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Continuity in palliative care
- Authors:
- MUNDAY D., SHIPMAN C.
- Publisher:
- Royal College of General Practitioners
- Publication year:
- 2007
- Pagination:
- 300p.
- Place of publication:
- London
A practical text to help primary care teams provide palliative care for patients and carers, faced with life-threatening diseases. It looks at achieving continuity in palliative care, from the perspective of patients, their carers and health care. There are chapters on the following topics: perspectives from primary, specialist and secondary care; continuity of care for the elderly; continuity of care for people with non-malignant disease; spiritual care; PCTs and organisational issues; end-of-life initiatives; patient-held records and IT systems; and ethical issues. The final chapter discusses palliative care provision in the context of health service reforms, outlining the continuing relevance of continuity in the face of these changes.
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.
Detection and prevalence of abuse of older males: perspectives from family practice
- Authors:
- YAFFE Mark J., et al
- Journal article citation:
- Journal of Elder Abuse and Neglect, 19(1/2), 2007, pp.47-60.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Family doctors' in the United States frequent contact with seniors put them in reasonable positions to detect elder abuse and initiate referral to adult protective services. Since doctor reporting is low, however, this paper explores whether the gender of patient and/or doctor impacts on identification of elder mistreatment, or creates differential detection of one gender over the other. Use of the validated Elder Abuse Suspicion Index (EASI), and a structured social work evaluation, is described to provide some gender-based data from Canadian family practice. Specifically, while the prevalence of elder abuse is estimated to range from 12.0% to 13.3%, the specific prevalence was found for females to be 13.6% to 15.2% and for males 9.1% to 9.7%. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Guided care for multimorbid older adults
- Authors:
- BOYD Cynthia M., et al
- Journal article citation:
- Gerontologist, 47(5), October 2007, pp.697-704.
- Publisher:
- Oxford University Press
The purpose of this study was to test the feasibility of a new model of health care designed to improve the quality of life and the efficiency of resource use for older adults with multimorbidity in the United States. Guided Care enhances primary care by infusing the operative principles of seven chronic care innovations: disease management, self-management, case management, lifestyle modification, transitional care, caregiver education and support, and geriatric evaluation and management. To practice Guided Care, a registered nurse completes an educational program and uses a customized electronic health record in working with two to five primary care physicians to meet the health care needs of 50 to 60 older patients with multimorbidity. For each patient, the nurse performs a standardized comprehensive home assessment and then collaborates with the physician, the patient, and the caregiver to create two comprehensive, evidence-based management plans: a Care Guide for health care professionals, and an Action Plan for the patient and caregiver. Based in the primary care office, the nurse then regularly monitors the patient's chronic conditions, coaches the patient in self-management, coordinates the efforts of all involved health care professionals, smoothes the patient's transitions between sites of care, provides education and support for family caregivers, and facilitates access to community resources. A 1-year pilot test in a community-based primary care practice suggested that Guided Care is feasible and acceptable to physicians, patients, and caregivers.
Memory impairment among primary care veterans
- Authors:
- CHODOSH Joshua, et al
- Journal article citation:
- Aging and Mental Health, 11(4), July 2007, pp.444-450.
- Publisher:
- Taylor and Francis
Memory impairment is the most frequent cognitive dysfunction for older patients. Though studies have shown that dementia is often overlooked in primary care settings, there has been minimal focus specifically on memory impairment, on patients' concerns about memory, or their desire to address these concerns. The objectives of this study were to (1) investigate the prevalence of memory impairment among patients without dementia diagnoses, (2) determine the degree of patients' concern about memory impairment and (3) identify other patient characteristics associated with memory impairment among older primary care patients. Using telephone versions of a four-item memory test and proxy-reported cognitive decline for patients unable to complete interviews, a memory assessment of randomly selected patients, 75 years and older, without dementia diagnoses who see primary care physicians at least twice every six months was performed. Among 260 patients and 20 proxies, 19.8% had memory impairment at a level indicative of probable dementia. Adjusting for age, ethnicity, and education, subjects who were more concerned about memory impairment were more likely to be impaired. (Adjusted odds ratio [AOR]: 1.4 (for each additional level of concern); 95% confidence interval [CI]: (1.0-2.0)). Similarly, subjects wanting their physician to discuss with them their memory concerns were more likely to be impaired (AOR: 1.4; 95% CI: 1.0-1.9). Memory impairment is common among older primary care patients without diagnosed dementia. Knowing patients' concerns about memory impairment and their desire to discuss these concerns may facilitate cognitive screening in this setting.
The single assessment process in primary care: older people's accounts of the process
- Authors:
- POWELL Jackie, et al
- Journal article citation:
- British Journal of Social Work, 37(6), September 2007, pp.1043-1058.
