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The centre for epidemiological studies-depression (CES-D) scale: assessment of depression in the medically ill elderly
- Authors:
- SCHEIN Rebecca L., KOENIG Harold G.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 12(4), April 1997, pp.436-446.
- Publisher:
- Wiley
Examines the use of the Centre for Epidemiological Studies-Depression Scale (CES-D in a sample of elderly, medically ill inpatients. Seventy-six individuals completed the CES-D and a psychiatric interview, from which DSM-III-R diagnoses of depression were obtained. Analyses of sensitivity and specificity indicated that use of an alternative scoring method which more closely approximates current diagnostic criteria for depression may improve the predictive power of the test. Item analyses demonstrated that seven of the CES-D items failed to discriminate major, minor and non-depressed patients, and that several of these items tapped somatic symptoms. These findings suggest that the validity of the CES-D may be compromised when used with elderly medical patients, and modifications for its use are recommended.
The NHS and Community Care Act 1990: is it a success for elderly people?
- Authors:
- AJAYI Victoria, MISKELLY Frank G., WALTON Ivan G.
- Journal article citation:
- British Medical Journal, 18.2.95, 1995, p.439.
- Publisher:
- British Medical Association
Very brief notes on statistical analysis in Hammersmith and Fulham into the effect of the NHS and Community Care Act on the discharge of older people from hospitals. Findings show that changes implemented on 1st April 1993 enabled patients to be discharged from home earlier and that they were more likely to be discharged home than elsewhere.
The utility of the clock drawing test in detection of delirium in elderly hospitalised patients
- Authors:
- ADAMIS Dimitrios, et al
- Journal article citation:
- Aging and Mental Health, 20(9), 2016, pp.981-986.
- Publisher:
- Taylor and Francis
Objectives: Delirium is common neuropsychiatric condition among elderly inpatients. The clock drawing test (CDT) has been used widely as bedside screening tool in assessing cognitive impairment in elderly people. Previous studies which evaluate its usefulness in delirium reported conflicting results. The objective of this study was to evaluate the utility of CDT to detect delirium in elderly medical patients. Method: Prospective, observational, longitudinal study. All acute medical admissions 70 years of age and above were approached within 72 hours of admission for recruitment. Patients eligible for inclusion were assessed four times, twice weekly during admission. Assessment included Confusion Assessment Method (CAM), Delirium Rating Scale (DRS-98R), Montreal Cognitive Assessment (MoCA), Acute Physiology and Chronic Health Evaluation II (APACHE) II, and CDT. Data was analysed using a linear mixed effect model. Results: Three hundred and twenty-three assessments with the CDT were performed on 200 subjects (50% male, mean age 81.13; standard deviation: 6.45). The overall rate of delirium (CAM+) during hospitalisation was 23%. There was a significant negative correlation between the CDT and DRS-R98 scores (Pearson correlation r = −0.618, p < 0.001), CDT and CAM (Spearman's rho = −0.402, p < 0.001) and CDT and total MoCA score (Pearson's r = 0.767, p < 0.001). However, when the data were analysed longitudinally controlling for all the factors, we found that cognitive function and age were significant factors associated with CDT scores (p < .0001): neither the presence nor the severity of delirium had an additional significant effect on the CDT. Conclusion: CDT score reflects cognitive impairment, independently of the presence or severity of delirium. The CDT is not a suitable test for delirium in hospitalised elderly patients. (Publisher abstract)
Conversational assessment in memory clinic encounters: interactional profiling for differentiating dementia from functional memory disorders
- Authors:
- JONES Danielle, et al
- Journal article citation:
- Aging and Mental Health, 20(5), 2016, pp.500-509.
- Publisher:
- Taylor and Francis
Objectives: In the UK dementia is under-diagnosed, there is limited access to specialist memory clinics, and many of the patients referred to such clinics are ultimately found to have functional (non-progressive) memory disorders (FMD), rather than a neurodegenerative disorder. Government initiatives on ‘timely diagnosis’ aim to improve the rate and quality of diagnosis for those with dementia. This study seeks to improve the screening and diagnostic process by analysing communication between clinicians and patients during initial specialist clinic visits. Establishing differential conversational profiles could help the timely differential diagnosis of memory complaints. Method: This study is based on video- and audio recordings of 25 initial consultations between neurologists and patients referred to a UK memory clinic. Conversation analysis was used to explore recurrent communicative practices associated with each diagnostic group. Results: Two discrete conversational profiles began to emerge, to help differentiate between patients with dementia and functional memory complaints, based on (1) whether the patient is able to answer questions about personal information; (2) whether they can display working memory in interaction; (3) whether they are able to respond to compound questions; (4) the time taken to respond to questions; and (5) the level of detail they offer when providing an account of their memory failure experiences. Conclusion: The distinctive conversational profiles observed in patients with functional memory complaints on the one hand and neurodegenerative memory conditions on the other suggest that conversational profiling can support the differential diagnosis of functional and neurodegenerative memory disorders. (Publisher abstract)
Parkinson's disease in the older patient
- Editors:
- PLAYFER Jeremy, HINDLE John, (eds.)
