Geriatric Mental Health Care最新文献

Introduction

The Mini-Cog is an easy-to-administer and reliable short screen for possible dementia. It is said to have high sensitivity and specificity comparable to those of Mini Mental Status Examination (MMSE). It consists of a delayed-recall (DR) test and a distractor-clock-drawing test (CDT). A positive screen is defined as either a score of zero in the 3-item DR or a score of 1–2 in the DR combined with an abnormal CDT. The Mini-Cog is said to be relatively free of language, educational and cultural bias. However the utility of the Mini-Cog for screening ethnic elders with minimal or no education remains largely unexplored.

Methods

Ninety-six community-dwelling Chinese elders from 7 social-recreational programs in Toronto were recruited and screened by the Mini-Cog for possible dementia. The feasibility and limitations of using the Mini-Cog for screening were evaluated. Participants' feedback on the acceptability of the Mini-Cog and their resistance to future Mini-Cog screening were collected through evaluative questionnaires. Fisher Exact test was used to determine whether there was significant association between participants' refusal to attempt or complete the Mini-Cog and each of the pertinent variables namely 1) participants' literacy; 2) resistance to the Mini-Cog re-screening; 3) difficulty understanding the Mini-Cog instruction; and 4) performance on the DR part of the Mini-Cog.

Results

Of the 96 participants, 10 (10.4%) refused to attempt the CDT part of the Mini-Cog, and expressed difficulty in writing and drawing. Of those 10, 7 reported having no education and 3 minimal education. A highly significant association was found between participants' refusal to attempt CDT and illiteracy (p=7E−0; p<0.001). While participants' refusal to attempt the CDT part of the Mini-Cog appeared to be independent of their self-reported difficulty in understanding the Mini-Cog instruction or their actual DR score in screening, it was found to be significantly related to their resistance to future mini-Cog test (p=0.4958; p<0.05).

Conclusion

The results suggest that there may be limitations in the utility of the Mini-Cog for screening elders with minimal education. This concurs with earlier findings about the negative effect of illiteracy on CDT performance. Further study is needed to explore possible modifications to the distracter component of the Mini-Cog for elders who are illiterate or have a very low level of education.

Background

The aim of this population-level study was to describe and characterize the utilization of AEDs in older people in New Zealand from 2005 to 2013.

Methods

De-identified individual level dispensing data for people aged 65 years and over for the period 2005–2013 were obtained from New Zealand Ministry of Health. AEDs were categorized using the ATC classification system of the WHOCC and Norwegian institute of public health. Utilization rates by year, age, sex, ethnicity and district health boards were measured as DDD per TOPD.

Results

The prevalence of AEDs utilization (DDD/TOPD) increased from 14.23 in 2005 to 14.39 in 2013. The newer AEDs increased from 0.64 in 2005 to 1.82 in 2013, but the prevalence for older AEDs decreased over the same study period from 13.59 to 12.57. AEDs utilization in males over the 9-year period was 17.18 (33.22% higher than females). Highest utilization was observed in those aged between 65 and 69 years, with average of 15.44 (28.88% higher than 85 plus age group). Sodium valproate followed by phenytoin and carbamazepine were the most common AEDs. Among the newer AEDs, gabapentin followed by lamotrigine was most frequently utilized.

Conclusion

Utilization of AEDs increased over the 9-year study period in older New Zealanders. The newer AEDs may have contributed to this increase. Further research is required to examine the utilization of AEDs by therapeutic indications.

Objectives

Depression is a major health risk factor among the older population, related to significant increases in total per person health care expenditures. Prior studies have shown significant regional variations in some clinical conditions. However, there has not been any study examining depressive symptoms across regions. The purpose of this study was to investigate the prevalence of the older population experiencing depressive symptoms across different regions in the United States.

Methods

Public data were obtained from the 2011–2014 National Health and Aging Trends Study, a longitudinal study that included a nationally representative sample of individuals aged 65 or older. Participants’ regions of residence were categorized by Northeast, Midwest, South and West census regions. A composite score of 3 or greater from the Personal Health Questionnaire-2 was used to indicate the presence of depressive symptoms. The comparison of proportion having depression across census regions were analyzed using chi-square tests.

