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The criterion validity of the Geriatric Depression Scale: a systematic review
- Authors:
- WANCATA J., et al
- Journal article citation:
- Acta Psychiatrica Scandinavica, 114(6), December 2006, pp.398-410.
- Publisher:
- Blackwell Publishing
Among many of the 42 studies included in this review, important aspects of research design such as sampling methods and blinding of researchers were not reported. This limits the usefulness of the pooled findings, despite the relatively large number of studies available for review. Sensitivity and specificity values were similar for the 30-item GDS and the shorter GDS-15 designed for use with people who have greater cognitive or concentration difficulties. In comparison with the Yale-1-question screening instrument, the GDS performed significantly better, while its criterion validity was on a par with that of the Center for Epidemiological Studies Depression scale (CES-D). The firmest conclusion that can be drawn is that the GDS should not be used with people who have marked cognitive impairment.
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.
A preliminary study of the diagnostic accuracy of the Gerontological Personality disorders Scale (GPS)
- Authors:
- VAN ALPHEN S. P. J., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(9), September 2006, pp.862-868.
- Publisher:
- Wiley
There is still a lack of diagnostic instruments that are specifically developed to diagnose personality disorders in the elderly. The aim was to develop a reliable and valid screening instrument to assess personality disorders in older adults. The draft version of the screening instrument (52 items) consists of two sections: one for patients and one for informants. The diagnostic accuracy of the instrument has been assessed in the Netherlands in 159 elderly patients in an ambulatory department of geriatric psychiatry and 96 informants. In the patient section, sixteen items had a reasonable score for both sensitivity and specificity (approx. 70%). The internal consistency was moderate for habitual behavior (HAB; 7 items) and good for biographical information (BIO; 9 items). The test and retest reliability was moderate for HAB and excellent for BIO. The informant section, on the other hand, had a low score for sensitivity (45%) and a good score for specificity (78%). A specific instrument has been developed to diagnose personality disorders in older adults. However, further research is necessary to improve the diagnostic accuracy of the Gerontological Personality disorders Scale (GPS).
Screening for depression in older medical inpatients
- Authors:
- CULLUM Sarah, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(5), May 2006, pp.469-476.
- Publisher:
- Wiley
Older people with depression make greater use of healthcare services, but the detection of the disorder is poor. The National Service Framework for Older People recommended screening for depression in acute healthcare settings to improve health outcomes of older people. This study aims to estimate, in a large representative sample of older medical inpatients in a UK hospital setting, the prevalence of depressive symptoms and ICD-10 depressive disorder and to examine the sensitivity and specificity of the 15-item Geriatric Depression Scale (GDS-15) as a screening instrument. A two-phase prevalence study of depressive disorder was carried out in acute wards of a district general hospital. Six hundred and eighteen (61%) of 1,009 eligible older medical inpatients were screened using the GDS-15. A stratified sample of 233 people was further assessed using the Geriatric Mental State, from which ICD-10 diagnoses were determined. The weighted prevalence estimate of ICD-10 depressive disorder was 17.7%. Forty-four percent of participants scored above the normally recommended cut-point of 5 on the GDS-15. However, on the basis of ROC, the optimal cut-point of the GDS-15 for screening for depressive disorder in this hospitalised population is two points higher at 7. This study confirms that depression is common amongst older UK medical inpatients with 1 in 6 suffering from clinical depression. The cut-point for GDS-15 for this population is 7.
Use of an Italian version of the telephone interview for cognitive status in Alzheimer's disease
- Authors:
- DAL FORNO, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(2), February 2006, pp.126-133.
- Publisher:
- Wiley
Enquires into the Validation of an Italian version of the Telephone Interview for Cognitive Status (I-TICS). Telephone administration of the I-TICS within 6 weeks of face-to-face testing with the Mini Mental State Examination (MMSE), in Probable Alzheimer's disease (AD) patients and healthy controls. Two hundred and seven consecutive outpatients with cognitive impairment were recruited from Dementia Clinic of University Campus BioMedico. Of these, 45 probable AD patients with complete data were analyzed. Other dementias, Mild Cognitive Impairment (MCI), and patients with incomplete data were excluded. The control sample consisted of 64 age- and sex-matched healthy subjects. For diagnosis, an extensive clinical evaluation, laboratory testing, brain imaging, EEG, neuropsychological battery and a depression scale were used. For I-TICS validation, telephone I-TICS and face-to-face MMSE were administered. The I-TICS correlated highly and linearly with the MMSE (Pearson's r = 0.904). Conversion equations are provided. Sensitivity and specificity were similar between tests (area under curve = 0.894 for the I-TICS; 0.966 for the MMSE). I-TICS sensitivity was 84% and specificity 86% at a cut-off score of 28. No significant difference in accuracy with the MMSE was present. Total agreement between I-TICS and MMSE was substantial at 86% (Cohen's K = 0.717). Repeated testing in a subset of patients showed a disease progression related decrease of 4.2 points/year (t = 2.664; p = 0.018) in I-TICS scores. The I-TICS is a valid instrument in clinical and research screening and monitoring of AD. Potential applications in other dementias and MCI are worth further studies.
The feasibility of a GP led screening intervention for depression among nursing home residents
- Authors:
- DAVIDSON Sandra, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(11), November 2006, pp.1026-1030.
