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Depression and barriers to mental health care in older cancer patients
- Authors:
- WEINBERGER Mark I., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(1), January 2011, pp.21-26.
- Publisher:
- Wiley
The authors conducted a review of the literature on depression in cancer patients, focusing on depression assessment and barriers to mental health treatment in older cancer patients. They found that depression is prevalent in cancer patients, but that little is known about prevalence rates of depression in older adults with cancer, assessing depression in such patients, and barriers impeding their mental health treatment. They concluded that improved diagnostic clarity and a better understanding of barriers to mental health treatment could help clarify and facilitate mental health referrals and improve access to care among older cancer patients in need. The article suggests that further work is needed to consider the complexities associated with diagnosing depression in older cancer patients, and to determine the prevalence of depression among this group and ways in which to overcome barriers to mental health care.
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.
Ageing patients in forensic psychiatric settings: a review of the literature
- Authors:
- DI LORITO Claudio, VOLLM Birgit, DENING Tom
- Journal article citation:
- International Journal of Geriatric Psychiatry, 33(12), 2018, pp.1548-1555.
- Publisher:
- Wiley
Objectives: The prevalence of ageing patients in forensic psychiatric settings is increasing. However, limited research has reported around this population. The aim of this scoping review is to synthesise the current evidence around ageing forensic psychiatric patients. Methods: The literature was searched through four databases and Google searches. The identified outputs were screened for suitability and assessed for quality. Quantitative data were extracted and analysed on SPSS; qualitative data were extracted and analysed onto NVivo. Results: Seven studies were included in the review. Quantitative results reported around demographics, service contact, offending patterns, mental, and physical health of ageing patients. Qualitative findings focused on age‐friendliness of services, staff‐patient rapport, activities, security issues, and discharge planning. Conclusions: Ageing forensic psychiatric patients present with complex and unique needs in relation to treatment, activities, mental, physical, and support. Further research looking at individual patients' needs is paramount to inform policy development and good practice in this area. (Edited publisher abstract)
Factors affecting older women’s adherence to medication and treatment
- Authors:
- LAWRENCE Shawn A., RITTNER Barbara
- Journal article citation:
- Journal of Human Behavior in the Social Environment, 19(7), October 2009, pp.859-872.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Over the past 25 years, there has been a growing interest in why many patients do not take prescribed medications or fail to follow medical advice. As many as 50% of all patients fail to adhere adequately to therapeutic advice or engage in inappropriate use of prescribed medications. Additionally, there has been a struggle over how best to describe this variance between what medical practitioners recommend and what patients actually do. The term ‘compliance’ is being replaced by the term ‘adherence’, which is believed to reflect the more collaborative nature of the health care practitioner-patient relationship. This article examines factors thought to affect women's adherence to medication and treatment regimens. Literature on age, comorbid conditions, socioeconomic factors, environmental factors, and perceived susceptibility for an illness is reviewed, as are individual psychological idiosyncratic dynamics that may influence health care behaviours. The article concludes with implications for social work practice and research, and suggests that incorporating a social worker into the primary care physician’s office may be one way of addressing the risk factors for and prevention of non-adherence while keeping physicians free to see patients.
Effectiveness and cost-effectiveness of integrated care models for elderly, complex patients: a narrative review. Don’t we need a value-based approach?
- Authors:
- MARINO Marta, et al
- Journal article citation:
- International Journal of Care Coordination, 21(4), 2018, pp.120-129.
- Publisher:
- Sage
Introduction: The management of patients with complex health and social needs is one of the main challenges for healthcare systems. Integrated care seems to respond to this issue, with collaborative working and integration efforts of the care system components professionals and service providers aimed at improving efficiency, appropriateness and person centredness of care. The authors conducted a narrative review to analyse the available evidences published on effectiveness and cost-effectiveness of integrated care models targeted on the management of such elderly patients. Methods: MEDLINE, Scopus and EBSCO were searched. They reported this narrative review according to the PRISMA Checklist. For studies to be included, they had to: (i) refer to integrated care models through implemented experimental or demonstration projects; (ii) focus on frail elderly ≥65 years old, with complex health and social needs, not disease-specific; (iii) evaluate effectiveness and/or cost and/or cost-effectiveness; (iv) report quantitative data (e.g. health outcomes, utilisation outcomes, cost and cost-effectiveness). Results: Thirty articles were included, identifying 13 integrated care models. Common features were identified in case management, geriatric assessment and multidisciplinary team. Favourable impacts on healthcare facilities utilisation rates, though with mixed results on costs, were found. The development of community-based and cost-effective integrated systems of care for the elderly is possible, thanks to the cooperation across care professionals and providers, to achieving a relevant impact on healthcare and efficient resource management. The elements of success or failure are not always unique and identifiable, but the potential clearly exists for these models to be successful and generalised on a large scale. Discussion: The authors found out a favourable impact of integrated care models/methods on health outcomes, care utilisation and costs. The selected interventions are likely to be implemented at community level, focused on the patient management in terms of continuity of care. A value-based framework for the evaluation of these services is proposed. (Edited publisher abstract)
Hospital outcomes of older people with cognitive impairment: an integrative review
- Authors:
- FOGG Carole, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 33(9), 2018, pp.1177-1197.
