Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society最新文献

Background: Antipsychotic prescribing in United States nursing homes (NHs) has decreased since the Center for Medicare & Medicaid Service debuted the National Partnership to Improve Dementia Care in Nursing Homes (NP); however, reductions have stalled. To help explain persistent antipsychotic use despite the NP's reduction efforts, the perspectives of diverse NP stakeholders were qualitatively assessed. This study aimed to re-evaluate these individual perspectives in combined thematic synthesis to discover NP improvement opportunities undetectable in single stakeholder assessments.

Methods: Thematic synthesis. Through immersive crystallisation, original source coding results were organised into related descriptive themes. Similarities and differences were identified, and descriptive themes were regrouped into new, increasingly abstract, analytical themes. This cycle continued until variances were resolved and analytic themes sufficiently described and explained all initial descriptive themes.

Results: Three analytic themes emerged regarding NP improvement opportunities. The NP's positive impacts would be augmented by: (i) a deeper and expanded appreciation of stakeholder perspectives; (ii) more urgent and rapid adaptation to unintended adverse outcomes; and (iii) greater recognition of the contextual and environmental factors influencing decisions to prescribe or not prescribe antipsychotic medications. Stakeholder groups described: perspectives they perceived as inadequately considered by the NP; insufficient NP engagement with the stakeholders capable of creating evidenced, affordable, and available non-pharmacologic therapies for dementia symptoms; recognition that dementia interventions effective for a specific individual at a specific time in a specific community may not generalise; and diverse ongoing undesirable outcomes from NP policies that could be mitigated by NP modifications.

Conclusions: The NP has done much to advance dementia care in NHs. Notwithstanding, these results suggest the NP would only be improved through increasingly comprehensive inclusion of stakeholder perspectives, enhanced incorporation of individual contextual factors, and a more decisive mechanism for ongoing and continual adaptation.

Background: Older adults with major depression are at risk of frailty and long-term care needs. Consequently, screening for major depression is imperative to prevent such risks. In Japan, the Late-Stage Elderly Questionnaire was developed to evaluate older adults' holistic health, including mental well-being. It comprises one specific question to gauge life satisfaction, but the effectiveness of this question to screen for major depression remains unclear. Therefore, we aimed to assess the usability of this question to screen for major depression.

Methods: This retrospective cohort study used a large, commercially available claims database in Japan. Participants were older adults aged ≥75 years who completed the Late-Stage Elderly Questionnaire and were classified with and without new major depression within 1 year. We evaluated the questionnaire's ability to screen for major depression using C-statistics, developing three models to assess the cut-off value based on responses to the life satisfaction question ('Satisfied', 'Somewhat satisfied', 'Somewhat unsatisfied', or 'Unsatisfied'), estimating the sensitivity and specificity of each model.

Results: Among 11 117 older adults, 77 newly experienced major depression within 1 year. The C-statistic for screening major depression was 0.587. The model setting the cut-off between 'Somewhat unsatisfied' and 'Unsatisfied' the demonstrated lowest sensitivity and highest specificity, while the model setting the cut-off between 'Satisfied' and 'Somewhat satisfied' demonstrated highest sensitivity and lowest specificity.

Conclusions: Our results suggest that due to its poor screening ability and high rate of false negatives, the question assessing life satisfaction in the Late-Stage Elderly Questionnaire may not be useful for screening major depression in older adults and may require modification.

Background: It is reported that reduced physical activity and malnutrition may trigger pneumonia, and the utilisation of the geriatric nutritional risk index (GNRI) upon admission to long-term nursing care can enable the implementation of accurate and timely rehabilitation and nutritional support, which may, in turn, minimise pneumonia incidence. However, to date, there is no reported association between GNRI and pneumonia among stable schizophrenic patients.

Methods: This is a retrospective investigation. We enrolled 434 hospitalised subjects aged ≥50 years, who were diagnosed with stable schizophrenia between January 2017 and June 2022. Baseline nutritional status information during the stable stage of schizophrenia was evaluated using body mass index, serum albumin, and GNRI. In addition, pneumonia-based information, including diagnosis and treatment, was retrospectively obtained within 1 year. To examine the potential association between nutrition indicators and pneumonia risk among stable schizophrenia patients, we employed a logistic regression analysis.