- Publisher:
- Oxford University Press
Recent government policies have been active in addressing social inclusion and active participation of older people in many aspects of societal life. Drawing on a feasibility study of the Single Assessment Process as a ‘case-finding’ approach, this paper presents findings drawn from older people’s accounts of this experience. These accounts indicate the potential of the process for identifying ‘low-level’ need, whilst raising issues of access to formal services and resource constraint; also they underline the importance of understanding how older people seek ways of managing their own health and well-being, whilst continuing to contribute to the social cohesion of society by providing support to their peers and to younger generations. Interdependence, it is suggested, rather than dependence should underlie any approach to assessing older people’s needs, if we are to appreciate and build upon the complexity of older people’s strategies for actively managing their lives.
The temporal relationship between falls and fear-of-falling among Chinese older primary-care patients in Hong Kong
- Authors:
- CHOU Kee-Lee, CHI Iris
- Journal article citation:
- Ageing and Society, 27(2), March 2007, pp.181-193.
- Publisher:
- Cambridge University Press
Although the association between falls and fear-of-falling has been established by previous studies, the temporal ordering of the two is uncertain. Moreover, the common and unique risk factors that contribute to falls and to fear-of-falling have not been investigated in either primary health-care settings or Asian societies. The aims of this study were to examine the temporal sequencing of fear-of-falling and a fall, and to identify the risk factors associated with the two. A prospective cohort study with three six-month measurement waves was conducted in primary-care settings in Hong Kong. The sample was derived from the waiting list control group of a randomised clinical trial, and 321 respondents participated in the three waves. They were evaluated with the Minimum Data Set for Home Care. It was found that falls and fear-of-falling at baseline were not independent predictors of respectively developing a fear-of-falling and becoming a faller, but that age was a common independent predictor for falls and the onset of a fear-of-falling. Individuals with a fear-of-falling were at risk of both falling and a fear-of-falling at 12 months. The good news is that no vicious cycle of falls and fear-of-falling was found, and modifiable risk factors, including IADL limitations, environmental hazards, and fear-of-falling were identified, so that effective prevention programmes for falls and for fear-of-falling can be designed.
An intervention to improve depression care in older adults with COPD
- Authors:
- SIREY Jo Anne, RAUE Patrick J., ALEXOPOLOUS George S.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(2), February 2007, pp.154-159.
- Publisher:
- Wiley
The aim was to describe an intervention for older persons with Major Depressive Disorder (MDD) and Chronic Obstructive Pulmonary Disease (COPD) to improve adherence to psychiatric, medical, and rehabilitation recommendations. The intervention supplements antidepressant therapy for depression with an individualized care manager who targets psychological barriers that interfere with treatment participation. Description of intervention development, training, and barriers to care, and illustration with case example. Depression and its associated lack of motivation, helplessness, and lack of energy can obstruct active participation in rehabilitation exercises recommended for COPD. Additionally, depressed older adults perceive the benefits of depression treatment; however they also fear side effects, addiction to antidepressants and have concerns about stigma. The intervention elucidates individual attitudes and beliefs that may become barriers. The care manager works with the older adult to address the barriers and improve treatment participation. Augmentation of traditional pharmacotherapy for depression with a care manager can improve adherence to both depression and COPD treatment. This improved adherence may lessen the physical, psychological, and functional costs of both diseases.
Treating late-life depression with interpersonal psychotherapy in the primary care sector
- Authors:
- SCHULBERG Herbert C., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(2), February 2007, pp.106-114.
- Publisher:
- Wiley
Interpersonal psychotherapy (IPT) is an empirically-validated intervention for treating late-life depression. The objective was to determine the manner in which IPT is utilized by primary care physicians in relation to antidepressant medications. The authors reviewed treatment logs prepared by care managers during the first 12 months of a patient's participation in the PROSPECT clinical trial to determine initial and longitudinal treatment patterns utilized by physicians, and clinical outcomes associated with initial treatment assignment. Primary care physicians in practices randomized to PROSPECT's intervention arm initially prescribed an antidepressant medication for 58% of eligible patients and referred only 11% of them to IPT. Over time, however, 27% of patients participated in IPT as monotherapy or augmentation therapy. Initial treatment assignment was not associated with depressive status at 4 and 12 months nor with suicidal ideation at 4, 8, and 12 months. IPT is an effective treatment for late-life depression whose greater use by primary care physicians should be encouraged.
Screening for generalized anxiety disorder in geriatric primary care patients
- Authors:
- WETHERELL Julie Loebach, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(2), February 2007, pp.115-123.
- Publisher:
- Wiley
Compares two brief screening measures as tools for detecting generalized anxiety disorder (GAD) among older primary care patients. Receiver operating characteristic curve analysis was used to compare the Hospital Anxiety and Depression Scale (HADS) and the Brief Symptom Inventory-18 (BSI-18) against GAD diagnoses obtained from a structured diagnostic interview. The HADS Anxiety subscale was the only measure that distinguished individuals with and without GAD. A cutpoint greater than or equal to 8 on the HADS Anxiety subscale resulted in a sensitivity of 0.967 and a specificity of 0.667 for detecting GAD. The HADS Anxiety subscale appears to show some advantages over the BSI-18 Anxiety subscale as a brief, self-report measure of anxiety symptoms among older medical patients.