- Publisher:
- Wiley
The aim was to examine the feasibility of a brief intervention training general practitioners (GPs) in the administration of a depression screening instrument for use among nursing home residents. GPs attended a single education session on late-life depression and were trained in the use of the Cornell Scale for Depression in Dementia. Following the intervention GPs reviewed their patients for depression. Diagnosis of depression pre and post intervention; changes in antidepressant medications post intervention. Ten GPs and 38 patients completed all components of the study. GPs identified that 24% of their patients had Cornell Scores indicative of probable major depression that was either unrecognised or inadequately treated. 88% of these patients had been previously diagnosed with depression. A further 32% of patients exhibited depression symptoms, half (50%) of whom had a previous diagnosis of depression. Reviewing patients had an effect on antidepressant prescribing for patients with probable major depression, with GPs making changes to the antidepressant medication of 29% of patients. The high rate of residents presenting with probable major depression despite being prescribed antidepressants indicate that depression symptoms are inadequately recognised and treated in nursing homes. This study demonstrated that a single education session on late-life depression was feasible and was associated with an improvement in GPs' recognition of depression among nursing home patients.
Depression among older people with cognitive impairment: prevalence and detection
- Authors:
- McCABE Marita P., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(7), July 2006, pp.633-644.
- Publisher:
- Wiley
Past research has demonstrated that there is a high level of depression among older people, particularly for those with cognitive impairment and those in residential care. The current study was designed to determine the prevalence of depression among older people in hostels with cognitive impairment using a structured diagnostic interview. A further aim was to determine an appropriate screening instrument to detect depression within this population. It was also designed to evaluate the extent to which depression among these older people had previously been detected. Five commonly used depression scales were administered and compared to the results of the diagnostic interview. The results demonstrated that 38.9% of older people were diagnosed with depression, but that only 50% of these people had been previously diagnosed with this disorder. All scales showed some level of validity to detect depression. The implications of these findings for our understanding of depression among older people with cognitive impairment are discussed.
A longitudinal study regarding conversion from mild memory impairment to dementia in a Japanese community
- Authors:
- ISHIKAWA Tomohisa, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(2), February 2006, pp.134-139.
- Publisher:
- Wiley
The aim was to estimate the rate that subjects with Mild Memory Impairment /Not Dementia (MMI/ND) shifted to dementia in a population-based cohort and to establish simple diagnostic methods for identification of high-risk persons for dementia. Subjects in a community-based elderly cohort of MMI/ND were followed longitudinally. Subjects were selected from the participants in the first Nakayama study. MMI/ND was defined as memory deficit with objective memory assessment, without dementia, impairment of general cognitive function, or disability in activities of daily living. The conversion rate was calculated using the person-year method. At baseline, the sample consisted of 104 subjects (59 female; 45 male) selected from 1162 community dwellers aged over 65 year. During the five-year follow-up, 14 subjects died, 13 moved to other communities, and six refused to participate further. Eleven (10.6%) subjects were diagnosed with Alzheimer's disease (AD), five (4.8%) were diagnosed with vascular dementia (VaD), and six (5.8%) were diagnosed with dementia of other etiology. The annual conversion rate that MMI/ND shifted to AD is calculated on 8.5% per 100 person-year, and shifted to dementia on 16.1% per 100 person-year in this survey. The rate at which subjects with MMI/ND whose conditions shifted to dementia was the same as the rate that subjects with mild cognitive impairment (MCI) shifted to dementia in a previous report. It would be useful to identify groups of high-risk individuals for dementia by simple diagnostic methods.
Outcomes of community-based screening for depression and suicide prevention among Japanese elders
- Authors:
- OYAMA Hirofumi, et al
- Journal article citation:
- Gerontologist, 46(6), December 2006, pp.821-826.
- Publisher:
- Oxford University Press
This study evaluates outcomes of a community-based program to prevent suicide among elderly individuals aged 65 and older. The study used a quasi-experimental design with intervention and referent municipalities. The program included a 7-year implementation of depression screening with follow-up by general practitioners and a 10-year implementation of public education conducted in Yasuzuka (population 4,940; elderly suicide rate for women, 275/100,000; for men, 323/100,000). Changes in the risk of completing suicide before and after the 10-year implementation by the incidence-rate ratio (IRR) were estimated. The results found risk for women in the intervention area was reduced by 64%, whereas there was no significant change in the risk for men in the intervention area and either men or women in the referent municipalities. A ratio of the IRR for women aged 65 to 74 in the intervention area to that in its prefecture was estimated at 0.23, showing that the risk reduction was greater than the secular trend. It is concluded that the management of depression by use of community resources involving public health and primary care physicians is effective in the prevention of suicide for elderly women but uncertain for men.
The prevalence of mistreatment among the elderly with mental disorders in primary health care settings
- Authors:
- RACIC Maja, et al
- Journal article citation:
- Journal of Adult Protection, 8(4), December 2006, pp.20-24.
- Publisher:
- Emerald
Elder mistreatment is a medical and social problem that is often under-recognised by primary care physicians. This study aimed to estimate the prevalence of elder mistreatment among elderly patients with mental disorders (depression, early dementia and anxiety disorders) in Bosnia and Herzegovina. One-hundred-and-eighty-four patients with different mental disorders were asked to complete the EAST questionnaire as part of a comprehensive geriatric assessment. Screening results were evaluated, and patients who had responses associated with 'mistreatment' were invited back to the clinics for additional clinical evaluation. Different types of mistreatment were identified in 71% of all patients. This led to a conclusion that screening for elderly mistreatment should be part of the routine health assessment for all older persons and part of a comprehensive geriatric assessment.