bluuebunny/crossref_metadata_2025 huggingface dataset:
The social environment of the agitated nursing home resident
Authors: Cohen‐Mansfield Jiska , Werner Perla , Marx Marcia S.
Published: December 2004

This study describes the characteristics of the social environment of 24 highly agitated and cognitively impaired nursing home residents, and the relationship between manifestations of agitation and attributes of the social environment. Results showed that the composition of the social environment of the agitated nursing home resident does not vary much with respect to time of day or day of the week. Additionally, most agitated behaviors were not generally affected by attributes of the social environment. The interaction of agitated behaviors with persons in the social environment is also examined. When agitated behaviors were directed towards someone, they were most likely to be directed towards staff members. Agitated behaviors were rarely triggered by any observable event, and few reactions to agitation were observed.
Brief report: Abnormal eating behavior in dementia—a descriptive study
Authors: Trinkle David B. , Burns Alistair , Levy Raymond
Published: December 2004

Recent research has focused on the behavioural disturbances in dementia patients. The authors review the literature on abnormal eating behaviour in dementia patients and then retrospectively examine a large cohort of dementia patients for such patterns. Thirteen per cent of these patients were found to have significant abnormalities in eating behaviour. These patients are described and possible aetiologies are discussed. A more thorough description of the non‐cognitive symptomatology of dementia is considered important for future research on dementia syndromes.
A survey of lithium use in the elderly
Authors: Bramble David
Published: December 2004

A survey of 37 psychiatrists practising within a health authority area revealed that they employed lithium therapy in elderly patients in a similar manner to how they used it in younger patients. Their responses to a questionnaire were compared to pooled laboratory data concerning lithium serum estimations. There was general agreement between clinicians concerning the important aspects of treatment, yet there were some variations in terms of pretreatment screening practice and maintenance monitoring practice which have resource implications. Overall, lithium was regarded as being as useful in the elderly as in younger patients and also appeared, from analysis of objective laboratory data, to be used in similar ways in this group.
A case of senile self‐neglect in a married couple: ‘Diogenes à deux’?
Authors: Cole Andrew J. , Gillett Timothy P. , Fairbairn Andrew
Published: December 2004

A case is presented of senile self‐neglect in a cohabiting pair. Many features of what has been called Diogenes syndrome are illustrated. Aetiological factors are discussed and parallels with models for folie À deux are drawn.
The psychiatry of elderly people with mental handicaps
Authors: Cooper Sally‐Ann
Published: December 2004

Little is known about the prevalence of psychiatric illness in elderly people with mental handicaps. Behaviour disorders occur less often in the elderly compared to younger groups, but which other illnesses they are vulnerable to or protected from is unknown. Associated characteristics are not clear, not is the interrelationship with social factors. Issues of treatment have not been addressed. Postmortem studies in Down's syndrome suggest almost 100% of individuals over 40 to have neuropathological changes of Alzheimer's disease, but this is probably an overestimation of the true prevalence. Attempts to link neuropathological findings with clinical findings have been disappointing; clinical dementia is elusive. When a decline in skills has been elicited, studies have often overlooked the differential diagnosis, making a presumptive diagnosis of Alzheimer's disease. To date there has been no comprehensive prospective study with neuropathological correlates in the field of Down's syndrome and dementia. People with mental handicaps are living longer, and hence the elderly are emerging as a new group in our society. The impact that this will have on services cannot be predicted and planning of provisions cannot be made until there is more knowledge about this group of individuals.
Psychic correlates of sleep symptoms in the elderly
Authors: Frisoni Giovanni B. , de Leo Diego , Rozzini Renzo , Bernardini Maria , Buono Marirosa Dello , Trabucchi Marco
Published: December 2004

Night sleep symptoms and their relationship to a number of psychic, somatic and social variables were investigated in 453 elderly subjects living in the community. Multivariate statistics indicated that: (a) higher levels of somatization and anxiety were independently associated with worse quality of sleep; (b) depression was not independently associated with poor sleep quality, and association in univariate analysis was explained by higher levels of somatization; (c) sexual interest, which may be an indicator of active sexual life, was associated with better sleep quality both in elderly men and women; (d) waking up frequently in the night showed a correlation pattern with psychic, social and somatic variables different from the other sleep symptoms, suggesting a different cause.
Measurement of depression in dementia: Self vs clinician rating
Authors: Ott Brian R. , Fogel Barry S.
Published: December 2004

The presence of depression was evaluated in a cross‐section of 50 outpatients with dementia using the self‐rated Geriatric Depression Scale and the clinician‐rated Cornell Depression Scale. Impaired insight, as manifested by unawareness of dementia, correlated with dementia severity and discriminated a group of patients in whom the self‐rated scale failed to show evidence of depression. Discrepancy between the two types of scales occurred among mildly as well as moderately demented patients when insight was impaired. Recognition of this discrepancy suggests that reliance on self‐ratings may underestimate the presence and degree of depression among patients with dementia.
Case report: Efficacy of verapamil in an elderly patient with mania unresponsive to neuroleptics
Authors: Gash A. J. , Cole A. J. , Bray G. P.
Published: December 2004

