Geriatric Mental Health Care最新文献

Background

Links between alcohol consumption and depression have been reported; however, associations amongst the elderly remain unclear. We aimed to investigate the relationship between alcohol consumption and self-reported depression in a population-based sample of 514 men aged 65+ (median 76.4yr, IQR 71.2–82.4).

Methods

Alcohol intake over the previous 12 months was estimated from a food frequency questionnaire. Participants were classified as non-drinkers or habitual consumers of ≤2 or ≥3 standard drinks per day. Symptoms of past and 12-month depression were ascertained by self-report based on DSM-IV criteria. Using logistic regression, we estimated the association between alcohol intake and depression, adjusting for age and lifestyle factors.

Results

There were 91 non-drinkers (17.7%), 249 (48.4%) consuming ≤2 drinks/day, and 174 (33.9%) consuming ≥3 drinks/day. Forty eight (9.3%) were identified as having lifetime depression and 31 (6.0%) with 12-month depression. With those consuming ≤2 drinks/day as the reference, the odds of lifetime depression were greater for non-drinkers (OR=2.50, 95% CI 1.15–5.44) and tended to be greater for those consuming ≥3 (OR=1.45 95% CI 0.70–3.00). After excluding those with past depression, the likelihood of 12-month depression tended to be greater for non-drinkers (OR=2.38 95% CI 0.89–6.38) and those consuming ≥3 drinks/day (OR=1.68 95% CI 0.70–4.07). These associations were not explained by age, mobility, smoking, BMI, SES or number of medications.

Conclusions

These results suggest a U-shaped relationship between alcohol consumption and depression in this sample of elderly men.

Introduction

The percentage of demented elderly is increasing worldwide and in Lebanon. Improvement in nutritional status would improve cognition in elderly. The purpose of this work is to investigate the presence of an association between nutritional status and cognitive function in elderly living in Lebanese institutions.

Materials and methods

This is a cross-sectional study performed in three long-stay elderly institutions in Beirut. Subjects who met the inclusion criteria filled out a questionnaire consisting of nutritional status scale (Mini Nutritional Assessment: MNA), cognitive function (Mini Mental State Evaluation: MMSE) and other parts (demographic, self-assessment of the state health, smoking and alcohol, physical dependence, quality of life, frailty, depression, social isolation and loneliness).

Results

Among 111 elderly (55 men and 56 women), 14(12.6%) elderly are malnourished, 54(48.7%) are at risk of malnutrition and 43(38.7%) had adequate nutrition. The majority of malnourished elderly (71.43%) showed a cognitive function deterioration (MMSE<24). The MMSE mean scores of malnourished elderly (20.21±4.61) was significantly lower (P=0.008) than elderly at risk of malnutrition and elderly with normal nutritional status (respectively 22.61±4.25 and 24.37±3.63). There was a significant positive correlation between the MMSE score and the MNA score (r=0.208, P=0.028). Multivariate analysis showed that cognitive state of elderly was only explained by lower nutrition status (ORa=3.03) and education (ORa=1.72).

Conclusion

Nutritional status is associated with cognitive function. Monitoring the status of elderly can help in preventing malnutrition and possibly their cognitive impairment.

In Austria, geriatric psychiatry is referred to as geriatric psychiatry or psychiatry of old age. It is recognized as a subspecialty of psychiatry focusing on the study, prevention, and treatment of mental disorders in humans with old age. The age limits vary between 60 and 65 years. In this review, we report the current status of geriatric psychiatry based on data sources published by government agencies or public health bodies, as well as telephone surveys of respective institutions or specific questionnaires. Overall, in Austria there is only one department for geriatric psychiatry. Several psychogeriatric units are located in Departments of Psychiatry. So far, no board certification has been established for geriatric psychiatry. An education on geriatrics for physicians in internal medicine, neurology, physical medicine and general rehabilitation or psychiatrist also includes courses for geriatric psychiatry. Patients suffering from various types of dementia constitute the largest group of psychogeriatric patients. Patients with dementia, however, are also treated by neurologists or general practitioners. To further promote education, medical trainings or research in the field of geriatric psychiatric, Austria should strive for close European co-operations, especially with countries with a comparable health system.

The increasing age of the population due to improvements in health care in the past century contributes to an increase in the number of people with dementia. However, with an appropriate support and symptomatic treatment, many patients can continue to have an active life and a good quality of life. Treatment and support work best if they are applied at an early stage and also new disease modifying treatments need to focus on predementia and presymptomatic stages of disease.

This article focuses on the role of molecular neuroimaging biomarkers in the reliable clinical diagnosis of dementia at the earliest possible stage of different forms of dementia like Alzheimer's disease, Dementia with Lewy Bodies and frontotemporal lobar degeneration. These different types of dementia are associated with characteristic patterns of hypometabolism in F-18-FDG PET. These reductions occur already years before the onset of symptoms and are strongly correlated with clinical severity.

