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Regression equations for predicting scores of persons over 65 on the Rey Auditory Verbal Learning Test, the mini-mental state examination, the trail making test and semantic fluency measures
- Authors:
- KNIGHT Robert G., et al
- Journal article citation:
- British Journal of Clinical Psychology, 45(3), September 2006, pp.493-402.
- Publisher:
- Wiley
Scores on neuropsychological tests are often used to detect abnormal changes in cognition in older persons. Accordingly, it is important to have normative data that allow the abnormality of a test score to be determined precisely and accurately. Regression equations that estimate an expected score based on demographic or premorbid factors can be an efficient method of making normative comparisons. Our aim was to compute regression equations with age, gender and estimated premorbid IQ as predictors of scores on the Rey Auditory Verbal Learning Test (AVLT), the Trail Making Test (TMT), Mini-mental State Examination (MMSE) and measures of semantic fluency. All measures were administered to a group of 272 healthy older persons aged between 65 and 90 during the pre-treatment phase of a study evaluating the effect of nutritional supplements on cognition. Premorbid IQ was estimated using the National Ault Reading Test (NART). Stepwise multiple regression procedures were used to determine the weights to be applied to the predictor variables. Age and premorbid IQ were found to be significantly correlated with all test variables; gender correlated significantly with most scores. Regression equations based on the 3 predictor variables explained between 10% and 30% of the variance of the range of test scores. The use of these equations in clinical practice was illustrated. The significant correlations between the predictor variables and test scores justified computing a set of equations for use in interpreting data from older persons. The abnormality of the difference between predicted and obtained scores provides a convenient index of an individual's current level of neuropsychological functioning.
Whole-system approaches to health and social care partnerships for the frail elderly: an exploration of North American models and lessons
- Author:
- KODNER Dennis L.
- Journal article citation:
- Health and Social Care in the Community, 14(5), September 2006, pp.384-390.
- Publisher:
- Wiley
Irrespective of cross-national differences in long-term care, countries confront broadly similar challenges, including fragmented services, disjointed care, less-than-optimal quality, system inefficiencies and difficult-to-control costs. Integrated or whole-system strategies are becoming increasingly important to address these shortcomings through the seamless provision of health and social care. North America is an especially fertile proving ground for structurally oriented whole-system models. This article summarises the structure, features and outcomes of the Program of All-Inclusive Care for Elderly People (PACE) programme in the United States, and the Systeme de soins Integres pour Personnes Agees (SIPA) and the Programme of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) in Canada. The review finds a somewhat positive pattern of results in terms of service access, utilisation, costs, care provision, quality, health status and client/carer satisfaction. It concludes with the identification of common characteristics which are thought to be associated with the successful impact of these partnership initiatives, as well as a call for further research to understand the relationships, if any, between whole-system models, services and outcomes in integrated care for elderly people.
Psychological disposition and self-reported health among the ‘oldest-old’ in China
- Authors:
- WU Zheng, SCHIMMELE Christoph M.
- Journal article citation:
- Ageing and Society, 26(1), January 2006, pp.135-151.
- Publisher:
- Cambridge University Press
This study contributes to the understanding of the ageing process by investigating whether particular psychological dispositions among older people are associated with healthy ageing. The study's objective is to further our knowledge about what constitutes ‘health’ for the ‘oldest-old’ (people aged 80 or more years) in China. It is recognised that apart from the absence of disease, good health is a subjective experience, and it is posited that self-reported health is associated with psychological disposition, or in other words, that an individual's personal attitudes, motivations, and beliefs condition their perception of health and illness. Using data from China's Longitudinal Healthy Longevity Survey (1998 and 2000 waves), the authors examine whether psychological disposition in 1998 had an independent effect on self-reported health in 2000. The study is based on a stratified random sample of 4,366 people aged 80 or more years. After introducing controls for health status and socio-demographic variables, the multivariate, longitudinal results demonstrate that a robust psychological disposition was indeed associated with good short-term, self-reported health. The findings also illustrate that the effect differed by age, for the relationship was significant for octogenarians and nonagenarians but insignificant for centenarians. Data limitations prevented an empirical investigation of the processes that underlie the relationship between psychological disposition and self-reported health.