This is a case report of an elderly hypertensive patient with mania relatively unresponsive to neuroleptics, whose illness was effectively controlled with verapamil in both the acute and the maintenance phase of treatment.
Evolution of research in geriatric psychiatry
Authors: Kalayam Balu , Shamoian Charles A.
Published: December 2004

During the past 30 years the knowledge base of geriatric psychiatry has grown exponentially to replace the folklore and myths which for many years pervaded the as yet undefined field of geriatric psychiatry. The advances in geriatric psychiatry, as with many areas of medicine, have been fostered by the appearance of sophisticated technologies including analytic chemistry techniques, functional and structural brain‐imaging studies and molecular biology. However, many of these advances could not have been achieved without the supported initiatives in education and research in geriatric psychiatry by major agencies such as the National Institute of Mental Health Center for Studies of Mental Health of the Aging and the National Institute for Aging. For example, the number of geriatric specialty training programs in the United States increased to more than 30 between 1978 and 1989 as compared to the existence of only one prior to 1978 in the setting of a medical school (Cohen, 1989). These clinical and research training programs continue to the present day and are not only the source of the future researchers in geriatric psychiatry but also the ‘centres’ of research activity in areas such as the mood disorders, dementias, late onset schizophrenia, anxiety, and other psychiatric disorders of the elderly which are reviewed in this issue of the Journal.
Funding research structures
Authors: Martinez Rick A. , Lebowitz Barry D. , Cohen Gene D.
Published: December 2004

Research priorities established by the field of geriatric psychiatry are the principal source of ideas for investigations supported by the National Institute of Mental Health, the National Institute of Aging and a host of private organizations and foundations. Individuals, at various stages in their careers, can compete for federal stipends to pursue these research inquiries. Knowledge of the assortment of awards available is part of an overall strategy candidates need to develop in planning and maintaining productive research careers.
Affective disorders in the elderly
Authors: Addonizio Gerard , Alexopoulos George S.
Published: December 2004

Geriatric affective disorders constitute a major clinical and public health problem. This article reviews clinical data and research in this area. Epidemiology, diagnosis, treatment, course of illness, biologic markers and pathophysiology are discussed and suggestions for the future course of research are made.
Epidemiology of alzheimer's disease: Research trends in the united states
Authors: de Figueiredo John M.
Published: December 2004

In the absence of a peripheral biochemical marker of Alzheimer's disease, case identification in community epidemiologic studies has to rely on a probabilistic diagnosis based on the exclusion of other causes of dementia. This article is a review of the advances made in the successive steps of this diagnostic process. Representative epidemiologic studies on diagnosis, prevalence, incidence, lifetime cumulative risk, mortality, risk factors, prognosis, and the overlap of dementia and depression are reviewed and discussed. Differences in case ascertainment and the methods used have, at times, led to conflicting findings. The recognition of these differences and the experience gained by the studies done so far are paving the way for new initiatives aimed at a better understanding and resolution of the issues left unsettled.
Subtypes in alzheimer's disease and the impact of excess disability: Recent findings
Authors: Fenn Howard , Luby Victoria , Yesavage Jerome A.
Published: December 2004

This article reviews selected recent findings which contribute to the delineation of the early onset, extrapyramidal symptom, and Lewy body subtypes. These examples underscore certain potential advances and pitfalls in research which attempts to define subtypes. A subtype of Alzheimer's disease is defined by the presence of a specific etiology, a set of clinical signs, a prognosis, and a response to treatment. Cognitive decline can also occur on the basis of factors not intrinsic to a particular subtype. The term ‘excess disability’ refers to a patient's functioning which declines more rapidly than is expected on the basis of cerebral pathology alone. This article discusses some relevant studies which show how the concept of ‘excess disability’ contributes to understanding the total disability of the Alzheimer's patient.
Psychosocial treatment of the geropsychiatric patient
Authors: Weiss Leonard J. , Lazarus Lawrence W.
Published: December 2004

Although clinicians believe strongly in the efficacy of various psychotherapeutic approaches to the geropsychiatric patient, to date there have been relatively few studies to validate these claims. We will selectively review some of the more clinically relevant studies concerning individual psychodynamic, cognitive, and behavioral psychotherapy, focusing on treatment of the depressed geriatric patient. Also reviewed are studies about the cost‐effectiveness of psychiatric intervention, as well as innovative hospital‐based treatment modalities. Although progress has been made, Rechtschaffen's succinct summary of the psychotherapy literature in 1959 is still pertinent today; ‘As is true for psychotherapy as a whole, systematic, controlled studies of the effectiveness of various treatments of older people are still lacking. Ultimately, there must be empirical grounds for predicting which type of treatment will work best for which type of patient’ (Rechtschaffen, 1959).
Late life depression and structural brain changes: A review of recent magnetic resonance imaging research
Authors: Baldwin R. C.
Published: December 2004

