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An in-home geriatric programme for vulnerable community-dwelling older people improves the detection of dementia in primary care
- Authors:
- PERRY M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(12), December 2008, pp.1312-1319.
- Publisher:
- Wiley
Dementia is under-diagnosed in primary care. This study investigated whether an in-home geriatric assessment and management programme could improve the identification of patients with dementia in primary care. A secondary analysis was performed, using data of a randomised controlled trial that studied the effects of an in-home geriatric evaluation and management programme compared with usual care. In this trial, 151 vulnerable community-dwelling patients, aged 70 years and older, living in the Netherlands participated: 86 in the intervention group and 66 in the control group. The effect of the programme on the dementia detection rate was determined by comparing the number of new dementia diagnoses in both study arms at 6 months follow-up. Of all 151 participants, 38 (25%) had a registered dementia diagnosis at baseline. During follow-up, 23 of 113 patients without a registered dementia diagnosis at baseline were identified as suffering from dementia. The difference between the numbers of new dementia diagnoses in the intervention group (19 of 66 patients) and the control group (4 of 47 patients) was significant. (p = 0.02). An in-home geriatric assessment and management programme for vulnerable older patients improves the detection of dementia and can therefore contribute to overcoming of under-diagnosis of dementia.
Development and preliminary validation of an Observation List for detecting mental disorders and social Problems in the elderly in primary and home care (OLP)
- Authors:
- TAK Erwin C.P.M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 31(7), 2016, pp.755-764.
- Publisher:
- Wiley
Objective: Even though the prevalence of mental disorders and social problems is high among elderly patients, it is difficult to detect these in a primary (home) care setting. Goal was the development and preliminary validation of a short observation list to detect six problem areas: anxiety, depression, cognition, suspicion, loneliness, and somatisation. Methods: A draft list of indicators identified from a short review of the literature and the opinions of 22 experts was evaluated by general practitioners (GPs) and home care organisations for feasibility. It was then used by GPs and home care personnel to observe patients, who also completed validated tests for psychological disorders (General Health Questionnaire 12 item version (GHQ-12)), depression (Geriatric Depression Scale 15-item version (GDS-15)), anxiety and suspicion (Symptom Checklist-90 (SCL-90)), loneliness (University of California, Los Angeles (UCLA)), somatisation (Illness Attitude Scale (IAS)), and cognition (Mini-Mental State Examination (MMSE)). Results: GPs and home care personnel observed 180 patients (mean age 78.4 years; 66% female) and evaluated the draft list during a regular visit. Cronbach's α was 0.87 for the draft list and ≥0.80 for the draft problem areas (loneliness and suspicion excepted). Principal component analysis identified six components (cognition, depression + loneliness, somatisation, anxiety + suspicion, depression (other signs), and an ambiguous component). Convergent validity was shown for the indicators list as a whole (using the GHQ-12), and the subscales of depression, anxiety, loneliness, cognition, and somatisation. Using pre-set agreed criteria, the list was reduced to 14 final indicators divided over five problem areas. Conclusion: The Observation List for mental disorders and social Problems (OLP) proved to be preliminarily valid, reliable, and feasible for use in primary and home care settings. (Publisher abstract)
A qualitative investigation of the impact of multimorbidity on GP diagnosis and treatment of depression in Australia
- Authors:
- STANNERS Melinda N., et al
- Journal article citation:
- Aging and Mental Health, 16(8), November 2012, pp.1058-1064.
- Publisher:
- Taylor and Francis
The detection of depression in patients in primary care with multiple chronic conditions is often challenging for GPs. In this study, eight GPs engaged in a semi-structured interview to discuss the impact of multimorbidity on the diagnosis and detection of depression in older people. Participants described multimorbidity as obscuring symptom causation, but also creating time to investigate causation and negotiate the depression diagnosis with the patient, and generating relationship through frequent presentations. Knowledge of the patient impacted on intervention recommendations, and trust facilitated patient receptivity. Treatment was affected by a range of variables, and included medical and social interventions. GP process for multimorbid patients is similar to that of patients with chronic illness. Further research is needed to know whether different processes or diagnostic categories are warranted where multiple chronic illnesses are present. Also, GPs recommend social interventions where medical interventions are perceived as inappropriate, but further research into the efficacy of social interventions is required.
Management of depression in older people: why this is important in primary care
- Authors:
- GRAHAM Carolyn Chew, et al
- Publisher:
- Forum for Mental Health in Primary Care
- Publication year:
- 2011
- Pagination:
- 4p.
- Place of publication:
- London
This factsheet provides an overview of the role of primary care in the management of depression in older people. It covers the prevalence of depression; diagnosis and barriers to diagnosis; management of depression in primary care; different management options, including mediation, psychological and talking therapies, psycho-social interventions; culturally sensitive interventions; prevention and mental health promotion. The factsheet has been produced by a number of different organisations.
