JOURNAL OF TEXTURE STUDIES, Issue 3 2005
STEFANIE KREMER
ABSTRACT The perception of texture and flavor and their interaction effects in white cream soups were studied in 12 young subjects (18,29 years) and 15 elderly subjects (60,84 years). Eight soup samples (2 × 2 × 2 factorial design) were prepared with or without potato starch, with or without mushroom flavor and with water or with milk. The elderly were less sensitive to changes in the flavor profile of the soups than the young, and their perception of creaminess was reduced. Solvent by flavor interaction effects were independent of age, whereas texture by flavor interaction effects were age specific. Besides the intensities of flavor and texture attributes, pleasantness was also assessed. No indication was found that the contribution of texture and flavor to food appreciation was different for the young and for the elderly in the current study. This study supports the assumption that age-related differences in product perception exist. [source]

PREVALENCE AND RISK FACTORS IN CHRONIC POLYNEUROPATHY IN THE ELDERLY

JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 1 2002
E. Scarpini
The elderly are a population at high risk of polyneuropathy because there is a correlation between age and impairment of the peripheral nervous system and because the number of agents that can damage peripheral nerves, including chronic systemic disorders and neurotoxic drugs, increases with age. The Italian Longitudinal Study on Aging (ILSA), a multicenter project designed to study age-associated diseases, collected data from 8 Italian municipalities. For this study, the definition of peripheral neuropathy by P.J. Dyck (1982) was used. However, only peripheral neuropathies with distal and symmetrical involvement of lower limbs were considered. Diagnosis was articulated in two phases: Phase 1 or screening, administered to all participants. The criteria were: a) self reported diagnosis; b) presence of at least one neurological symptom; and c) presence of at least one positive test at short neurological evaluation. A validation of the screening instruments was performed. Phase 2 or clinical confirmation by a neurologist, based on: a) review of the clinical records; b) a neurological examination; c) a clinical history of the disease; and, d) when available, EMG, blood and spinal fluid examination, and a sural nerve biopsy. Three diagnostic categories were identified: possible, probable and definite DSNLL. The neuropathy was classified as definite only when confirmation by a positive EMG was available. A random sample of 5632 subjects aged 65,84 years was evaluated. A total number of 337 DSNLL were identified (possible, probable, defined). The prevalence is 6.5% (95% C.I. 5.8,7.2) in men and women; the rates by age, geographic area, and clinical severity are described, and the prevalence in the different groups of diabetic patients and non-diabetic subjects is analyzed. The prevalence obtained in our study is slightly lower than that in a similar recent multicentric study (IGPSG, 1995), but the diagnostic criteria were different. Diabetes is the most common associated disorder with the 20.8% of association, followed by toxic/drug exposure (5% of association). [source]

ASSOCIATIONS BETWEEN AIR POLLUTION AND HOSPITAL VISITS FOR CARDIOVASCULAR DISEASES IN THE ELDERLY IN SYDNEY USING BAYESIAN STATISTICAL METHODS

AUSTRALIAN & NEW ZEALAND JOURNAL OF STATISTICS, Issue 3 2009
Hiep Duc
Summary Using generalized linear models (GLMs), Jalaludin,et al. (2006;,J. Exposure Analysis and Epidemiology,16, 225,237) studied the association between the daily number of visits to emergency departments for cardiovascular disease by the elderly (65+) and five measures of ambient air pollution. Bayesian methods provide an alternative approach to classical time series modelling and are starting to be more widely used. This paper considers Bayesian methods using the dataset used by Jalaludin,et al.,(2006), and compares the results from Bayesian methods with those obtained by Jalaludin,et al.,(2006) using GLM methods. [source]

Brain Natriuretic Peptide and Diastolic Dysfunction in the Elderly: Influence of Gender

CONGESTIVE HEART FAILURE, Issue 2 2005
Chanwit Roongsritong MD
Diastolic heart failure is common in the elderly, particularly women. Previous studies on the value of brain natriuretic peptide in diastolic dysfunction have been largely limited to male subjects. The authors found that female gender, in addition to diastolic function, is an independent predictor of brain natriuretic peptide levels in the elderly without systolic ventricular dysfunction. The authors' data indicate that an optimal threshold of brain natriuretic peptide for detecting diastolic dysfunction should be qender-specific. [source]

Heart Failure in the Elderly

CONGESTIVE HEART FAILURE, Issue 6 2003
Susan M. Nelson LPN
No abstract is available for this article. [source]

Can Latin America Protect the Elderly with Non-Contributory Programmes?