Subjective well-being in centenarians
- Authors:
- ROTT Christoph, JOPP Daniela
- Journal article citation:
- Global Ageing, 4(1), April 2006, pp.52-62.
This article summarises two investigations which examined the level and mechanisms related to subjective well-being in centenarians by focusing on two facets of subjective well-being, the valuation of life and happiness. Subjects of both studies were 56 individuals from the population-based Heidelberg Centenarian Study who were able to give self-reports. The findings of both studies indicate that despite the constraints centenarians facie in their daily lives, they show surprisingly high levels of subjective well-being.
Age differences in depression and morale among the oldest old
- Authors:
- MARTIN Peter, da ROSA Grace
- Journal article citation:
- Global Ageing, 4(1), April 2006, pp.42-51.
The world's population is aging and many countries are experiencing an increase in life expectancy. As a result, questions arise about their morale and emotional status during their advanced age. This American study sought to investigate whether there are age differences in depressive symptoms and morale among the oldest old. The study also explored the in which specific domains of depression and morale age differences might found. Participants in the study were 53 centenarians and 49 nonagenarians, 84 women and 10 men. Half of the residents were in a long-term care facility and half lived at home; 85 were widowed. The results found there were significant age differences when comparing centenarians to nonagenarians, but there did not appear to be mental health differences when comparing by residential status.
Social relations, language and cognition in the ‘oldest old’
- Authors:
- KELLER-COHEN Deborah, et al
- Journal article citation:
- Ageing and Society, 26(4), July 2006, pp.585-605.
- Publisher:
- Cambridge University Press
This paper reports a study of the associations between social relations, language and cognition among people aged 85 or more years (hereafter the ‘oldest old’). Although the links between cognition and both social relations and language ability are well-established, less is known about the relationship between social relations and language skills, especially among the oldest old. With a sample of 20 adults aged 85–93 years living independently in two retirement communities (a seniors' apartment complex and independent apartments in a continuum-of-care setting), we used the approach of the Rochester Interaction Record to assess the frequency, purpose and quality of their social interactions over one week. It was hypothesised that aspects of social relations, as well as the type of residential setting, would associate with both cognitive skills (measured using the Composite Cognistat) and language skills (measured using the Boston Naming Test). It was found that participants who had a low proportion of interactions with family members, or a high proportion with friends, as well as those with diverse relationships, performed better on the cognitive and language tasks. Furthermore, those from the setting with more programmed activities performed better on the language task. The conclusion critically examines the findings about the influence of family relationships and the importance of residential setting.
The palliative care in assisted living (PCAL) pilot study: successes, shortfalls, and methodological implications
- Authors:
- JERANT Anthony F., et al
- Journal article citation:
- Social Science and Medicine, 62(1), January 2006, pp.199-207.
- Publisher:
- Elsevier
The authors present results of the Palliative Care in Assisted Living pilot, comparing two TLC (Timely and Team-oriented, Longitudinal, and Collaborative and Comprehensive) model-based, facility delivered interventions for improving the palliative care (PC) of elderly assisted living residents in Sacramento, California. The less intensive intervention involved one assessment followed by a PC improvement recommendation letter to the resident, family member, primary provider, and facility staff, while the more intensive intervention involved assessments and letters every three months. Primary outcomes were SF-36 Physical (PCS) and Mental (MCS) Component scores and recommendation adherence. Eighty-one subjects enrolled (mean age 85), 58 in the more and 23 in the less intensive group. A loved one attended 56% of baseline assessments. Most subjects expressed a preference for maintaining current quality of life over prolonging life at reduced quality. None were eligible for hospice care. A total of 418 recommendations were generated concerning symptoms, mood, functional impairments, and advance directives. The authors found no significant differences in recommendation adherence between more (42%) and less (44%) intensive groups, and no significant changes in PCS and MCS scores within or between groups. However, a loved one's attendance of the baseline assessment was associated with improved PCS scores. This pilot study had methodological limitations that could account for the lack of significant outcome effects. In this context, and given the myriad unmet PC needs detected, interventions based on the TLC model might allow delivery of timely PC to assisted living residents not eligible for hospice care. Further studies exploring the TLC model appear warranted.