Early intervention in dementia care in an Asian community: lessons from a dementia collaborative project
- Authors:
- SEABROOKE Viniti, MILNE Alisoun
- Journal article citation:
- Quality in Ageing, 10(4), December 2009, pp.29-36.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
The number of older Asians in the UK, and therefore at risk of developing dementia is increasing. The emerging need to address early diagnosis is especially prominent in areas where Asian communities are long established. Set up under the auspices of the South East Dementia Services Collaborative, this pilot project aimed to raise awareness of memory problems and facilitate access to early intervention for older Asians in North West Kent. Using an evaluation methodology adopted by the Collaborative and working through a multi-agency steering group, the project identified an appropriate primary care practice, established a link with a specially trained Asian nurse and devised a set of project materials. By inviting older Asian patients with memory problems to make an appointment with the nurse, and enclosing a culturally relevant information leaflet, older people were encouraged to come forward. The project outcomes include significantly increased referral rates from black and minority ethnic communities to specialist services and greater awareness of dementia-related issues in both primary care and Asian care services. Overall, the evaluation suggests that by engaging with a committed primary care practice it is possible to engage a hitherto marginal group of older people in early intervention in dementia and raise awareness about its benefits.
The role of patient personality in the identification of depression in older primary care patients
- Authors:
- McCRAY Laura W., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(11), November 2007, pp.1095-1100.
- Publisher:
- Wiley
The aim was to evaluate whether personality factors significantly contribute to the identification of depression in older primary care patients, even after controlling for depressive symptoms. The authors examined the association between personality factors and the identification of depression among 318 older adults who participated in the Spectrum study. High neuroticism (unadjusted Odds Ratio (OR) 2.36, 95% Confidence Interval (CI) [1.42, 3.93]) and low extraversion (adjusted OR 2.24, CI [1.26, 4.00]) were associated with physician identification of depression. Persons with high conscientiousness were less likely to be identified as depressed by the doctor (adjusted OR 0.45, CI [0.22, 0.91]). Personality factors influence the identification of depression among older persons in primary care over and above the relationship of depressive symptoms with physician identification. Knowledge of personality may influence the diagnosis and treatment of depression in primary care.
Communication in heart failure: perspectives from older people and primary care professionals
- Authors:
- BARNES Sarah, et al
- Journal article citation:
- Health and Social Care in the Community, 14(6), November 2006, pp.482-490.
- Publisher:
- Wiley
The objective of this study was to explore the attitudes of older people and primary care professionals towards communication of diagnosis, prognosis and symptoms in heart failure. Forty-four interviews were conducted with people aged over 60 years with heart failure (New York Heart Association III–IV) recruited from general practices in the UK. Ten focus groups were held with primary care professionals involved in heart failure management. Data were analysed thematically with the aid of the NUD*IST computer program. Participants reported problems with communication, including not being given enough information about their condition, or being given complex information that they did not understand. Many understood little about heart failure and the causes of, and ways to manage, their symptoms. Few participants had had discussions about the prognosis with any health professional, and this was confirmed in professional accounts. Difficulties with terminology were frequently reported: a diagnosis of 'heart failure' was rarely communicated to patients to avoid causing anxiety. Educational needs were identified by most primary care professionals in relation to heart failure management and specifically in relation to communication. In conclusion, communication was identified as being inadequate within primary care from both the patient and professional perspectives. These findings point to a need for an educational intervention tailored specifically to the need to improve the communication skills of primary care professionals in chronic heart failure.
The Hopkins Symptom Checklist-25 is a sensitive case-finder of clinically important depressive states in elderly people in primary care
- Authors:
- FROJDH Karin, HAKASSON Anders, KARLSSON Ingvar
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(4), April 2004, pp.386-390.
- Publisher:
- Wiley
No depression rating scale has yet been designed to identify all clinically important depressive states in elderly. Therefore, this study investigated the Hopkins Symptom Checklist-25 (HSCL-25), a self-rating scale for depression, to see if it was a sensitive indicator of major, minor and subsyndromal depression. Structured interviews of 37 people with a high depressive score and an age and sex matched control group comprised of 37 persons with a low depressive score in HSCL-25, in order to compare the HSCL-25 ratings with the Montgomery- Åsberg-Depression Rating Scale (MADRS) as well as with the criteria for major, minor and subsyndromal depression. The sensitivity for identifying any depression was 94% and the specificity was 94% for HSCL-25 compared to the diagnostic criteria for depressive disorders. HSCL-25 is a sensitive case-finder of any depressive disorder and may be useful in general practice and for screening studies of depression in elderly people
General practitioner's views on the early diagnosis of dementia
- Authors:
- RENSHAW Judy, et al
- Journal article citation:
- British Journal of General Practice, 51(462), January 2001, pp.37-38.
- Publisher:
- Royal College of General Practitioners
This study investigates the views on the early diagnosis of dementia from over 1000 general practitioners (GPs) from 12 Health Authority areas in England and Wales. Almost half of the GPs did not believe it was beneficial to make an early diagnosis, yet most admitted they needed more training in the area. In areas where there had been specific efforts to contact and educate local GPs, the GPs were far more likely to believe in the value of early diagnosis.
Can delays in the recognition of dementia in primary care be avoided?
- Author:
- ILIFFE S.
- Journal article citation:
- Aging and Mental Health, 1(1), February 1997, pp.7-10.
- Publisher:
- Taylor and Francis
Dementia is a complex problem that may be difficult in its early stages and hard to manage as it progresses. Dementia may only become apparent to the GP when revealed in a crisis precipitated by the absence of the usual carer or by the onset of another illness; although symptoms may have been present for a long period of time. This article reviews the reasons for such delays in the diagnosis of dementia in primary care and proposes an agenda for development of primary care services for dementia suffers and their carers that may avoid crises or at least allow appropriate responses to them.