Recent findings using magnetic resonance imaging to investigate late life depression have reported an unexpectedly high prevalence of white matter and other structural brain changes, suggesting a possible organic aetiology to the disorder in a proportion of cases. These findings are examined critically and it is concluded that their significance is not yet clear, although they may reflect underlying cerebrovascular change. A lack of postmortem data constitutes a major deficiency in this area of enquiry. An approach combining structural and dynamic imaging with postmortem examination would be the best strategy for future research.
Intervening to reduce distress in caregivers of impaired elderly people: A preliminary evaluation
Authors: Harper David J. , Manasse Paul R. , James Owen , Newton J. Tim
Published: December 2004

Data from a sample of 82 impaired elderly people and their carers were gathered before (T1) they started to receive support from a home‐based care aide service. Several variables were significantly correlated with, but only two were predictive of reported carer distress at T1. Data gathered from a subsample of 45 carers after receiving support for 3 months (T2) showed that reported distress decreased significantly between T1 and T2. The only variable which significantly correlated with, and was predictive of carer distress at T2 was distress at T1. A ladder plot showed great variability in changes in distress with 11 subjects actually reporting increased distress at T2. There was no relationship between initial distress scores and change in distress over time. The implications of these findings are discussed.
Factors associated with mortality in national health service nursing homes for elderly people and longstay geriatric wards in hospital
Authors: Bowling Ann , Formby Juliet , Grant Kenneth
Published: December 2004

This article presents the analyses of mortality rates of elderly people in a randomized controlled trial of nursing home and long‐stay ward care in hospital. No statistically significant differences between settings were found in relation to mortality rates. Age, accident rate and existence of cognitive impairment were associated with mortality with bivariate analyses, although they were found to explain very little of the variation between survival and mortality when logistic regression analysis was employed. In both settings, those who had some cognitive impairment had just over twice the relative risk of dying than others, although this difference was not statistically significant.
Housebound elderly people: Definition, prevalence and characteristics
Authors: Lindesay James , Thompson Catherine
Published: December 2004

This study examines various physical, psychiatric, social and environmental factors associated with being housebound in an urban elderly community sample. Using a narrow definition of houseboundness, the overall rate in this sample was 3.5%; in respondents aged 85 years and over the rate was 20.0%. In a logistic regression analysis, physical health status, age, access to a car, floor of entry to household and household tenure emerged as significant independent predictors of houseboundness. Psychiatric disorder was not independently associated with houseboundness in this analysis. Housebound respondents reported higher rates of both formal and informal care; in those aged 65–74 years this extra care was provided by domiciliary health and social services, but in those aged 85 years and over only care by home helps and by family and friends was increased.
First symptoms of dementia: A study of relatives' reports
Authors: La Rue Asenath , Watson Jennifer , Plotkin Daniel A.
Published: December 2004

Fifty relatives who accompanied patients to a dementia clinic for diagnostic evaluation completed questionnaires inquiring about initial symptoms of illness, changes in symptoms over time, current functional and psychiatric problems of the patient, and caregiver stress. Forgetfulness was the most commonly reported initial symptom, followed by confusion, depression, agitation, inattention, getting lost, language problems, and motor problems. Usually, multiple initial symptoms were endorsed (mean = 3.28 ± 1.83). Spouses reported fewer initial symptoms overall and less frequent depression than younger relatives. In addition, there was a significant relationship between informants' reports of first symptoms and the reported levels of caregiver stress and current psychiatric problems in patients. Patients with clinical diagnoses of Alzheimer‐type or multi‐infarct dementia had a different profile of initial symptoms from those with mood disturbance, but there was no difference in reported symptoms between the dementia groups.
The prevalence of psychotic, depressive and anxiety syndromes in demented and non‐demented 85‐year‐olds
Authors: Skoog Ingmar
Published: December 2004

One‐month prevalence of mental syndromes in demented and non‐demented subjects was studied in a representative sample of 85‐year‐olds living in Gothenburg, Sweden (N = 494). All subjects were examined by a psychiatrist. Schizophreniform syndrome was significantly more common in subjects with Alzheimer's disease than in nondemented subjects (13% vs 1%, p < 0.001), and more common in severe dementia (p > 0.01). Depressive syndromes were significantly more common in subjects with mild dementia than in non‐demented subjects (34% vs 20%, p > 0.05). Phobic syndrome was less common in demented than in non‐demented subjects. It is hypothesized that the occurrence of mental syndromes in demented subjects may be related to structural and neurochemical brain changes.
Does psychiatric morbidity predict mortality in continuing care geriatric inpatients?
Authors: Shah Ajit , Phongsathorn Virach , George Collette , Bielawska Celia , Katona Cornelius
Published: December 2004