DEVELOPMENT POLICY REVIEW, Issue 6 2005
The Case of Uruguay
Coverage of contributory pension programmes has been quite disappointing in Latin America in the aftermath of the reforms. The question thus arises as to whether non-contributory programmes could fill the gap. Uruguay is atypical in this region in that the proportion of the elderly receiving contributory pensions is high, and the incidence of poverty among the aged population is lower than among any other age group. But several observers fear that this situation could deteriorate in the future, because the conditions for accessing the pensions have been significantly tightened in the past decade. This article assesses several options for reforming the existing non-contributory pension programme, and estimates their fiscal cost. [source]

Glycaemia and insulinaemia in elderly European subjects (70,75 years)

DIABETIC MEDICINE, Issue 2 2001
A. U. Teuscher
SUMMARY Aims To determine glycaemia and insulinaemia in elderly subjects aged 70,75 years, living across Europe, who participated in the EURONUT-SENECA (Survey in Europe on Nutrition and the Elderly, a Concerted Action) study. Methods Fasting plasma glucose (FPG) and fasting insulin concentrations were measured in 1830 subjects aged 70,75 years living in 15 traditional towns in 11 European countries. For the diagnosis of diabetes, the recommendations of the 1997 report of the American Diabetes Association ,Expert Committee on the diagnosis and classification of diabetes mellitus' were used. Results A total of 31.6% of the study subjects had either diabetes (17.5%) or impaired fasting plasma glucose (FPG) (14.1%). Fifty-one per cent of the subjects with diabetes were unaware of the disease. No difference in diabetes prevalence was found for sex, but male subjects were more likely to have impaired FPG than female subjects (16.8 vs. 11.5%, P = 0.001). Hyperinsulinaemia (fasting insulin levels in the highest quartile) was associated with increased FPG, body mass index, and waist-to-hip ratio. Conclusions It was found that a substantial number of elderly Europeans have impaired glucose homeostasis, with diabetes and impaired FPG being present in almost a third of European subjects aged 70,75 years. [source]

Renal Artery Fibromuscular Dysplasia Is a Cause of Refractory Hypertension in the Elderly

ECHOCARDIOGRAPHY, Issue 1 2009
Raed Aqel M.D.
Fibromuscular dysplasia (FMD) is predominantly a disease of younger women, but it can occur and cause refractory hypertension in the elderly. We present here classic angiographic and intravascular ultrasound images of FMD in a 70-year-old woman with refractory hypertension. Renal artery FMD should be included in the differential diagnosis of refractory hypertension even in older patients since recognizing and treating this condition will add favorably to the outcome of these patients. [source]

Seizure Semiology in the Elderly: A Video Analysis

EPILEPSIA, Issue 3 2004
Christoph Kellinghaus
Summary: Purpose: To describe the seizure semiology of patients older than 60 years and to compare it with that of a control group of younger adults matched according to the epilepsy diagnosis. Methods: Available videotapes of all patients aged 60 years and older who underwent long-term video-EEG evaluation at the Cleveland Clinic Foundation (CCF) between January 1994 and March 2002 were analyzed by two observers blinded to the clinical data. A younger adult control group was matched according to the epilepsy diagnosis, and their seizures also were analyzed. Results: Fifty-four (3.3%) of the 1,633 patients were 60 years or older at the time of admission. For 21 of them, at least one epileptic seizure was recorded. Nineteen patients had focal epilepsy (nine temporal lobe, two frontal lobe, two parietal lobe, eight nonlocalized), and two patients had generalized epilepsy. Seventy-three seizures of the elderly patients and 85 seizures of the 21 control patients were analyzed. In nine elderly patients and 14 control patients, at least one of their seizures started with an aura. Eleven elderly patients and 19 control patients lost responsiveness during their seizures. Approximately two thirds of the patients in both groups had automatisms during the seizures. Both focal and generalized motor seizures (e.g., clonic or tonic seizures) were seen less frequently in the elderly. Conclusions: Only a small percentage of the patients admitted to a tertiary epilepsy referral center for long-term video-EEG monitoring are older than 60 years. All seizure types observed in the elderly also were seen in the younger control group, and vice versa. Simple motor seizures were seen less frequently in the elderly. [source]