Results

A total of 3863 participants over the age of 65 were included in this study. Of those, 1583 (41.0%) were male and 2757 (71.4%) were White. A majority of the participants (22.1%, n=852) were between 70 and 74 years old at the baseline year. Disparities in the prevalence of depressive symptoms were observed across different regions in the United States. From 2011 to 2014, depressive symptoms among this population significantly declined in the South (p<0.05) and increased significantly in the Midwest and West (p<0.05).

Conclusion

Understanding regional variations of depressive symptoms in older adults can inform the public regarding resource allocation and treatment models. By showing which areas of the US are more prone to depressive symptoms, local, state, and federal funding can be appropriated to the areas with the greatest need.

Responsive behaviours (RB's) are variable responses to an individual's environment that are disruptive to the person exhibiting the behaviour as well as to those around them. Throughout the community and continuing care service sectors, managing RB's in the resident population is an increasing concern. In Alberta at present, the magnitude or impact of RB's at a provincial level is unknown. This is significant as current healthcare policies, facilities, and programs are governed at this level. A symposium of health care providers, policy and decision makers, academics, and researchers with expertize in RB's was convened with two broad aims: (1) identify and discuss issues related to the provision of health care services for individuals across Alberta, who live and cope with RB's; and (2) to develop a plan to address this challenge across the continuum of care. The findings from the symposium highlight the readiness and need for a provincial framework/strategy to develop guiding principles to cope with RB's across conditions and ages.

Introduction

‘Awakened Art Stories’ is the first creative expression intervention study for persons with dementia (PWD) and their caregivers. The study was conducted at the Kunsthaus Museum in Switzerland. The intervention utilised TimeSlips to encourage persons living with dementia to create stories about artwork in response to open-ended questions. The aim of this pilot study was to assess the efficacy and feasibility of an intervention through storytelling and a social gathering.

Materials and method

A mixed-method pre-post design using semi-structured interviews, written questionnaires, validated and adapted scales, and a self-generated observations' sheet as well as a visual analogue scale assessed the efficacy as well as the feasibility of the intervention. Participants were four PWDs and their caregivers as well as four volunteers, who supported the PWDs during the sessions. Qualitative data were analysed using thematic analyses and descriptive observations, as well as further feedback from participants, while a Wilcoxon signed-rank test was used to analyse quantitative data.

Results

The quantitative findings revealed a statistically significant, positive effect on PWDs' and caregivers' mood on the Smiley-Face Assessment Scale directly after the museum session (all participants: Z=−4.84, p<0.001; PWDs: Z=−3.57, p<0.001; Caregivers: Z=−3.34, p<0.001). On the Dementia Attitudes Scale, no significant differences in the caregivers' and volunteers' attitudes towards dementia were found. No significant differences were found on the Caregiver Burden Inventory either. Although the qualitative findings revealed via thematic analyses that while PWDs attributed their mood to the atmosphere, caregivers attributed it rather to social contacts. All caregivers and most of the volunteers reported a positive change in their attitude towards dementia. In addition, PWDs' reported that they welcomed the opportunity to contribute and express their thoughts. All participants were highly satisfied with their experience.

Conclusion

Despite the small sample size, the many benefits of making art accessible to PWDs and their caregivers, as well as the feasibility of an innovative intervention based on TimeSlips resulted in both quantitative and qualitative evidence.

Introduction

Conventionally apathy is defined as a symptom primarily characterized by loss of feelings and emotional display and is the most common behavioural symptom in dementia patients. Neuronal network of emotions has ceased to function in patients suffering from dementia associated apathy.

Objective and methods

We measured changes in skin conductance and heart rate from n=12 demented nursing home residents with clinical significant apathy (sumscore>40 in the Apathy Evaluation Scale, AES) to images taken from the International Affective Picture System (IAPS, Lang et al., 2008). Additionally we used autobiographical material to study the responsiveness of the neuronal network of emotions and the adequacy of somatic indicators to demonstrate emotional reactions in individuals diagnosed with dementia and apathy.