All patients in continuing care geriatric beds in a London Health District were screened for psychiatric morbidity and physical dependency in 1990. This sample was followed up 1 year after screening. Forty‐four per cent (32/72) were dead at follow‐up. Patients in hospital‐based continuing care beds had higher mortality than those in health authority beds in a private nursing home. Dementia, physical dependency and depression measured by Depressive Signs Scale (DSS) were associated with mortality. Using multivariate analysis, to partial out independent effects, depressive signs score measured by the DSS was the only significant predictor of mortality.
Age‐associated memory impairment: Diagnostic and treatment issues
Authors: Barker Andrew , Jones Roy
Published: December 2004

There has been an enormous increase in research to identify potential pharmacological treatments for cognitive impairment in elderly people. Currently, well over 150 such compounds are under development by the pharmaceutical industry. However, among those who are potential targets for such treatment are many who suffer from relatively mild disorder, where the distinction from both dementia and ‘normality’ is not clear. These people include those described as suffering from benign senescent forgetfulness and age‐associated memory impairment. This article discusses principles of diagnosis and treatment in this area with particular reference to age‐associated memory impairment. For ethical, practical and economic reasons it is essential that these issues are examined thoroughly before any apparent breakthrough in therapy.
Clinical experience with the nosger (nurses' observation scale for geriatric patients): Tentative normative data and sensitivity to change
Authors: Tremmel Lothar , Spiegel René
Published: December 2004

The NOSGER is an assessment instrument used in psychogeriatrics, consisting of 30 observable items of behaviour and measuring impairments in six areas: memory, IADL (instrumental activities of daily living), ADL (activities of daily living), mood, social behaviour and disturbing behaviour. Data collected in the course of validation studies were reanalysed to calculate tentative normative scores and to assess the scale's sensitivity to change. Cutoff scores for elderly normal subjects living in the community are estimated around 10 for ADL and around 15 for memory and IADL disturbances. Cutoff values for the three non‐cognitive NOSGER dimensions are not yet available. Sensitivity to change (over 3 months) was shown to be relatively highest for memory, IADL and disturbing behaviour and lowest for ADL in a group of patients with mild to moderate dementia. Correlations between NOSGER change scores and physicians‐ overall assessments of treatment efficacy in a drug study were highest for social behaviour, IADL and mood, suggesting that non‐cognitive factors were at least as important to determine doctors‐ assessments of change as changes in cognitive areas of behaviour. Further studies are on their way to supplement the present data set.
Screening for problem drinking in the elderly: A study in the elderly mentally ill
Authors: Mears Helen J. , Spice Claire
Published: December 2004

Abuse of alcohol in the elderly may be commoner than previously thought, but accurate detection is hampered by, among other things, lack of information about the most suitable screening or detection methods in this group. One hundred and ten consecutive admissions to an acute unit for the elderly mentally ill were studied to identify problem drinkers and to examine characteristics of these patients. The prevalence of problem drinking was found to be 19%, one third of whom had been undetected during routine medical assessment. A highly significant difference in consumption of alcohol was found between problem drinkers and the remainder of the group (p<0.001), with consumption of 14 or more units of alcohol per week in males and females being associated with high risk of adverse consequences. Thus, consumption of 14 or more units of alcohol per week may be applied as a useful screening test for problem drinking in the elderly, with sensitivity of 0.92 and specificity of 0.98. The pattern of drinking showed a similar distinction with consumption of alcohol on 3 or more days per week being associated with high risk of adverse consequences (p<0.001).
The single eeg in alzheimer's disease: What value for prognosis?
Authors: Bach L. , McCulloch J. , Hunter R.
Published: December 2004

The article reports an investigation into whether abnormal EEG patterns are predictive of faster rate of decline in patients with Alzheimer's disease. Data for 24 patients with probable Alzheimer's disease (NINCDS‐ADRDA criteria) were analysed. Patients were divided into two groups, those with normal EEG pattern (N = 9) and those with abnormal EEG pattern (N = 15). There was no difference between the initial MMSE and CAMCOG scores for either group. There was also no difference in terms of rate of decline, as measured by MMSE and CAMCOG scores, between patients with normal and abnormal EEG records. We therefore conclude that the single EEG is of limited value in predicting rate of cognitive decline in Alzheimer patients.
Aggressive behaviour in elderly people with dementia: A review
Authors: Patel Vikram , Hope Tony
Published: December 2004

The progressive degeneration of the brain seen in dementia is often accompanied by behavioural disturbances. Aggressive behaviour is one of the most serious of these disturbances and is a common cause for psychiatric referral, admission to hospital and drug treatment. In this article, we discuss the conceptual issues associated with defining aggressive behaviour in cognitively impaired patients. We then review the aetiology, epidemiology, methods of assessment, and management of aggressive behaviour in elderly people with dementia.
Insomnia in the elderly : Prevalence, gender differences and relationships with morbidity and mortality
Authors: Brabbins C. J. , Dewey M. E. , Copeland J. R. M. , Davidson I. A. , McWilliam C. , Saunders P. , Sharma V. K. , Sullivan C.
Published: December 2004