Recently developed Amyloid-PET-tracers hold promises to be efficient tools in the near future to depict the earliest stages of AD. They may also serve to directly monitor changes of amyloid load due to new treatment approaches.

At the end of life in western medicine often a decision has to be made about treatment options and the therapeutic strategy. The concept of autonomy which forms one of the four ethical principles plays a significant role in the decision-making process. Competing issues can be involved in end-of-life decisions and the patient and his/her relatives are often overwhelmed by the situation. Therefore, a “jointly supported” or “borne autonomy” requires knowlegde and open discussion with the physician who is able to provide a clear and concise treatment suggestion which the patient and his/her relatives (“unit of care”) are truly able to follow. Decision making is a step-wise process which ends in a concerted action focusing further procedures based on the “jointly supported” or “borne autonomy”. This kind of autonomy stands against uncertainty and provides end-of-life decisions which enable autonomy and quality of life for the patient and his/her relatives.

Demographic developments contribute to an increasing proportion of elderly and age-associated diseases in industrialized countries worldwide. Dementia is one of the most prevalent in these. Dementia will cause growing support needs for the elderly and thus becomes a stability factor for the care system. Especially industrialized countries like North America, the EU or Asia need to prepare for this and develop strategies for their health care systems.

In Germany, there have been interventions into the care systems developed and implemented. This manuscript describes a selection of these. Firstly, we describe the AGNES study as an example of a successful translation from scientific evaluation into routine care. The AGNES study has shown positive results upon the delegation of medical tasks to specifically trained nurses and the model was introduced into the regular health care system on the federal level in Germany. Secondly we describe the DelpHi concept as dementia specific concept and study currently under evaluation. This study will yield results, how to deliver optimum care to persons with dementia and their caregivers in an efficient and effective way. And thirdly, we describe the IDemUck concept which shows measurable advantages on the management of dementia patients in an interdisciplinary network with respect to the provision of dementia-specific medication and the utilization of medical treatment.

On a policy level, the WHO stated co-ordination and care management as a clear goal in their dementia planning model. The international concepts are similar but the heterogeneity of integrated care models makes comparisons and translation into different contexts difficult. There is a further need to clearly describe aims and goals of concepts, describe the means to achieve these and prove their efficacy and efficiency. For an integration in routine care there is a need to adapt these concepts nationally and even regionally.

Demographic and epidemiological studies predict an increasing number of people with Alzheimer's disease and dementia worldwide. Early diagnosis and intervention will help to attenuate the course of disease and lower its burden on patients, care-givers and the health care systems. Going even beyond early clinical diagnosis, new diagnostic research criteria define preclinical and predementia stages of Alzheimer's disease based on imaging and neurochemical biomarkers. Studying Alzheimer's disease in its preclinical stages gives researchers the chance to explore how brain function and structure mediates the effect of amyloid and other molecular lesions on cognitive performance and how this interaction is modulated by genetic and environmental risk and protective factors. This will have three major implications: (i) to design novel intervention studies that aim to strengthen protective factors and cognitive reserve, (ii) to provide an in vivo test system for the mode of action of potentially protective interventions, and (iii) to serve as a secondary endpoint for the effectiveness of interventions. This review summarizes key findings of the best established imaging markers of Alzheimer's disease, including markers of amyloid, metabolic and synaptic function, structural connectivity and brain atrophy. It outlines the present and future role of multimodal imaging in defining a preclinical stage of Alzheimer's disease and in the identification and evaluation of factors of risk and resilience of Alzheimer's disease.

Social integration plays a key role in the maintenance of quality of life and health status of people with dementia and their care-givers. Here, we outline a general concept for cognitive assistance and argue for the specific importance of technical support for outdoor mobility to preserve opportunities for social contacts and activities. Based on commercially available devices and systems described in the literature, we provide a conceptual framework for mobility assistance which integrates both technical features and user requirements. The technical development of assistive systems so far was mainly concentrated on static user models. In order to account for the progressive nature of dementia due to Alzheimer's disease, more dynamic approaches need to be pursued to enable optimal assistive effects.

The paper discusses anthropological questions that are raised by the phenomenon of dementia. Do persons with dementia still have the ability for autonomous decisions? Is there a will of a demented person? The paper argues that this relies on how we understand the concept of the self of a person. While the traditional concept of autonomy relies on the idea of an a-material self, the author argues by reference to Biblical traditions and to the philosophical tradition of phenomenology for the concept of an embodied self. Body, mind and soul are different aspects of the embodied existence of human beings. Autonomy then is not only a cognitive function, but is also bodily enacted—even by persons with dementia.