Social Networks and the Elderly: Conceptual and Clinical Issues, and a Family Consultation

FAMILY PROCESS, Issue 3 2000
Carlos E. Sluzki M.D.
After a general introduction to the construct "social networks," this article discusses the progressive transformation of the personal social network,family, friends and acquaintances, work and leisure relationships, et cetera,as individuals reach an advanced age. This is followed by a summary and discussion of a clinical consultation, with an emphasis on the reciprocal influence between individual and social network. [source]

Save the Young,the Elderly Have Lived Their Lives: Ageism in Marriage and Family Therapy,

FAMILY PROCESS, Issue 2 2000
David C. Ivey Ph.D.
The paucity of literature addressing mental health issues concerning geriatric populations represents the perpetuation of ageist practices and beliefs in the field of marriage and family therapy. The purpose of this study was to assess whether client age and clinical training relate to the evaluation of couples who present for conjoint therapy. Written vignettes describing two couples, one older and one younger, who report issues involving the absence of sexual intimacy, increased frequency of arguments, and increased use of alcohol were evaluated by practicing marriage and family therapists, therapists-in-training, and individuals with no clinical background. It was hypothesized that respondents' views would vary in connection with the age of the couple and with the three levels of participant training. Results indicate that client age and participant training are associated with perceptions of individual and couple functioning. Our findings suggest that the relational and mental health concerns experienced by elder couples are not perceived as seriously as are identical concerns experienced by younger couples. Contrary to our expectations the observed differences between views of the two age conditions did not significantly differ between levels of participant training. Training and experience in marriage and family therapy may not significantly mitigate vulnerability to age-discrepant views. [source]

Validity and reliability of the Physical Activity Scale for the Elderly (PASE) in Japanese elderly people

GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2008
Akiko Hagiwara
Aim: In Japan, there are no valid and reliable physical activity questionnaires for elderly people. In this study, we translated the Physical Activity Scale for the Elderly (PASE) into Japanese and assessed its validity and reliability. Methods: Three hundred and twenty-five healthy and elderly subjects over 65 years were enrolled. Concurrent validity was evaluated by Spearman's rank correlation coefficient between PASE scores and an accelerometer (waking steps and energy expenditure), a physical activity questionnaire for adults in general (the Japan Arteriosclerosis Longitudinal Study Physical Activity Questionnaire, JALSPAQ), grip strength, mid-thigh muscle area per bodyweight, static valance and bodyfat percentage. Reliability was evaluated by the test,retest method over a period of 3,4 weeks. Results: The mean PASE score in this study was 114.9. The PASE score was significantly correlated with walking steps (, = 0.17, P = 0.014), energy expenditure (, = 0.16, P = 0.024), activity measured with the JALSPAQ (, = 0.48, P < 0.001), mid-thigh muscle area per bodyweight (, = 0.15, P = 0.006) and static balance (, = 0.19, P = 0.001). The proportion of consistency in the response between the first and second surveys was adequately high. The intraclass correlation coefficient for the PASE score was 0.65. Conclusions: The Japanese version of PASE was shown to have acceptable validity and reliability. The PASE is useful to measure the physical activity of elderly people in Japan. [source]

Automobile Reliance Among the Elderly: Race and Spatial Context Effects

GROWTH AND CHANGE, Issue 2 2003
Brigitte Waldorf
To meet their mobility needs, the elderly assign pivotal importance to the automobile despite the potential challenge of driving cessation and searching for alternatives to automobile transportation. Older persons' generally strong reliance on the automobile varies, however, by land use patterns (density) as well as by demographic and socioeconomic characteristics. This paper analyzes the effects of spatial context and personal attributes on automobile reliance among the elderly. Using the 1995 Nationwide Personal Transportation Survey (NPTS) trip data, two models of automobile reliance among elderly (65+) trip makers are estimated. The results show that spatial context effects of automobile reliance vary by demographic characteristics; in particular, they are more pronounced for black than for white elderly. Moreover, race variation in automobile reliance is strongest in urban locations rather than less dense spatial contexts. Finally, the differentiation between being a passenger rather than a driver is salient in order to understand locational and racial variations in automobile reliance among the elderly. [source]

