benefit for the patient can reasonably be expected (non-therapeutic research). The majority of the research with dementia patients falls within the latter category. Several ethical issues are discussed, and special attention is paid to the ethical justification of non-therapeutic research involving incompetent subjects suffering from dementia. Five conditions that should be met in order to make this kind of research ethically acceptable are formulated.
Health effects of the relocation of patients with dementia: a scoping review to inform medical and policy decision-making
- Authors:
- RYMAN Frida V M, et al
- Journal article citation:
- Gerontologist, 59(6), 2019, pp.e674-e682.
- Publisher:
- Oxford University Press
Background and Objectives: Research into the relocation (including international relocation) of people with dementia is increasingly important due to the ageing population and latest developments in the international politics (including globalisation and concerns over international migration). There is need for an overview of the health effects of relocation to facilitate and inform decision- and policy-making regarding these relocations. The aim of this literature review was to provide insight into the physical, psychological, and social consequences of varied types of relocations of older adults suffering from dementia. Research Design and Methods: A scoping literature review with a systematic search was performed in PubMed, Web of Science, PsychInfo, JSTOR, and ScienceDirect. The articles dealing with subject of relocation of older adults from 1994 to 2017 were included and analysed. Methodological quality assessment was performed for all articles. Results: Final list included 13 articles. The effects of relocation were discussed in terms of mortality and morbidity. In most studies, the health effects of the relocation of older adults suffering from dementia were negative. A decline in physical, mental, behavioural, and functional well-being was reported. The most recurring effect was a higher level of stress, which is more problematic for patients with dementia. In general, unless it is carefully planned, it is best to avoid changing lives of people with dementia and it is recommended to actively work to reduce their exposure to stress. Discussion and Implications: The outcomes of the study suggest definite evidence for the negative effects of relocation of the older adults. This research aims to be used as the support of the legal and medical decisions of relocation of patients with dementia. (Edited publisher abstract)