Search results for ‘Subject term:"older people"’ Sort:
Results 1 - 10 of 34
Motivational interviewing and the older population in psychiatry
- Authors:
- BUGELLI Tania, CROWTHER Terrence R.
- Journal article citation:
- Psychiatric Bulletin, 32(1), January 2008, pp.23-25.
- Publisher:
- Royal College of Psychiatrists
Motivational interviewing is a psychological intervention that could potentially give clinical staff working with older people a way of tackling ambivalence and/or resistance to change in therapy. Although it has been shown to be effective in various spheres of mental health, this paper discusses the main principles of this intervention and some adaptations necessary to meet the needs of older people (i.e. those over 65 years old). Patients require the capacity to understand and retain new information in order to make use of this intervention, which hence limits its use to those who retain good cognitive functioning.
Survey of the provision of psychological therapies for older people
- Authors:
- EVANS Ceri, REYNOLDS Paul
- Journal article citation:
- Psychiatric Bulletin, 30(1), January 2006, pp.10-13.
- Publisher:
- Royal College of Psychiatrists
The aim of the present study was to assess the current state of provision of psychological therapies for older people in Wales. A postal questionnaire was sent to all consultant old age psychiatrists in Wales, requesting information regarding the consultant’s community mental health team (CMHT) and access to psychological therapies. A response rate of 85% was achieved: 45% of CMHTs had team members providing psychological therapy; 31% of CMHTs had access to psychological therapy via the team and also generic services. The estimated average wait for generic services was 29 weeks. There was no access to psychological therapies for 17% of CMHTs. In some areas of Wales there is limited or no access to psychological therapies via mental health services for older people. This may represent an important unmet need. Long-term strategies, taking into account recruitment and retention, training and new ways of working, need to be implemented.
GP concordance with advice for treatment following a multidisciplinary psychogeriatric assessment
- Authors:
- WOLFS Claire A. G., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(3), March 2007, pp.233-240.
- Publisher:
- Wiley
The aim was to evaluate the concordance of General Practitioners (GPs) with advice for treatment after a multidisciplinary psychogeriatric assessment by the Diagnostic Observation Centre for PsychoGeriatric patients (DOC-PG). Concordance checklists, listing the recommendations from the multidisciplinary team, were sent to the GPs in order to establish GP concordance. Regression models were used to study the associations between various patient and GP characteristics and level of concordance. Furthermore, results of a questionnaire (to identify the level of satisfaction regarding the services provided by the DOC-PG) were compared with the level of GP concordance. Based on 530 recommendations, the overall GP concordance rate amounted to 71%. The most common types of advice pertained to medication, GP follow-up/advice and referral. GP concordance with advice regarding admissions was the highest, followed by advice concerning the arrangement of daycare, home care and the adaptation of medication. GP concordance was lowest for referral recommendations to other specialties and recommendations regarding psychoeducation. Concordance was higher for patients who lived alone, for patients with fewer cognitive problems, when the number of recommendations did not exceed six and in group practices. Concordance was dependent on the type of advice. Satisfaction with DOC-PG did not correlate with the level of concordance. In general, GPs showed a high level of concordance with advice from the DOC-PG. Enhancement of GP concordance can be achieved by limiting the number of recommendations, giving detailed explanations about the purpose of recommendations and educating GPs by doing.
Depression in late-life: shifting the paradigm from treatment to prevention
- Authors:
- WHYTE Ellen M., ROVNER Barry
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(8), August 2006, pp.746-751.
- Publisher:
- Wiley
Late-life depression is very common and is associated with high rates of morbidity and mortality. While the field of geriatric psychiatry is focused on depression treatment, prevention is an enticing option. Prevention of late-life depression would decrease both emotional suffering and depression-associated morbidity and mortality and may decrease dependence on non-mental health professionals to detect depression and to initiate a treatment referral. This paper will review current thinking on prevention research with a particular focus on its application to late-life depression. To illustrate these issues, we discuss recent and ongoing clinical trials of interventions to prevent depression in two populations of older persons: those with age-related macular degeneration (AMD) and those with cerebrovascular disease.