Effect of Prescription Drug Coverage on Health of the Elderly

HEALTH SERVICES RESEARCH, Issue 5p1 2008
Nasreen Khan
Objective. To estimate the effect of prescription drug insurance on health, as measured by self-reported poor health status, functional disability, and hospitalization among the elderly. Data. Analyses are based on a nationally representative sample of noninstitutionalized elderly (,65 years of age) from the Medicare Current Beneficiary Survey (MCBS) for years 1992,2000. Study Design. Estimates are obtained using multivariable regression models that control for observed characteristics and unmeasured person-specific effects (i.e., fixed effects). Principal Findings. In general, prescription drug insurance was not associated with significant changes in self-reported health, functional disability, and hospitalization. The lone exception was for prescription drug coverage obtained through a Medicare HMO. In this case, prescription drug insurance decreased functional disability slightly. Among those elderly with chronic illness and older (71 years or more) elderly, prescription drug insurance was associated with slightly improved functional disability. Conclusions. Findings suggest that prescription drug coverage had little effect on health or hospitalization for the general population of elderly, but may have some health benefits for chronically ill or older elderly. [source]

Meeting the Need for Personal Care among the Elderly: Does Medicaid Home Care Spending Matter?

HEALTH SERVICES RESEARCH, Issue 1p2 2008
Peter Kemper
Objective. To determine whether Medicaid home care spending reduces the proportion of the disabled elderly population who do not get help with personal care. Data Sources. Data on Medicaid home care spending per poor elderly person in each state is merged with data from the Medicare Current Beneficiary Survey for 1992, 1996, and 2000. The sample (n=6,067) includes elderly persons living in the community who have at least one limitation in activities of daily living (ADLs). Study Design. Using a repeated cross-section analysis, the probability of not getting help with an ADL is estimated as a function of Medicaid home care spending, individual income, interactions between income and spending, and a set of individual characteristics. Because Medicaid home care spending is targeted at the low-income population, it is not expected to affect the population with higher incomes. We exploit this difference by using higher-income groups as comparison groups to assess whether unobserved state characteristics bias the estimates. Principal Findings. Among the low-income disabled elderly, the probability of not receiving help with an ADL limitation is about 10 percentage points lower in states in the top quartile of per capita Medicaid home care spending than in other states. No such association is observed in higher-income groups. These results are robust to a set of sensitivity analyses of the methods. Conclusion. These findings should reassure state and federal policymakers considering expanding Medicaid home care programs that they do deliver services to low-income people with long-term care needs and reduce the percent of those who are not getting help. [source]

Comparing United States versus International Medical School Graduate Physicians Who Serve African- American and White Elderly

HEALTH SERVICES RESEARCH, Issue 6 2006
Daniel L. Howard
Objective. To examine the relationship that international medical school graduates (IMGs) in comparison with United States medical school graduates (USMGs) have on health care-seeking behavior and satisfaction with medical care among African-American and white elderly. Data Sources. Secondary data analysis of the 1986,1998 Piedmont Health Survey of the Elderly, Established Populations for the Epidemiological Study of the Elderly, a racially oversampled urban and rural cohort of elders in five North Carolina counties. Study Design. Primary focus of analyses examined the impact of the combination of elder race and physician graduate status across time using a linear model for repeated measures analyses and ,2 tests. Separate analyses using generalized estimating equations were conducted for each measure of elder characteristic and health behavior. The analytic cohort included 341 physicians and 3,250 elders (65 years old and older) in 1986; by 1998, 211 physicians and 1,222 elders. Data Collection/Extraction Methods. Trained personnel collected baseline measures on 4,162 elders (about 80 percent responses) through 90-minute in-home interviews. Principal Findings. Over time, IMGs treated more African-American elders, and those who had less education, lower incomes, less insurance, were in poorer health, and who lived in rural areas. White elders with IMGs delayed care more than those with USMGs. Both races indicated being unsure about where to go for medical care. White elders with IMGs were less satisfied than those with USMGs. Both races had perceptions of IMGs that relate to issues of communication, cultural competency, ageism, and unnecessary expenses. Conclusion. IMGs do provide necessary and needed access to medical care for underserved African Americans and rural populations. However, it is unclear whether concerns regarding cultural competency, communication and the quality of care undermine the contribution IMGs make to these populations. [source]

