Current awareness in geriatric psychiatry,
doi: 10.1002/gps.2122pmid: N/A
In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of geriatric psychiatry. Each bibliography is divided into 9 sections: 1 Reviews; 2 General; 3 Assessment; 4 Epidemiology; 5 Therapy; 6 Care; 7 Dementia; 8 Depression; 9 Psychology. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted
World psychiatric association section of old age psychiatry consensus statement on ethics and capacity in older people with mental disordersKatona, C.; Chiu, E.; Adelman, S.; Baloyannis, S.; Camus, V.; Firmino, H.; Gove, D.; Graham, N.; Ghebrehiwet, T.; Icelli, I.; Ihl, R.; Kalasic, A.; Leszek, L.; Kim, S.; Lima, C. de M.; Peisah, C.; Tataru, N.; Warner, J.
doi: 10.1002/gps.2279pmid: 19472302
The World Psychiatric Association (WPA) Section of Old Age Psychiatry, since 1997, has developed Consensus Statements relevant to the practice of Old Age Psychiatry. Since 2006 the Section has worked to develop a Consensus Statement on Ethics and Capacity in older people with mental disorders, which was completed in Prague, September 2008, prior to the World Congress in Psychiatry. This Consensus meets one of the goals of the WPA Action Plan 2008–2011, ”to promote the highest ethical standards in psychiatric practice and advocate the rights of persons with mental disorders in all regions of the world“. This Consensus Statement offers to mental health clinicians caring for older people with mental disorders, caregivers, other health professionals and the general public the setting out of and discourse in ethical principles which can often be complex and challenging, supported by practical guidance in meeting such ethical needs and standards, and to encouraged good clinical practice. Copyright © 2009 John Wiley & Sons, Ltd.
A model for intervention research in late‐life depressionAlexopoulos, George S.; Bruce, Martha L.
doi: 10.1002/gps.2287pmid: 19391184
Objective To serve as a conceptual map of the role of new interventions designed to reduce the burden of late‐life depression. Methods We identified three needs to be addressed by intervention research: (1) the need for novel interventions given that the existing treatments leave many older adults depressed and disabled; (2) the need for procedures enabling community‐based agencies to offer interventions of known efficacy with fidelity; and (3) the need to increase access of depressed older adults to care. Results Our model orders novel interventions according to their role in serving depressed older adults and according to their position in the efficacy, effectiveness, implementation, and dissemination testing continuum. We describe three interventions designed by our institute to exemplify intervention research at different level of the model. A common element is that each intervention personalizes care both at the level of the individuals served and the level of community agencies providing care. To this end, each intervention is designed to accommodate the strengths and limitations of both patients and agencies and introduces changes in the patients' environment and community agencies needed in order to assimilate the new intervention. Conclusions We suggest that this model provides conceptual guidance on how to shorten the testing cycle and bring urgently needed novel treatments and implementation approaches to the community. While replication studies are important, propose that most of the support should be directed to those projects that take rational risks, and after adequate preliminary evidence, make the next step along the testing continuum. Copyright © 2009 John Wiley & Sons, Ltd.
The impact of anxiety on conversion from mild cognitive impairment to Alzheimer's diseaseDevier, Deidre J.; Pelton, Gregory H.; Tabert, Matthias H.; Liu, Xinhua; Cuasay, Katrina; Eisenstadt, Rachel; Marder, Karen; Stern, Yaakov; Devanand, D.P.
doi: 10.1002/gps.2263pmid: 19319929
Objective To compare state and trait anxiety in mild cognitive impairment (MCI) patients and matched control subjects, and to assess the impact of these variables in predicting conversion to Alzheimer's disease. Methods One hundred and forty‐eight patients with MCI, broadly defined, were assessed and followed systematically. Baseline predictors for follow‐up conversion to AD (entire sample: 39/148 converted to Alzheimer's disease (AD)) included the Spielberger State‐Trait Anxiety Inventory (STAI). Results At baseline evaluation, MCI patients had higher levels of state and trait anxiety than controls, with no differences between future AD converters (n = 39) and non‐converters. In age‐stratified Cox proportional hazards model analyses, STAI State was not a significant predictor of conversion to AD (STAI State ≤30 vs. > 30 risk ratio, 1.68; 95% CI, 0.75, 3.77; p = 0.21), but higher Trait scores indicated a lower risk of conversion when STAI State, education, the Folstein Mini‐Mental State Examination and HAM‐D (depression score) were also included in the model (STAI Trait ≤30 vs. > 30 risk ratio, 0.36; 95% CI, 0.16, 0.82; p = 0.015). Conclusions In contrast to two other recent studies that showed anxiety predicted cognitive decline or conversion to AD, in this clinic‐based sample, state anxiety was not a significant predictor. However, higher Trait anxiety predicted a lower risk of future conversion to AD. Further research with systematic long‐term follow‐up in larger samples is needed to clarify the role of state and trait anxiety in predicting MCI conversion to AD. Copyright © 2009 John Wiley & Sons, Ltd.