Results: The pneumonia incidence among all stable schizophrenia patients was 10.14%, and there were no statistically significant difference between sexes (male vs. female, 10.63% vs. 9.44%, P = 0.687). Based on the univariate analysis of nutrition indicators and pneumonia, female patients exhibited a strong correlation between serum albumin and pneumonia (P = 0.022). Furthermore, we adjusted for potential influencing factors of pneumonia infection, and confirmed that only serum albumin was linked to pneumonia risk in female stable schizophrenia patients (odds ratio = 0.854, 95% CI: 0.749-0.975, P = 0.02).

Conclusions: Based on our analysis, serum albumin was strongly correlated with pneumonia risk in female stable schizophrenia patients.

Background: Understanding the development of cognitive impairment and its influencing factors in older adults is crucial for formulating early intervention strategies.

Purpose: To identify the early dimensions of cognitive impairment and provide a comprehensive description of the trajectories of cognitive decline in older adults prior to death.

Methods: Based on the data of 9883 older adults in the Chinese Longitudinal Healthy Longevity Survey from 2002 to 2018, a longitudinal item response theory (Longitudinal IRT) model including covariates was applied to estimate the following parameters. The items in which older adults encountered obstacles first had the least difficulty parameters (δ). The earlier the information curve of an item is lifted, the more information it provides in the early stages of cognitive impairment. Regression coefficient (β) represents the relative rate of cognitive decline. The cognitive impairment values estimated from the Longitudinal IRT were fitted to a mixed-effects model to examine cognitive impairment trajectories.

Results: 'Draw the figure on B Card' (δ = -0.816) was the most challenging item, followed by 'recalling 'clothes" (δ = 0.348) and 'recalling 'apples" (δ = 0.419), while 'name the 'pen" (δ = 4.402) was the simplest instruction for the old adults. The curves of the items in the recall dimension began to rise in the early stages of cognitive impairment. Cognitive impairment of older adults who were women (β = 0.061), elder (β = 0.111), smokers (β = 0.060), living in rural areas (β = 0.052), not participating in organised social activities (β = 0.092), suffering from hypertension (β = 0.022), hyperglycaemia (β = 0.035), dyslipidaemia (β = 0.314), low education levels (β = 0.128), manual labourers (β = 0.027), and eventual development of dementia (β = 0.212) exhibited a more accelerated progression. These individuals also had poorer cognitive trajectories.

Conclusion: Recall is the earliest dimension of cognitive impairment. The subjects who were women, elder, smokers, living in rural areas, not participating in organised social activities, suffering from hypertension, hyperglycaemia, dyslipidaemia, low education, manual labourers, and eventually development of dementia, had a faster descending speed and poorer trajectories.

Background: The present study aimed to investigate the relation between lifelong exposure to traumatic life events, social support, and health-related quality of life (QOL) in a sample of older people.

Method: A sample of 172 participants (mean age = 68.81, SD = 7.15; 68.6% female and 31.4% male) was involved in this study. The participants completed scales measuring lifelong exposure to traumatic events, social support, and health-related QOL.

Results: The results showed that lifelong exposure to traumatic events was negatively related to physical and mental health-related QOL. Moreover, social support moderated the relation between traumatic life events exposure and mental health-related QOL.

Discussion: Geriatric services could identify and implement adequate measures to provide social support and to improve different dimensions of QOL among older adults.

Background: Evidence suggests that reminiscence therapy can effectively reduce cognitive and psychological symptoms. This study was conducted to examine the effect of individual reminiscence therapy on cognitive level, quality of life and depressive symptoms in older adults with type 2 diabetes.

Methods: This study is an experimental type, randomised controlled study designed in pre-test - post-test design. The sample size of the study consisted of 58 older adults with type 2 diabetes, consisting of 29 intervention and 29 control subjects. The older adults in the intervention group were individually subjected to 5 weeks of reminiscence therapy in two sessions (each session 40-45 min) per week. No intervention was applied to the control group. Personal Information Form, Standardised Mini Mental Test, SF-36 Quality of Life and Beck Depression Inventory were used to collect the data.