Access to Health Care Services for the Disabled Elderly

HEALTH SERVICES RESEARCH, Issue 3p1 2006
Donald H. Taylor Jr.
Objective. To determine whether difficulty walking and the strategies persons use to compensate for this deficit influenced downstream Medicare expenditures. Data Source. Secondary data analysis of Medicare claims data (1999,2000) for age-eligible Medicare beneficiaries (N=4,997) responding to the community portion of the 1999 National Long Term Care Survey (NLTCS). Study Design. Longitudinal cohort study. Walking difficulty and compensatory strategy were measured at the 1999 NLTCS, and used to predict health care use as measured in Medicare claims data from the survey date through year-end 2000. Data Extraction. Respondents to the 1999 community NLTCS with complete information on key explanatory variables (walking difficulty and compensatory strategy) were linked with Medicare claims to define outcome variables (health care use and cost). Principal Findings. Persons who reported it was very difficult to walk had more downstream home health visits (1.1/month, p<.001), but fewer outpatient physician visits (,0.16/month, p<.001) after controlling for overall disease burden. Those using a compensatory strategy for walking also had increased home health visits/month (0.55 for equipment, 1.0 for personal assistance, p<.001 for both) but did not have significantly reduced outpatient visits. Persons reporting difficulty walking had increased downstream Medicare costs ranging from $163 to $222/month (p<.001) depending upon how difficult walking was. Less than half of the persons who used equipment to adapt to walking difficulty had their difficulty fully compensated by the use of equipment. Persons using equipment that fully compensated their difficulty used around $300/month less in Medicare-financed costs compared with those with residual difficulty. Conclusions. Difficulty walking and use of compensatory strategies are correlated with the use of Medicare-financed services. The potential impact on the Medicare program is large, given how common such limitations are among the elderly. [source]

Annual Change of Primary Resistance to Clarithromycin among Helicobacter pylori Isolates from 1996 through 2008 in Japan

HELICOBACTER, Issue 5 2009
Noriyuki Horiki
Abstract Background:, Recent studies have shown that the combination of proton pump inhibitor, amoxicillin and clarithromycin is one of the best choices for Helicobacter pylori eradication therapy. However, increasing number of cases of H. pylori infection showing resistance to clarithromycin therapy has been reported and this is currently the main cause of eradication failure. We investigated the annual changes of the antimicrobial susceptibility to clarithromycin, amoxicillin and minocycline during a period of 12 years in Japan. Methods:, This study comprised 3521 patients (mean age (SD), 55.4 (13.7) years-old, 2467 males and 1054 females) positive for H. pylori as assessed by microaerobic bacterial culture from 1996 through 2008. All patients were previously untreated for H. pylori and were enrolled in the study to assess primary resistance to the three antibiotics. Results:, The overall primary resistance to clarithromycin, amoxicillin and minocycline were 16.4%, (577/3521), 0.03% (1/3521) and 0.06% (2/3521), respectively. From1996 through 2004, the resistance rate to clarithromycin increased gradually to approximately 30% and then it remained without marked fluctuation since 2004. Analysis by gender showed a significant increase (p < .0001) in resistance rate to clarithromycin among females (217/1057, 20.6%) compared to males (360/2467, 14.6%). Analysis by age, disclosed significantly (p < .0001) higher resistance rate to clarithromycin in patients of more than 65-years-old compared to the younger population. Conclusions:, The resistance rate of H. pylori infection to clarithromycin in Japan has increased gradually to approximately 30% from 1996 through 2004, and remained unchanged since 2004. Elderly and females were at high risk of having resistance to clarithromycin. Our results suggested that the level of clarithromycin resistance in Japan has now risen to the point where it should no longer be used as empiric therapy. [source]

The informant questionnaire on cognitive decline in the elderly (IQCODE) is associated with informant stress

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 11 2009
Harald A. Nygaard
Abstract Objective To study the association between informant stress and appraisal of patients' cognitive functioning as reported by the Informant Questionnaire on Cognitive Decline in the Elderly,IQCODE. Methods Routinely collected data from a geriatric outpatient department (207 dyads) during the years 1995,1998 were analysed. Relative stress scale (RSS) has been categorised for possible low, intermediate and high risk of psychiatric morbidity and caregivers were combined to four groups (female and male spouses and female and male non-spouses, respectively). The relationship between IQCODE (dependent) and categorised RSS and informant groups and patient age was further studied by means of the general linear model (GLM,UNIANOVA). Results In general, spouses reported better cognitive functioning than non-spouses. There was a significant association between IQCODE and RSS (p,<,0.001), and the composite variable informant group and informant gender (p,<,0.001). The main effect of the interaction term RSS,×,informant group,+,informant gender was not significant. Post hoc test, however, revealed a significant effect of the interaction term RSS,×,female spouses (p,<,0.001) on IQCODE. Conclusion IQCODE is associated with informant stress. Categorisation of RSS score into groups of low, intermediate and high risk for psychiatric morbidity can be a valuable contribution to a more meaningful application of RSS in general practice. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Prevalence and correlates of alcoholism in community-dwelling elderly living in São Paulo, Brazil