A sample of 1070 people aged 65 and over living in the Liverpool community was interviewed in 1982/3. Those traced were then reinterviewed 3 years later. Information was collected on the prevalence of perceived insomnia using a community version of the Geriatric Mental State (GMS), which also provided a diagnosis using AGECAT. Thirty‐five per cent reported trouble sleeping, which was twice as common in women as men and was not wholly accounted for by the increased prevalence of mental illness in elderly women. There was no change in prevalence with age, but insomnia was more frequent in the depressed group (70%). Insomnia is more likely with increasing serverity of depression but was also common in the well group and hence is not a specific indicator. No relationship was found between mortality at year 3 and insomnia or hypnotic use at year 0. Use of hypnotics was related to the presence of sleep disturbance, but not to having a psychiatric diagnosis. Medical intervention may be much more successful in reducing the prevalence of benzodiazepine usage than may have been realized.
The effect of demographic and health variables on a modified form of mini‐mental state examination scores in nigerian elderly community residents
Authors: Baiyewu Olusegun , Bella Andrew F. , Jegede R. Olukayode
Published: December 2004

A culturally relevant form the Mini‐Mental State Examination was administered to 502 persons aged 60 years and over living in three locations representing rural and urban settings in southwestern Nigeria. Multivariate statistical methods show that variables like sex, age, education and self‐assessed health affect the scores on MMSE. The coefficient alpha for the instrument was low for those with less than complete primary education, but for those with full primary education or more, it gave a value similar to those obtained in some studies in western countries.
Alcohol abuse in an inner city elderly population: The gospel oak survey
Authors: Livingston Gill , King Michael
Published: December 2004

One hundred and seventy‐nine men and 335 women over the age of 65 years, ascertained in a community survey, completed the CAGE questionnaire to detect possible alcohol abuse. Only three subjects were CAGE positive and thus at risk for alcohol abuse. It is concluded that current alcohol abuse does not underlie neuropsychiatric conditions in the elderly and fears of significant rates of abuse in this population are probably unfounded. Further research is necessary.
Physical assaults by psychogeriatric patients: Patient characteristics and implications for placement
Authors: Eastley Rebecca , Mian Ihsan
Published: December 2004

The case notes of 137 patients admitted to a psychogeriatric assessment ward over 12 months were reviewed. The characteristics of patients who were assaultive prior to, or during admission were compared with those who were not. The reported prevalence of assaultive behaviour from the case notes was compared with that from the formal ‘violent incident’ forms. Twenty‐three per cent of the patients had assaulted others prior to their admission, and 23% were assaultive during their admission. Those patients who were assaultive prior to admission were likely to be assaultive during their admission. Assaultive behaviour prior to and during admission was associated with male gender, dementia, and increased age in female patients. Assaults were underreported on the formal ‘violent incident’ forms by nursing staff. Assaultive behaviour prior to admission predicted discharge to a higher dependency setting, but assaultive behaviour during admission did not. The implications of these findings are discussed.
Relocation mortality in dementia: The effects of a new hospital
Authors: Robertson Carol , Warrington Jill , Eagles John M.
Published: December 2004

Relocation mortality has been cited as an important factor when considering the placement of elderly patients. This study describes the fate of dementia patients relocated to facilitate the move to a new hospital. Some wards were moved as intact units—that is, the patients were kept together and there was little change in the nursing or medical staff. Two other wards were closed, and these patients were dispersed to several existing and new wards and experienced changes of nursing and medical staff. All patients underwent prerelocation and postrelocation orientation programmes. The mortality figures for the total patient group before and after the relocation do not show any statistically significant increase in mortality postrelocation. However, for wards that were closed and where the patients suffered maximum disruption to patient group and nursing staff, there was a significant increase in mortality rates.
Person and process in dementia
Authors: Kitwood Tom
Published: December 2004

Outlines are given of an ‘ethological’ programme of research into the social psychology of dementia in old age. Here the manifestations and progress of a dementing illness are seen to be crucially dependent on the nature of the interpersonal context. The quality of dementia care can be evaluated, including quantitative measures. Earlier conceptualizations of the dementing process were overly deterministic and pessimistic. New challenges are created for service provision and policy.
A critique of current criteria for early dementia in epidemiological studies
Authors: Burvill Peter Walter
Published: December 2004