White matter lesions on magnetic resonance imaging and their relationship with vascular risk factors in memory clinic attenders
- Authors:
- LAZARUS R., PRETTYMAN R., CHERRYMAN G.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(3), March 2005, pp.274-279.
- Publisher:
- Wiley
The association between white matter lesions on magnetic resonance imaging (MRI) and the presence of vascular risk factors has been investigated in different populations, and results have varied widely. However, this relationship has not been adequately addressed in memory clinic attenders who have relatively early cognitive impairment. This study was undertaken to determine the relationship between the severity of white matter lesions and vascular risk factors in elderly subjects referred to a Memory Clinic, irrespective of their diagnoses. Patients attending the Memory Clinic had relatively early, mild cognitive impairment and differed, in this respect, from typical unselected community-based samples and from patients with established dementia. The study also investigated whether periventricular and deep white matter lesions differed in their relationship with vascular risk factors. All patients assessed in the Memory Clinic at Leicester General Hospital between April 1998 and October 2000 who had undergone an MRI scan were included in the study. They received a comprehensive clinical and cognitive assessment, a standard dementia laboratory screen and evaluation of vascular risk factors. MRI scans were reviewed by two independent raters and semi-quantitative ratings of the severity of white matter lesions were made using standardised protocols. The relationship between cerebral white matter lesions and vascular risk factor variables was examined by multiple linear regression. One hundred and seventy-seven subjects were included in the study. The mean age was 69.8 and the mean MMSE score was 23.2. Of the risk factors investigated, only age and prior cerebrovascular disease were significantly associated with severe periventricular white matter lesions; age, hypertension and diabetes were significantly associated with severe deep white matter lesions. Periventricular and deep white matter lesions are differentially influenced by vascular risk factors.
Clinical application of operationalized criteria for Depression of Alzheimer's Disease
- Authors:
- ROSENBERG Paul B., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(2), February 2005, pp.119-127.
- Publisher:
- Wiley
Depression of Alzheimer's Disease (dAD) is a common complication of Alzheimer's disease and is increasingly recognized as a syndrome with a clinical presentation differing from major depression. Criteria for the diagnosis of dAD have been proposed previously. This paper presents these criteria in operationalized format designed to be accessible for clinical use. Four cases are discussed that demonstrate the use of these criteria and illustrate important differences between dAD and major depression. The dAD criteria are broader than DSM-IV criteria for Major Depressive Episode and incorporate caregiver input. Given the differences between dAD and major depression diagnoses, it is important to assess the efficacy of treatments for dAD. Depression in Alzheimer's Disease-2 (DIADS-2) is a controlled trial of dAD treatments that will also assess the validity of these criteria.
The effects of reminiscence on depressive symptoms and mood status of older institutionalized adults in Taiwan
- Author:
- WANG Jing-Yy
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(1), January 2005, pp.57-62.
- Publisher:
- Wiley
This study examined the effects of reminiscence on depressive symptoms and mood status of elderly people residing in long-term care facilities. A longitudinal quasi-experimental design was conducted, using two equivalent groups for pre-post test and purposive sampling. Each subject was administered pre- and post- tests at a 4 month interval, but subjects in the experimental group underwent weekly individual reminiscence therapy. Geriatric Depression Scale short form (GDS-SF) and Apparent Emotion Rating Scale (AER) were used as study instruments. Forty-eight subjects completed the study, with 25 in the experimental group and 23 in the control group. The experimental findings indicated that the experimental group demonstrated fewer depressive symptoms (p < 0.05) and better mood status (p = 0.05) on the post-test comparing to the control group. These warranted that reminiscence therapy is a recommended therapy for older people who reside in care facilities. It can provide a basis for planning geriatric care in community to promote the well being and quality of life of older people.