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2009
Edson Shiguemi Hirata
Abstract Objectives To assess the prevalence of alcoholism in elderly living in the city of São Paulo (Brazil) and investigate associated risk factors. Methods A total of 1,563 individuals aged 60 years or older, of both genders of three districts of different socioeconomic classes (high, medium and low) in the city of São Paulo (Brazil) were interviewed. The CAGE screening test for alcoholism was applied and a structured interview was used to assess associated sociodemographic and clinical factors. The tests Mini Mental State Examination, Fuld Object Memory Evaluation, The Informant Questionnaire on Cognitive Decline in the Elderly and Bayer-Activities of Daily Living Scale were used for cognitive and functional assessment. Results Prevalence of alcoholism was 9.1%. Multivariate regression analysis showed that alcoholism was associated with male gender, ,mulatto' ethnicity, smoking, and cognitive and functional impairment. In addition, the younger the individual and the lower the schooling level, the higher the risk for alcoholism. Conclusions The results obtained in this study show that alcoholism is highly frequent in the community-dwelling elderly living in São Paulo, and that it is associated with socio-demographic and clinical risk factors similar to those reported in the literature. This suggests that alcoholism in the elderly of a developing country shares the same basic characteristics seen in developed countries. These findings suggest that it is essential for health services and professional to be prepared to meet this demand that will significantly grow in the next years, especially in developing countries, where the rates of population aging are higher than those of developed countries. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Integrated specialty mental health care among older minorities improves access but not outcomes: results of the PRISMe study

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2008
Patricia A. Areán
Abstract Objective In this secondary data analysis of Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRIMSe) study, we hypothesized that older minorities who receive mental health services integrated in primary care settings would have greater service use and better mental health outcomes than older minorities referred to community services. Method We identified 2,022 (48% minorities) primary care patients 65 years and older, who met study inclusion criteria and had either alcohol misuse, depression, and/or anxiety. They were randomized to receive treatment for these disorders in the primary care clinic or to a brokerage case management model that linked patients to community-based services. Service use and clinical outcomes were collected at baseline, three months and six months post randomization on all participants. Results Access to and participation in mental health /substance abuse services was greater in the integrated model than in referral; there were no treatment by ethnicity effects. There were no treatment effects for any of the clinical outcomes; Whites and older minorities in both integrated and referral groups failed to show clinically significant improvement in symptoms and physical functioning at 6 months. Conclusions While providing services in primary care results in better access to and use of these services, accessing these services is not enough for assuring adequate clinical outcomes. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Comparison of the diagnostic accuracy of the Cognitive Performance Scale (Minimum Data Set) and the Mini-Mental State Exam for the detection of cognitive impairment in nursing home residents

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2007
Louis Paquay
Abstract Objective To compare the diagnostic accuracy of an outcome measurement scale of the Minimum Data Set of the Resident Assessment Instrument for nursing homes (MDS/RAI-NH), the Cognitive Performance Scale (CPS) and the Mini-Mental State Exam (MMSE) for the detection of cognitive impairment. The Cambridge Examination for Mental Disorders of the Elderly , Revised (CAMDEX-R) was used as the reference standard. Study design and setting This study was part of a larger prospective study (QUALIDEM) involving a diagnostic procedure and two-year follow-up on the quality of primary care for demented patients. CAMDEX-R and MDS/RAI-NH were administered to 198 residents, aged 65 or more, living in 42 low and high care institutions for aged people. Main outcome measures Indicators of diagnostic accuracy: sensitivity, specificity, predictive values, likelihood ratios, odds ratio and area under receiver operating characteristics curve (AUC). Results The CAMDEX-based prevalence of cognitive impairment was 75%. The diagnostic values of a CPS score of two or more for the detection of cognitive impairment were: sensitivity,=,0.81; specificity,=,0.80; PPV,=,0.92; NPV,=,0.57. The diagnostic values of a MMSE score of less than or equal 23 were: sensitivity,=,0.97; specificity,=,0.59; PPV,=,0.88; NPV,=,0.85. For CPS, the area under the receiver operating characteristic (ROC) curve was 0.87 (95% CI, 0.81,0.91), and not significantly different (p,=,0.63) from the MMSE score, 0.88 (0.83,0.93). Conclusions CPS and MMSE demonstrated similar performance to detect cognitive impairment in nursing home residents. Copyright © 2006 John Wiley & Sons, Ltd. [source]