Differences between age‐associated memory impairment and mild dementia have yet to be clarified. Attempts to validate the diagnosis of mild dementia have raised considerable difficulties in the absence of a ‘gold standard’. Agreed criteria of mild dementia are still lacking. Progressive deterioration of cognition is generally held to be a cardinal feature of dementia. Many of the multiple factors which can impair cognition and give a spurious impression of mild dementia still present major methodological problems. Agreed diagnostic criteria, use of standardized measuring instruments, clinical interview, key informant inquiry and possibly psychometric testing are highly desirable in order to detect early dementia. For epidemiological surveys reliable screening instruments are important. It is concluded that, at present, there are too many fundamental conceptual and methodological problems to be overcome before we can successfully undertake large‐scale community epidemiological studies of mild dementia.
Idiopathic clouding of consciousness—do the patients have cortical lewy body disease?
Authors: Ballard C. G. , Mohan R. N. C. , Patel A. , Bannister C.
Published: December 2004

Sixteen out of 58 patients assessed at a day hospital for probable dementia fulfilled the study definition for idiopathic clouding of consciousness. These patients were significantly more likely than other patients in the sample to have visual hallucinations, depression, extrapyramidal symptoms and to experience falls. They hence had the same symptom profile as patients described as having cortical Lewy body dementia, an observation supported by the fact that 14 of the 16 fulfilled McKeith's criteria for the aforementioned condition. Fifty per cent of the patients with idiopathic clouding of consciousness had a family history of Parkinson's disease. The implications of the findings are discussed.
Atrial fibrillation and nortriptyline in the elderly
Authors: Caracci Giovanni , Reggev Avner
Published: December 2004

Seven cases of atrial arrhythmia associated with nortriptyline in elderly patients are presented. The clinical and therapeutic significance of our observations is discussed.
A brief cognitive behavioural therapy group for the elderly: Who benefits?
Authors: Leung Sai Ning Mary , Orrell Martin W.
Published: December 2004

This study looks at the efficacy of brief focused cognitive‐behavioural group intervention in the treatment of mood disorders in older adults in different diagnostic groups. At 1‐year follow‐up, out of a total of 27 patients, 70% required no input from the mental health services and also reported that they were ‘recovered’ and functioning well. When separated into two groups according to the diagnoses on DSM‐III‐R, 92% of the major depressive episode (MDE) group in contrast to 50% of the other disorders group were discharged and functioning well. This suggests that selection of patients using the DSM‐III‐R diagnostic method has helped to identify which depressed elderly people benefit most. A tentative link between personality difficulties is proposed as a possible obstacle to therapy.
Empirical evaluation of the ‘Cognitive Difficulties Scale’ for assessment of memory complaints in general practice: A study of 1628 cognitively normal subjects aged 45–75 years
Authors: Derouesné C. , Dealberto M. J. , Boyer P. , Lubin S. , Sauron B. , Piette F. , Kohler F. , Alpérovitch A.
Published: December 2004

The Cognitive Difficulties Scale (CDS, McNair and Kahn, 1984) was used to assess memory complaints in 1648 subjects devoid of severe medical or psychiatric disorder. The subjects, aged 45–75 years, were recruited when visiting their general practitioner. The CDS was well accepted and showed a good and stable factorial structure. A weak correlation was found between CDS score and the results of a short neuropsychological battery. A high CDS score was associated with advancing age, low educational level, and psychological motives for visiting. A reduced 26‐item version is proposed to shorten the time required to fill in the scale.
The elderly chronic schizophrenic inpatient: A study of psychiatric morbidity in ‘elderly graduates’
Authors: Soni Som D. , Mallik Ather
Published: December 2004

This study surveyed all chronic schizophrenic patients from 11 long‐stay wards of a mental hospital. Patients were assessed on a variety of rating scales to assess clinical psychopathology and behaviour. Patients above the age of 65 years were studied in detail and also compared with those under that age living on the same wards. It was found that all the elderly schizophrenic patients in the sample had severe deficits in the form of residual negative symptoms and thought disorder. They had significantly fewer positive but more negative symptoms as compared to a younger sample on the same wards; there was no differences between the groups for affective symptoms or thought disorder. Although there were more males in the sample, no difference was found on any of the parameters between the two sexes. It was concluded that there are significant clinical differences in the ‘elderly graduates’ as compared to younger patients living in an identical environment; such findings could assist managers and administrators in the development of plans for other patients in this age group who are likely to be relocated from psychiatric hospitals in the near future or are already living in the community.
Predictors of nursing home placement in patients with alzheimer's disease
Authors: Haupt Martin , Kurz Alexander
Published: December 2004

Sixty‐six outpatients with mild to moderate dementia in Alzheimer's disease at baseline were examined twice with an interval of 12 months. Twenty‐two of these patients who were admitted to a nursing home within this period were compared to a group of 44 patients who remained living at home with respect to demographic data, cognitive and physical dysfunction, behavioural changes in daily living and the burden of caregivers. Stepwise discriminant function analysis revealed that older age, global cognitive decline, incontinence, aggression, depression, and the caregiver's wish to leave the care to someone else were predictors for nursing home placement ithin 1‐year follow‐up and correctly classified 82% of the cases. The study indicates that factors predicting nursing home placement in Alzheimer patients are complex, including demographic characteristics, level of cognitive and physical functioning, behavioural abnormalities in daily living, as well as burden of the caregiver, and are consistent with predictors of institutionalization found in healthy elderly individuals.
The behavioural assessment scale of later life (BASOLL): A Description, factor analysis, scale development, validity and reliability data for a new scale for older adults
Authors: Brooker D. J. R. , Sturmey P. , Gatherer A. J. H. , Summerbell C.
Published: December 2004