Differences in psychological morbidity among Australian and Chinese caregivers of persons with dementia in residential careWu, Helen Zong Ying; Low, Lee‐Fay; Xiao, Shifu; Brodaty, Henry
doi: 10.1002/gps.2264pmid: 19391171
Objective The aim of the present study was to determine the effects of culture on caregiver psychological morbidity among informal caregivers of institutionalised persons with dementia in three different populations: (1) Shanghai, (2) Australian‐Chinese and (3) Australian mainstream (non‐Chinese). Methods Caregivers and residents with dementia were recruited from (1) a dementia hospital in Shanghai, (2) three ethno‐specific Chinese nursing homes in Sydney and (3) four mainstream nursing homes in Sydney. Psychological morbidity was assessed using the Geriatric Depression Scale, mental health component (MHC) of the RAND‐36 Health Status Inventory and a guilt scale. Results There were no significant differences between the three groups as measured by the guilt scale and MHC. Shanghai caregivers had higher mean depression scores than Australian‐Chinese caregivers (p < 0.001), who in turn had higher mean depression scores than Australian mainstream caregivers (p = 0.015). Higher depression scores were found to be inversely associated with the caregiver's education level and physical health status, and associated with increased frequency of nursing home visits, but not with levels of behavioural and psychological symptoms of dementia (BPSD). Conclusion Levels of depression in caregivers of institutionalised persons with dementia differ by culture and country of residence. Copyright © 2009 John Wiley & Sons, Ltd.
A screen for cognitive assessments for patients with vascular cognitive impairment no dementiaZhou, Aihong; Jia, Jianping
doi: 10.1002/gps.2265pmid: 19347838
Objective To screen for cognitive assessment for patients with vascular cognitive impairment (VCI) no dementia (V‐CIND) from a set of cognitive measures. Methods Extensive neuropsychological tests covering five cognitive domains were performed on 80 V‐CIND patients and 80 normal controls. The impaired domains in V‐CIND were determined and the most discriminating tests were selected to form a comprehensive assessment. The discriminating validity of the individual tests and the comprehensive assessment were explored. Results Compared with the control group, five cognitive domains were all impaired in V‐CIND group. World Health Organization‐University of California‐Los Angeles Auditory Verbal Learning Test (WHO‐UCLA AVLT) immediate recall, Semantic Category Verbal Fluency Test (animal), Chinese version of the Wechsler Adult Intelligence Test (WAIS‐RC) Digit Symbol Subtest, and Block Design Subtest were finally selected to form a comprehensive assessment tool, which achieved a sensitivity of 92.5% and a specificity of 98.8% in differentiating V‐CIND patients from normal controls. Even in the subjects with Mini‐Mental State Examination (MMSE) scores of 28 or above, high discriminative validity was also obtained. Conclusions Our study revealed a multiple domain cognitive deficit in V‐CIND patients. The comprehensive assessment tapping memory, executive functions, mental processing speed, and visuoconstructive skill may be potentially useful for an overall cognitive evaluation for V‐CIND. Copyright © 2009 John Wiley & Sons, Ltd.
Mental capacity to consent to treatment and admission decisions in older adult psychiatric inpatientsMaxmin, Kate; Cooper, Claudia; Potter, Laurence; Livingston, Gill
doi: 10.1002/gps.2272pmid: 19378346
Objectives There is little information about older adult psychiatric inpatients' capacity to consent to clinical decisions. In younger adults, lack of capacity is associated with poor insight and psychosis rather than cognitive impairment. We assessed the prevalence and predictors of mental capacity to make treatment and admission decisions in older psychiatric inpatients, and asked their views about who should make these decisions. Methods We interviewed 99 participants using the MacArthur Competence Assessment Tool for Treatment (MacCAT‐T) in three geographical locations. Results Fifty‐two (52.5%) participants had capacity for admission and 38 (38.4%) for treatment decisions. Capacity was associated with not having dementia, and higher levels of insight and cognition. Those with depression were more likely to have capacity than those with psychosis. 75% of patients without capacity for admission were not detained legally. Conclusions Patients can have capacity to make decisions in one area but not in others. Many people are admitted and treated in a way that is contrary to the human rights legislation. The new Deprivation of Liberty Safeguards in England and Wales are likely to apply to a significant proportion of older inpatients. Most people wanted doctors to make treatment and admission decisions and very few wanted their family to make decisions on their behalf. Copyright © 2009 John Wiley & Sons, Ltd.
Non‐pharmacological management of behavioural symptoms in nursing homesDeudon, Audrey; Maubourguet, Nathalie; Gervais, Xavier; Leone, Elsa; Brocker, Patrice; Carcaillon, Laure; Riff, Simone; Lavallart, Benoît; Robert, Philippe Henri
doi: 10.1002/gps.2275pmid: 19370714
Background Behavioural and psychological symptoms of dementia (BPSD) are often reported in institutions for the elderly. Objective To evaluate the effectiveness of a staff education intervention to manage BPSD in older people with a diagnosis of dementia. Methods The trial was conducted in 16 nursing homes; 306 patients with a diagnosis of dementia and presenting BPSD were selected. Nursing homes were randomly allocated to an intervention group or a control group. An 8‐week staff education and training programme was conducted in the nursing homes in the intervention group. The main outcome measures were the Cohen‐Mansfield Agitation Inventory (CMAI) and an Observation Scale (OS) score. Assessments were done at baseline (W0), at the end of the ‘intervention’ period (W8) and 12 weeks after (W20). Results There was a significant decrease in the global CMAI score between baseline and W8 (−7.8; p > 0.01) and between baseline and W20 (−6.5; p > 0.01) in the intervention group but not in the control group. Results of mixed linear models showed that the CMAI global score, the CMAI physically non‐aggressive behaviours subscale score and verbally non‐aggressive behaviours subscale score significantly decreased in the intervention group (p < 0.001) although there was no significant evolution in the control group. Direct assessment with the OS produced the same pattern of results, with a significant decrease only in the intervention group. Conclusion The intervention reduced BPSD in severely demented nursing home residents and this effect was still present 3 months after the end of the programme. Copyright © 2009 John Wiley & Sons, Ltd.