The needs of older people with dementia in residential care

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 1 2006
Geraldine A. Hancock
Abstract Background People with dementia often move into care homes as their needs become too complex or expensive for them to remain in their own homes. Little is known about how well their needs are met within care homes. Method The aim of this study was to identify the unmet needs of people with dementia in care and the characteristics associated with high levels of needs. Two hundred and thirty-eight people with dementia were recruited from residential care homes nationally. Needs were identified using the Camberwell Assessment of Needs for the Elderly (CANE). Results Residents with dementia had a mean of 4.4 (SD 2.6) unmet and 12.1 (SD 2.6) met needs. Environmental and physical health needs were usually met. However, sensory or physical disability (including mobility problems and incontinence) needs, mental health needs, and social needs, such as company and daytime activities, were often unmet. Unmet needs were associated with psychological problems, such as anxiety and depression, but not with severity of dementia or level of dependency. Conclusion Mental health services and residential home staff need to be aware that many needs remain unmet and much can be done to improve the quality of life of the residents with dementia. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Personal characteristics and depression-related attitudes of older adults and participation in stages of implementation of a multi-site effectiveness trial (PRISM-E)

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2005
Marsha N. Wittink
Abstract Background No study has assessed attitudes about depression and its treatment and participation at each step of recruitment and implementation of an effectiveness trial. Our purpose was to determine the association between personal characteristics and attitudes of older adults about depression with participation at each step of the Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISM-E) treatment effectiveness trial. Methods Information on personal characteristics and attitudes regarding depression and its treatment were obtained from all potential participants in PRISM-E. Results Persons who reported better social support were more likely to complete a baseline interview, but were less likely to meet with the mental health professional carrying out the intervention. Attitudes about taking medicines were significantly associated with uptake of the intervention, but not with earlier phases of recruitment. Persons were much more likely to have a visit with the mental health professional for treatment of depression if they were willing to take medicine for depression but did not endorse waiting for the depression to get better [odds ratio (OR),=,3.16, 95% confidence interval (CI),=,1.48,6.75], working it out on one's own (OR,=,5.18, 95% CI,=,1.69,15.85), or talking to a minister, priest, or rabbi (OR,=,2.01, 95% CI,=,1.02,3.96). Conclusion Social support and other personal characteristics may be the most appropriate for tailoring recruitment strategies, but later steps in the recruitment and implementation may require more attention to specific attitudes towards antidepressant medications. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Dementia Care Mapping reconsidered: exploring the reliability and validity of the observational tool

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2004
A. Thornton
Abstract Background Dementia Care Mapping (DCM) is a widely used observational method for evaluating the service quality provided to people with dementia. However, there is little evidence concerning its reliability and validity when used by routine care staff for whom it was designed. Method The study evaluated levels of inter-observer agreement; The ability of the five-minute time frame to reflect the ,actual passing of time'; And the nature of the relationship between individual Well/Ill-Being values (WIB) and dependency levels. Data collected using DCM and continuous time sampling (CTS) were compared. The methods were used in parallel where the CTS coder and the DCM mapper(s) observed the same participants. Observations were carried out with 64 people with dementia within a day hospital and a continuing care ward. Inter-observer agreement was calculated across 20 participants. Dependency levels were measured using the Clifton Assessment Procedure for the Elderly (CAPE) (Pattie and Gilleard, 1979). Results Low levels of inter-observer agreement were found where 11 of the 25 Behaviour Category codes and all six Well/Ill-being Codes produced unacceptable kappas (<0.6). The Behaviour coding frame provided a meaningful picture of activities participants engaged in, but significantly underestimated participant levels of inactivity. A strong relationship was demonstrated between participants' WIB score and levels of dependency, thus DCM was unable to measure well-/ill-being as a separate construct from participants' levels of dependency. Conclusions Questions were raised regarding the reliability and validity of DCM as used by routine care staff. Possible reasons for this, and suggestions for amendments are made. Copyright © 2004 John Wiley & Sons, Ltd. [source]