Results

Analysis of the EDA data revealed a significant difference in the change of skin conductance between the different image categories. The autobiographical material generated the largest change in skin conductance. Analysis of the heart rate did not yield any significant difference between the image categories.

Conclusions

Our findings demonstrate that the neuronal network underlying emotion is still responsive in patients diagnosed with dementia associated apathy, although residents don׳t seem to be involved emotionally from an extraneous visual focus. Non pharmacological therapy approaches should deal with individual, familiar, autobiographic material to ensure a high level of emotional response and therefore reduce apathy severity.

Objective

The purpose of this study was to examine the association between mental disorder comorbidity and in-hospital mortality, and whether subgroups of mental disorder comorbidity have differential impacts on in-hospital mortality in acute myocardial infarction (AMI) patients.

Methods

A cross-sectional study was conducted using the 2010 Nationwide Inpatient Sample (NIS) database of the Healthcare Cost and Utilization Project (HCUP). The study sample included discharges for which the primary diagnosis was AMI. As the primary exposure, the presence of any mental disorder comorbidity was identified as discharges for which one or more mental disorders listed as the non-primary diagnosis. The secondary exposure was subgroups of the mental disorder comorbidity (schizophrenia, major affective disorder, substance abuse, and other). The outcome of interest was in-hospital mortality. Logistic regression and resulting odds ratios (ORs) with associated 95% confidence intervals (CIs) were used to estimate the impact of mental disorder comorbidity on in-hospital death.

Results

A total of 42,416 discharges were included in the analysis. Of these, 16,140 (38%) had at least one diagnosis of a mental disorder. No significant differences were observed in in-hospital mortality between patients with and without mental disorder comorbidity. However, when the mental disorder comorbidity is specified into subgroups, the impact differentiated depending on the subgroup. More specifically, patients with schizophrenia were associated with increased in-hospital mortality (OR 1.72, 95% CI 1.02–2.90) and patients with substance abuse disorder were associated with decreased in-hospital mortality (OR 0.80, 95% CI 0.70–0.91). Major affective disorder and other mental disorders were not statistically significant.

Conclusions

Mental disorder comorbidity has a differential impact on post-AMI in-hospital mortality depending on the subgroup of mental disorders. We argue that mental disorder comorbidity should not be treated as a single category when assessing its impact on a health outcome.

Introduction

Demographic aging of the Polish population is becoming a challenge for health and social policy, similarly to other European countries. It is also seen as one of the most important causes for developing formal long-term care.

Objective

The aim of this study was to analyse the complex needs of residents of nursing homes over 75 years old in different Polish cities from different perspectives and to explore the unmet need associations of health-related factors.

Material and methods

The sample consisted of 300 randomly selected people over 75 years old from different nursing homes in three metropolises: Wroclaw, Poznan and Lublin. The detailed needs were assessed using the CANE questionnaire and psychophysical condition was based on MMSE, GDS and BI.

Results

Comparison of needs examined from three different perspectives showed that nursing home residents reported significantly fewer problems than nursing home staff and rater and significantly more unmet needs than staff. The most common areas where unmet needs were reported were company/friends and psychological distress. Moreover, the more severe the depression and the worse the cognitive functions were, the more unmet needs were reported by nursing home residents.

Conclusions

In order to improve the care provided for elderly people, it seems necessary to promote knowledge concerning wider needs of elderly patients among the employees of different geriatric care facilites. Interventions to reduce senior׳s unmet needs should be targeted at organisational and medical assessment issues. Future studies with longitudinal follow-ups are required.

We report the effects of a treatment with methylene blue over 6 months in a 46-year-old male suffering from the behavioral variant of frontotemporal dementia. This treatment was initiated after the clinical status of the patient had deteriorated rapidly in the preceding months. After 4 months of treatment with methylene blue we observed a definite and lasting reduction of negative behavioral symptoms, an improvement in motor functions, particularly gait, and an improvement in basic activities of daily living. These improvements may be attributed to a disease-modifying effect of methylene blue, possibly mediated by its tau-filament dissolving properties.