Preliminary data on the Behavioural Assessment Scale of Later Life (BASOLL) (Brooker and Nissenbaum, 1986) are described. The BASOLL is based upon Zarit's Memory and Behavioural Problem Checklist (MBPC; Zarit et al., 1980) and the Blessed Dementia Scale (BDS; Blessed et al., 1968). The BASOLL was administered to a sample of 177 psychogeriatric patients over a period of 2 years during regular clinical practice in outpatient, day patient and inpatient settings. A factor analysis revealed three factors which were named self‐care behaviour, memory and orientation, and challenging behaviour. The similarity with factors derived from Zarit's MBPC is discussed. Summative scales derived from the factor analysis of the BASOLL were internally consistent. Data on test‐retest and interrater reliability are presented which suggest that the scales are reliable. The scales included in the BASOLL were all able to distinguish between patients in day hospital, respite care and continuing care settings. Thus the scales can be said to have good criterion validity for these settings. The clinical development and utility of the BASOLL is discussed.
Late paraphrenia, advanced schizophrenic deterioration and dementia
Authors: Charlesworth Georgina M. , Hymas Nigel , Wischik Claude M. , Hodges John R. , Sahakian Barbara J.
Published: December 2004

This is a report of a clinical case presentation from the Neuropsychiatry Conference held at Fulbourn Hospital, Cambridge on March 13, 1992. The conference, chaired by Dr Nigel Hymas, was asked to comment on the diagnosis of a case first referred during September 1990. A 60‐year‐old man with no previous history of psychiatric illness presented with persecutory ideation, delusions and hallucinations in the absence of cognitive impairment. At the time, the initial tentative psychiatric diagnosis was one of late paraphrenia, but it later became clear that the patient was dementing. Were the paraphrenia and dementia related? If so, how? What was the nature of the dementing illness? Could life‐long personality abnormalities have been the earliest expression of cerebral abnormalities predisposing him to his current illness? Incompatible evidence from clinical features, functional brain scanning and comprehensive neuropsychological testing demonstrates the inadequacy of current diagnostic criteria.
The domus philosophy: A prospective evaluation of two residential units for the elderly mentally ill
Authors: Dean Rachel , Briggs Kate , Lindesay James
Published: December 2004

This article reports the findings of a prospective study of the first year of operation of two residential domus units for elderly people with dementia (domus A) and chronic schizophrenia (domus B). Residents, staff and the process of care were assessed at baseline in long‐stay mental hospital wards, and at 3 months, 6 months and 12 months after the move to a domus. At 12 months, both domuses were providing more policy choice, resident control, provision for privacy and availability of social and recreational activities than a baseline psychogeriatric ward. Residents' cognitive function improved steadily over the follow‐up period in both domuses, significantly so in domus A. There was also some improvement in residents' self‐care (ADL) skills at follow‐up in both domuses. Residents' communication skills were rated as significantly improved by staff in domus A at all follow‐up assessments, and by staff in domus B at 6 months. Compared to baseline, substantially higher levels of activities and interpersonal interactions were observed at follow‐up in both domuses. There was no evidence that staff suffered from low job satisfaction or psychological impairment at either domus.
The costs of domus care
Authors: Beecham Jeni , Cambridge Paul , Hallam Angela , Knapp Martin
Published: December 2004

In this article we examine the costs and certain characteristics of domus care in two facilities. The domuses are registered mental health nursing homes and the charge made to residents covers many of the service needs of residents. All residents are dependent on social security benefits. The two facilities are highly staffed and each client receives between 17 and 25 hours per week of individual, one‐to‐one support. The research uses the Client Service Receipt Interview to gather data which allow measures of costs for all domus residents to be built up. Use of services based outside the domuses was rare, nevertheless a wide variety of professionals visited the domuses. The main service gaps and deficiencies related to day support services and the inputs of GPs. Accommodation (including in‐house services) dominated the aggregate total costs of care (96%). Average total community care cost was £951 per week for current domus A residents and £909 for domus B residents. Although the new service was more costly than the hospitals from which residents came, the results from the outcomes study suggest that domus residents are experiencing a better quality of life than in hospital.
Computerized cognitive examination of the elderly (ECO): The development of a neuropsychological examination for clinic and population use
Authors: Ritchie Karen , Allard Michel , Huppert Felicia A. , Nargeot Christine , Pinek Bojidar , Ledesert Bernard
Published: December 2004