Selective non-response to clinical assessment in the longitudinal study of aging: implications for estimating population levels of cognitive function and dementia

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2002
Kaarin J. Anstey
Abstract Objective To identify the cognitive outcome of interviewed participants who did not progress to partake in clinical assessments in a longitudinal aging study. Design A retrospective study was conducted on participants who were interviewed but who did not complete the clinical assessment (including an extended cognitive assessment) at either Wave 1 or both Wave 1 and Wave 3 of the Australian Longitudinal Study of Ageing. A total of 1947 participants aged 70 and older commenced the study, 246 participants without clinical data at either or both Waves 1 and 3 were identified for the sub-sample followed-up retrospectively. The Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) was administered to informants and medical records were reviewed. Results Participants who did not complete the clinical assessment at Wave 3 reported poorer health and had poorer cognitive function at Wave 1 independent of age and gender. Rates of possible dementia or cognitive decline were higher in the group who did not undertake the clinical assessment compared with both those who did the clinical assessment and with population data. Conclusion Selective non-response to clinical assessment in a longitudinal aging study is associated with higher risk of cognitive decline and probable dementia. Longitudinal aging studies may underestimate rates of dementia and population levels of cognitive decline. Copyright © 2002 John Wiley & Sons, Ltd. [source]

The systematic assessment of depressed elderly primary care patients

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 6 2001
Patrick J. Raue
Abstract Studies of the primary care treatment of depressed elderly patients are constrained by limited time and space and by subject burden. Research assessments must balance these constraints with the need for obtaining clinically meaningful information. Due to the wide-ranging impact of depression, assessments should also focus on suicidality, hopelessness, substance abuse, anxiety, cognitive functioning, medical comorbidity, functional disability, social support, personality, service use and satisfaction with services. This paper describes considerations concerning the assessment selection process for primary care studies, using the PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial) study as an example. Strategies are discussed for ensuring that data are complete, valid and reliable. Copyright © 2001 John Wiley & Sons, Ltd. [source]

The Galicia study of mental health of the Elderly I: general description of methodology

INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 4 2000
Professor R. Mateos
Abstract Reports of epidemiological surveys do not always adequately provide a careful description of the methodology used and the sociocultural context involved. The objective of this paper is to describe the methodology used in a survey whose aim was to study the prevalence of the wide range of psychiatric disorders that were present in a population aged 60 and above who were living at home. The Galicia Community Study of Mental Health of the Elderly was designed in two phases. In the first, a random sample of 3,580 people over 60 years of age, representative of each of the nine public health authority areas, was interviewed at home. The 60-item version of Goldberg's General Health Questionnaire (GHQ) was the screening instrument. In the second phase, all the traced subjects with high GHQ scores (N = 532) and a representative sample (N = 149) of people below the cut-off point, were interviewed at home using the Diagnostic Interview Schedule (DIS-III). This paper analyses the sociodemographic context of Galicia (a natural region in south-western Europe with a population of 2.7 million inhabitants), the sampling method, the sociodemographic makeup of the sample, the fieldwork, and the method for obtaining the estimate of prevalence. Copyright © 2000 Whurr Publishers Ltd. [source]

The Galicia study of mental health of the Elderly II: the use of the Galician DIS

INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 4 2000
Professor R. Mateos
Abstract Reports of epidemiological surveys do not always provide adequate careful descriptions of the methodology used and the sociocultural context involved. Galicia, a natural region in south-west Europe, possesses certain characteristics that differ from those in other communities within the Spanish state. Galician is a Romance language, which is, in fact, closer to Portuguese than it is to Spanish. The population (2.7 million inhabitants) is widely dispersed, with two-thirds of them living in the countryside. More than 18% are older than 65, and the educational level of this elderly population is low. A total of 681 persons over 60 years of age were interviewed in their homes using the DIS-III as the main diagnostic instrument during the second phase of the Galicia Study of Mental Health of the Elderly. This paper analyses some methodological implications of this epidemiological study, focusing on the translation of the DIS into Galician and its performance and acceptability in this community. The possible cultural bias that can affect the rates of prevalence in some specific disorders, the limitations of lifetime prevalence and the advantages of using six-month prevalence rates is discussed. Besides some interesting anecdotes, which are described in the article, the main result is the very high acceptance of DIS-III in this elderly population. Copyright © 2000 Whurr Publishers Ltd. [source]