Worries of the oldest-old
- Authors:
- JEON Hae-Sook, DUNKLE Ruth, ROBERTS Beverly L.
- Journal article citation:
- Health and Social Work, 31(4), November 2006, pp.256-265.
- Publisher:
- Oxford University Press
With the emerging population of the oldest-old (those ages 85 and older), it is crucial to understand and prepare for their psychosocial needs. Worry is linked to psychological well-being and physical health, but little is known about the oldest-old's everyday worries. The authors explored four research questions: (1) What are the worries of the oldest-old? (2) What are their specific dimensions of worry? (3) How alike or different are the worry patterns over time? (4) What factors are related to variations in the pattern of change in worry? A convenience sample of 193 community-dwelling people ages 85 and older in the United States was recruited to examine various aspects of health and well-being between 1986 and 1995. This article reports on the 23 survivors across three time points, waves 1, 4, and 5. The findings suggest that the very old mainly worry about health and memory and that, although worry increased over the study period, there were variations in the pattern of worry over time. Results of t tests show that at wave 4 elderly respondents with a higher level of worry reported more frequent social contact than those with a lower level of worry. Implications for social work practice and future research are discussed.
Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data
- Authors:
- GRAVELLE Hugh, et al
- Journal article citation:
- British Medical Journal, 6.01.06, 2006, pp.31-34.
- Publisher:
- British Medical Association
This study aimed to determine the impact on outcomes in patients of the Evercare approach to case management of elderly people. Nine primary care trusts in England that, in 2003-5, piloted case management of elderly people selected as being at high risk of emergency admission were involved in the study. Main outcome measures were rates of emergency admission, emergency bed days, and mortality from April 2001 to March 2005 in 62 Evercare practices and 6960-7695 control practices in England (depending on the analysis being carried out). The results found the intervention had no significant effect on rates of emergency admission (increase 16.5%, (95% confidence interval –5.7% to 38.7%), emergency bed days (increase 19.0%, –5.3% to 43.2%), and mortality (increase 34.4%, –1.7% to 70.3%) for a high risk population aged >65 with a history of two or more emergency admissions in the preceding 13 months. For the general population aged 65 effects on the rates of emergency admission (increase 2.5%, –2.1% to 7.0%), emergency bed days (decrease –4.9%, –10.8% to 1.0%), and mortality (increase 5.5%, –3.5% to 14.5%) were also non-significant. It is concluded that case management of frail elderly people introduced an additional range of services into primary care without an associated reduction in hospital admissions. This may have been because of identification of additional cases. Employment of community matrons is now a key feature of case management policy in the NHS in England. Without more radical system redesign this policy is unlikely to reduce hospital admissions.
Time to move?: a literature review of housing for older people
- Authors:
- RICHARDS Francesca, et al
- Publisher:
- Scotland. Scottish Executive. Social Research
- Publication year:
- 2006
- Pagination:
- 82p.
- Place of publication:
- Edinburgh
A scoping review of existing literature and research findings of housing for older people. This report will inform the Scottish Executive's Review of Older People's Housing (ROOPH) and help identify the future requirements, and provision, of older people's housing and housing support in Scotland. Population projections indicate a considerable increase in the number of older people in Scotland, particularly of ‘very old’ people (aged 85+) and older men. It is anticipated that these demographic changes will lead to further pressure on services for older people. There is also a general acceptance that the existing specialist older people’s housing stock is becoming increasingly unfit for purpose.