Results: While there was no significant difference between the pre-test Mini Mental Test, Beck Depression Inventory total score and SF-36 Quality of Life Scale mental and physical health sub-dimension mean scores of the older adults in the intervention group and the mean scores of those in the control group (P > 0.05), the difference between the Mini Mental Test, Beck Depression Inventory total score and SF-36 Quality of Life Scale mental and physical health sub-dimension mean scores of the older adults in the intervention and control groups in the post-test was found to be statistically significant (P < 0.05). The post-test Mini Mental Test total score, SF-36 Quality of Life Scale mental and physical health sub-dimension mean scores of the older adults in the intervention group were higher than the older adults in the control group. It was determined that the post-test Beck Depression Inventory total mean scores of the older adults in the intervention group were lower than the older adults in the control group.

Conclusion: Reminiscence therapy can positively affect cognitive levels, quality of life and depression symptoms of older adults living in the community. Individual reminiscence therapy can be used as a nursing intervention in primary healthcare.

Background: Dementia is a worldwide public health concern. Implementing lifestyle changes that target modifiable risk factors is crucial for reducing the risk of dementia. The aim of this study was to investigate the effect of having family members with dementia on individuals' health beliefs and tendencies towards adopting healthier lifestyles and behaviours.

Methods: A cross-sectional, comparative study was conducted with 338 people aged 40 years and older, of whom 168 have the experience of having family members with dementia, and 170 have no such experience. Data were collected using a characteristics form, the Motivation to Change Lifestyle and Health Behaviours for Dementia Risk Reduction scale, and the modified Charlson comorbidity index. Descriptive statistics, Pearson's chi-square and independent t-tests, were used.

Results: Those with family members with dementia were more likely to have greater motivation to modify their lifestyle (perceived susceptibility, severity, benefits, and cues to action) to reduce their risk of developing dementia. Additionally, they had greater perceived barriers to gain by adopting a healthy lifestyle, in contrast to those without such family members.

Conclusion: The presence of family members with dementia could be an important factor to consider when designing initiatives targeting health beliefs related to dementia prevention behaviours and lifestyle changes.

Research criteria for the diagnosis of prodromal dementia with Lewy bodies (DLB) include three clinical subtypes: mild cognitive impairment with Lewy bodies (MCI-LB), delirium-onset prodromal DLB, and psychiatric-onset prodromal DLB. Late-onset psychiatric manifestations are at a higher risk of developing dementia, but its relation to prodromal DLB remains unclear. In addition to the risk of severe antipsychotic hypersensitivity reactions, accurate discrimination from non-DLB cases is important due to the potential differences in management and prognosis. This article aims to review a rapidly evolving psychiatric topic and outline clinical pictures of psychiatric-onset prodromal DLB, including the proposed biomarker findings of MCI-LB: polysomnography-confirmed rapid eye movement sleep behaviour disorder, cardiac [¹²³I]metaiodobenzylguanidine scintigraphy, and striatal dopamine transporter imaging. We first reviewed clinical pictures of patients with autopsy-confirmed DLB. Regarding clinical reports, we focused on the patients who predominantly presented with psychiatric manifestations and subsequently developed DLB. Thereafter, we reviewed clinical studies regarding the diagnostic applications of the proposed biomarkers to patients with late-onset psychiatric disorders. Clinical presentations were mainly late-onset depression and psychosis; however, other clinical manifestations were also reported. Psychotropic medications before a DLB diagnosis may cause extrapyramidal signs, and potentially influences the proposed biomarker findings. These risks complicate clinical manifestation interpretation during the management of psychiatric symptoms. Longitudinal follow-up studies with standardised evaluations until conversion to DLB are needed to investigate the temporal trajectories of core features and proposed biomarker findings. In patients with late-onset psychiatric disorders, identification of patients with psychiatric-onset prodromal DLB provides the opportunity to better understanding the distinct prognostic subgroup that is at great risk of incident dementia. Advances in the establishment of direct biomarkers for the detection of pathological α-synuclein may encourage reorganising the phenotypic variability of prodromal DLB.