- Publisher:
- Wiley
Objectives: To summarise existing knowledge of outcomes of older hospital patients with cognitive impairment, including the type and frequency of outcomes reported, and the additional risk experienced by this patient group. Methods: Integrative literature review. Health care literature databases, reports, and policy documents on key websites were systematically searched. Papers describing the outcomes of older people with cognitive impairment during hospitalisation and at discharge were analysed and summarised using integrative methods. Results: One hundred four articles were included. A range of outcomes were identified, including those occurring during hospitalisation and at discharge. Older people with a dementia diagnosis were at higher risk from death in hospital, nursing home admission, long lengths of stay, as well as intermediate outcomes such as delirium, falls, dehydration, reduction in nutritional status, decline in physical and cognitive function, and new infections in hospital. Fewer studies examined the relationship of all‐cause cognitive impairment with outcomes. Patient and carer experiences of hospital admission were often poor. Few studies collected data relating to hospital environment, eg, ward type or staffing levels, and acuity of illness was rarely described. Conclusions: Older people with cognitive impairment have a higher risk of a variety of negative outcomes in hospital. Prevalent intermediate outcomes suggest that changes in care processes are required to ensure maintenance of fundamental care provision and greater attention to patient safety in this vulnerable group. More research is required to understand the most appropriate ways of doing this and how changes in these care processes are best implemented to improve hospital outcomes. (Edited publisher abstract)
Comprehensive care: older people living with frailty in hospitals
- Author:
- NIHR DISSEMINATION CENTRE
- Publisher:
- NIHR Dissemination Centre
- Publication year:
- 2017
- Pagination:
- 48
- Place of publication:
- London
This review looks at the concept of 'frailty' in older people and what can be done to raise awareness amongst hospital staff, so that they can better identify and manage the needs of this ‘frail’ older people. It features 53 completed and ongoing studies funded by the National Institute of Health Research. The review covers four key aspects of caring for older people living with frailty in hospital: assessment; identifying and managing symptoms associated with frailty in hospital; discharge planning; and caring environments which consider the context in which inpatient diagnosis and treatment is delivered. The review highlights promising evaluations of workplace training and interventions. It also identifies a number of tools, such as the Frailty Index, that can help hospital staff to identify the severity of needs and help to provide targeted support. It also finds good evidence that the Comprehensive Geriatric Assessment (CGA) is a reliable way of diagnosing and meeting the needs of older people with input from multi-disciplinary teams. It also identifies areas where more research is needed, which include: maintaining activities of daily living for people admitted to hospital; and the effectiveness and cost-effectiveness of different models of delivering care. The review also includes a series of questions that hospital boards, staff and families can ask about the care of older people with frailty in hospitals. Summaries of the 53 studies are also included. (Edited publisher abstract)
Efficacy of integrated interventions combining psychiatric care and nursing home care for nursing home residents: a review of the literature
- Authors:
- COLLET Janine, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(1), January 2010, pp.3-13.
- Publisher:
- Wiley
Nursing home residents needing both psychiatric and nursing home care for either somatic illness or dementia combined with psychiatric disorders or severe behavioural problems are referred to as Double Care Demanding (DCD) patients. This study examined which integrated interventions combining both psychiatric care and nursing home care in DCD nursing home residents are described in the research literature, and which effects of these integrated models are reported in the literature. Following a critical review of studies and a systematic literature search performed in a number of international databases, eight intervention trials were identified as relevant for the purposes of the review. Seven studies, 3 of which were randomised controlled trials, showed beneficial effects of a comprehensive, integrated multidisciplinary approach combining medical, psychiatric and nursing interventions on severe behavioural problems in DCD nursing home patients. The authors conclude that important elements of a successful treatment strategy for DCD nursing home patients include a thorough assessment of psychiatric, medical and environmental causes as well as programmes for teaching behavioural management skills to nurses, and that this review underlines the need for more rigorously designed studies.
Conceptualisation of mild cognitive impairment: a review
- Authors:
- DAVIS Heather S., ROCKWOOD Kenneth
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(4), April 2004, pp.313-319.
- Publisher:
- Wiley
Several factors have prompted renewed interest in the concept of declines in cognitive function that occur in association with aging, in particular the area between normal cognition and dementia. We review the changing conceptualization of what has come to be known as mild cognitive impairment (MCI) in an effort to identify recent developments and highlight areas of controversy. Standard MEDLINE search for relevant English-language publications on mild cognitive impairment and its associated terms, supplemented by hand searches of pertinent reference lists. Many conditions cause cognitive impairment which does not meet current criteria for dementia. Within this heterogenous group, termed Cognitive Impairment, No Dementia (CIND), there are disorders associated with an increased risk of progression to dementia. Still, the conceptualization of these latter disorders remains in flux, with variability around assumptions about aging, the relationship between impairment and disease, and how concomitant functional impairment is classified. Amongst patients with MCI, especially its amnestic form, many will progress to Alzheimer's disease (AD). In contrast with clinic-based studies, where progression is more uniform, population-based studies suggest that the MCI classification is unstable in that context. In addition to Amnestic Mild Cognitive Impairment (AMCI), other syndromes exist and can progress to dementia. For example, an identifiable group with vascular cognitive impairment without dementia shows a higher risk of progression to vascular dementia, Alzheimer's disease and mixed dementia. Recent attempts to profile patients at an increased risk of dementia suggest that this can be done in skilled hands, especially in people whose symptoms prompt them to seek medical attention. Whether these people actually have early AD remains to be determined. The more narrowly defined MCI profiles need to be understood in a population context of CIND.
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)