The development of a computerized neuropsychological examination (ECO), designed to evaluate intellectual functioning in elderly populations, is described. The examination is based on clinical and laboratory observations of cognitive functioning in normal and pathological ageing. ECO provides extensive information on attention, memory, and visuospatial and linguistic functioning, and the use of a touch screen permits the recording of reaction time and response delays. Information regarding qualitative aspects of responses is also recorded. The examination takes relatively little time given the extent of the information obtained (approximately 40 min), is highly acceptable to the elderly, and provides qualitative neuropsychological data although administered by lay interviewers. The results obtained by a normaal group of 335 elderly persons aged between 60 and 100 years are discussed in relation to age and education level.
Age of onset and duration of dementia in people with down syndrome: Integration of 98 reported cases in the literature
Authors: Prasher V. P. , Krishnan V. H. R.
Published: December 2004

The published case reports of 98 people with Down Syndrome were studied with respect to the age of onset and duration of clinically diagnosed dementia. The incidence of dementia was unimodal, increasing rapidly from 40 years to a peak of 30% incidence in the fifth decade of life, followed by a further rapid decline. Females with Down syndrome had an earlier onset. Duration of dementia decreased with increasing age of onset for both males and females.
Five‐year prognosis for dysthymic disorder in old age
Authors: Kivelä Sirkka‐Liisa , Köngäs‐Saviaro Päivi , Pahkala Kimmo , Kesti Erkki , Laippala Pekka
Published: December 2004

The 5‐year prognosis for 199 elderly patients (60 yr+) suffering from dysthymic disorder is described. Twenty‐nine per cent of the men and 39% of the women recovered, 26% of both were suffering from depression after 5 years, 9% of both had a possible dementia, 32% of the men and 22% of the women had died and 3% of the men and 5% of the women could not be contacted. The outcome did not differ between the sexes or age groups. A poor prognosis among men was related to a low educational level, a non‐independent previous occupation, the occurrence of depression previously, a high number of hobbies and the following depressive symptoms: initial and delayed insomnia, retardation and psychomotor agitation. A poor prognosis was also found for those whose functional capacities, hobbies or emotional relations with their wives had declined or who had experienced a pulmonary disease or few or no social growth events during the follow‐up. A poor prognosis among women was related to low self‐perceived health, high sum score of the Hamilton Rating Scale for Depression, thyroid disorder and the following depressive symptoms: loss of libido and diurnal variation of symptoms. A poor prognosis was also found for those whose physical health, functional capacities, social participation rate or hobbies had declined or who had experienced a serious disease during the follow‐up. A favourable prognosis was found for women who moved to live alone or became more active in taking physical exercise.
‘Rementia’: Challenging the limits of dementia care
Authors: Sixsmith Andrew , Stilwell John , Copeland John
Published: December 2004

Dementia is conventionally defined in terms of neurological changes in the brain and an inevitable and progressive decline in the individual's cognitive powers and functional ability. However, this ‘biomedical’ model fails to recognize other important factors within the dementing process, such as the social and care context within which the dementing person lives. It is argued that appropriate care interventions can have a considerable impact on the progress of dementia. Data from an evaluation of three experimental homes for the elderly mentally ill show that some degree of ‘rementia’, the regaining of lost cognitive and functional abilities, is possible for some individuals. This evidence is used to argue for a more positive approach to dementia care.
Physician input into guardianship cases involving the elderly
Authors: Juretic Mark C. , Martin Deandra L. , Taffet George E. , Wilson Nancy L. , Gregory Honorable Patrick , Luchi Robert J.
Published: December 2004

The determination of an elderly person's competence in guardianship decisions rests primarily on the written statement of an examining physician. We evaluated this physican input by retrospectively reviewing 40 competency case files of persons over age 60 from the Harris County Probate Courts. Of the 40 physician letters reviewed: 10 (25%) did not include a medical or psychiatric diagnosis; 37 (92.5%) did not include results of a formal mental status exam; 19 (47.5%) of the letters were essentially unsupported statements of incompetence. Finally, 29 (72.5%) of the cases failed to include a statement on prognosis or potential need for reevaluation. The medical information transmitted to the courts in guardianship cases involving the elderly was inadequate for the courts to make informed decisions. Guidelines for evaluation were developed to facilitate the transmission of adequate patient data, and to direct physicians as to what information is needed by the court in making guardianship decisions.
All work? A day in the life of geriatric psychiatrists
Authors: Benbow Susan M. , Jolley David J. , Leonard Ian J.
Published: December 2004

A pilot study of old age psychiatrists' workloads was carried out using a list of old age psychiatrists compiled by the Section of Old Age Psychiatry, Royal College of Psychiatrists. Respondents gave details of their working hours and practices on one day in 1992. As a group old age psychiatrists worked long hours and continued to work after returning home, with little time for personal study and research. If confirmed in a larger study, the findings are of concern in relation to health of the workforce, and need to be considered in relation to ‘manpower’ recommendations, requirements for continuing medical education and supportive staffing, and work patterns.