A comparison of the effects of Snoezelen and reminiscence therapy on the agitated behaviour of patients with dementia
- Authors:
- BAILLON Sarah, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(11), November 2004, pp.1047-1052.
- Publisher:
- Wiley
Behavioural disturbance, such as agitation, is a common feature of dementia, and causes significant problems and distress for carers. Snoezelen is increasingly used with people who have dementia, but there is limited evidence of its efficacy. This crossover randomised controlled study aimed to evaluate the effect of Snoezelen on the mood and behaviour of patients with dementia, in comparison to the effect of an established and accepted intervention, reminiscence therapy. Twenty patients with dementia and significant agitated behaviour, received three sessions each of Snoezelen and reminiscence. The effects were assessed using measures of observed agitated behaviour and heart rate over the course of the sessions, and mood and behaviour during the sessions. Both interventions had a positive effect. Snoezelen was no more beneficial than reminiscence in terms of effecting a significant reduction in agitated behaviour or heart rate. There was considerable variation in the way individuals responded to each intervention. Snoezelen may have a more positive effect than reminiscence, but due to the observed differences between the interventions being small, and the small number of subjects, this advantage was not demonstrated statistically. Further research, with larger numbers of subjects, and an appropriate control is required to establish the benefits of Snoezelen for people at different stages of dementia, and to identify any benefits additional to those derived from increased staff attention.
A survey of the provision of psychological treatments to older adults in the NHS
- Author:
- EVANS Sandra
- Journal article citation:
- Psychiatric Bulletin, 28(11), November 2004, pp.411-414.
- Publisher:
- Royal College of Psychiatrists
A questionnaire was sent to old age psychiatrists to ascertain their experience, views and clinical practice regarding psychological therapies in their services. The provision of psychological treatments of all modalities to older people is widely varied in Britain. The main difficulty seems to be a lack of resources, but it would appear that inexperience with psychological therapies applied to older adults is also a factor. Most mental health teams (95%) provide anxiety management therapy, and cognitive–behavioural therapy is widely available (76% of teams), but areas such as training and staff supervision appear to be poorly provided. Suggestions are made to increase provision and quality of service within existing resources; improving services to the standards of the National Service Framework would be a bigger challenge.
A counseling intervention for caregivers: effect on neuropsychiatric symptoms
- Authors:
- SENANARONG Vorapun, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(8), August 2004, pp.781-788.
- Publisher:
- Wiley
In Thailand, family caregivers have an important role in delivering care to patients with dementia. Most patients with dementia in Thailand and also in Western societies live in the community. Training caregivers may improve care of dementia patients. The authors performed a treatment study of a six-month caregiver intervention with group counseling and support with provision of techniques to cope with non-cognitive symptoms of patients with dementia. They hypothesized that this caregiver intervention with group counseling and support would reduce behavioral and neuropsychiatric symptoms in the demented patients. They conducted a parallel group intervention study. A manual for group counseling and support was developed focusing on education regarding dementia, behavioral analysis and intervention, and environmental adaptation. Fifty nonprofessional caregivers - 25 from the control group and 25 from the study group - of patients with dementia from the memory clinic at Siriraj Hospital were alternately assigned to each group as they presented to the clinic if they met the inclusion criteria and agreed to participate. The Thai Mental State Examination (TMSE) was used to assess dementia severity. Forty-five minute counseling sessions were conducted every 6-8 weeks for 6 months and assessments were conducted at 3 months and 6 months. The primary outcome measure was the Neuropsychiatric Inventory (NPI). A paired samples analysis of the NPI scores demonstrated a significant change of the total NPI scores at the end of six month from baseline in the intervention group (P = 0.045). Change from baseline of the comparison group was not significant. There was a trend towards improvement of the TMSE scores between the two groups at month six (p = 0.061). The result favored the treatment group. This study provided evidence of the utility of a non-pharmacologic intervention using group counseling in an out-patient setting for caregivers of patients with dementia.