- Publisher:
- Radcliffe
- Publication year:
- 2008
- Pagination:
- 410p.
- Place of publication:
- Oxford
- Edition:
- 2nd ed.
Parkinson’s Disease in the Older Patient, Second Edition has been fully revised, updated and expanded to include new treatments and entirely new chapters. This text is written by recognised specialists in the field and provides accessible, easy-to-read information. The practical approach comprehensively covers all aspects of treatment, and although it focuses on the older patient, it is also highly relevant for younger patient groups with an emphasis on multidisciplinary assessment and management. Detailed information on the aetiology and pathogenesis of the condition, drug and surgical treatments, sleep disturbances, quality of life, and carers is now included, along with the more prevalent older patient issues such as neuropsychiatric disturbances, speech and swallowing problems, balance and falls, and autonomic disturbances. The updates also include new advice on the management and services in primary care, linked to the recent NICE guidelines. With official endorsement from The Parkinson’s Disease Academy of the British Geriatrics Society, this new edition is highly recommended for general practitioners, geriatricians, neurologists and psychiatrists. Physiotherapists, occupational therapists, speech therapists, dieticians, and psychologists will also find it invaluable. It is suitable for general and specialist nurses, and will be of great use to researchers with an interest in Parkinson’s disease.
Profile of discrete emotions in affective disorders in older primary care patients
- Authors:
- SEIDLITZ Larry, et al
- Journal article citation:
- Gerontologist, 41(5), October 2001, pp.643-651.
- Publisher:
- Oxford University Press
This research examined whether the frequencies of specific emotions are associated with major and minor depression in older primary care patients in the USA. Older primary care patients prescreened with a depression questionnaire, completed a diagnostic interview and an emotions questionnaire. Controlling for age, sex and other psychiatric and medical illnesses, major depressives differed from nondepressed controls in nine emotions; minor depressives differed from controls in four emotions. Major depressives differed from the controls more in sadness, joy, and interest-but not anger, fear, or guilt-than in comparison sets of emotions. Minor depressives differed from the controls more in sadness and inner-directed hostility-but not guilt, anger, fear, joy, or interest- than in comparison sets of emotions. The frequencies of discrete emotions are differentially associated with major and minor depression; future research is needed to determine their specific diagnostic and treatment implications.
High prevalence of anxiety symptoms in hospitalized geriatric patients
- Authors:
- KVAAL Kari, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 16(7), July 2001, pp.690-693.
- Publisher:
- Wiley
Examines the prevalence of anxiety symptoms in hospitalized geriatric patients using a controlled cross-sectional study of ninety-eight geriatric in-patients and 68 healthy home-dwelling controls of similar age recruited from senior citizen centres in Norway. The geriatric patients scored significantly higher than the controls. Applying Spielberger's recommended cut-off of 39/40 on the STAI sumscore, 41% of the female and 47% of the male geriatric patients might be suspected of suffering from significant anxiety symptoms. Concludes that STAI proved feasible for use in the elderly. The scoring on the STAI is high in geriatric in-patients. Further studies are needed to clarify to what extent this relates to a high prevalence of anxiety disorders.
A comparison of self-reported function assessed before and after depression treatment among depressed geriatric inpatients
- Authors:
- CASTEN Robin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 15(9), September 2000, pp.813-818.
- Publisher:
- Wiley
The purpose of this study was to determine whether self-perceptions of function among depressed, geriatric psychiatry inpatients improved as their depression resolved. Self-perceptions of function improved over time, while caregivers' perceptions remained stable, suggesting that patients' perceptions of function is in part influenced by their depression. Further, correlations between patient and caregiver perceptions of function were higher at 3 months post discharge (when patients were not depressed) than they were at admission. The implication is that self-perceptions of function are more accurate when not depressed.
Lost in a no-man's land
- Author:
- MOORE Alison
- Journal article citation:
- Health Service Journal, 26.2.98, 1998, p.5.
- Publisher:
- Emap Healthcare
Reports on how a recent court ruling on a mentally ill patient's 'illegal' detention throws into question the ability to treat many psychiatric patients.
Caring for confused people in the general hospital setting
- Author:
- SAUNDERS Pete
- Journal article citation:
- Nursing Times, 22.11.95, 1995, pp.27-29.
- Publisher:
- Nursing Times
Highlights the need for the thorough assessment of confused patients and goes on to explore some strategies for communicating and dealing with the confused patient.