Background: In the absence of an easily applicable performance test for making valid measurements of fundamental activities of daily living (ADL) in dementia patients, this study reports the development of an ADL performance test which constitutes both a reliable and a valid measurement of the relevant autonomous areas of everyday activities for dementia patients.

Methods: The Erlangen Test of Activities of Daily Living (E-ADL-Test) consists of five items: pouring a drink, cutting a piece of bread, opening a small cupboard, washing hands and tying a bow. Each test item underwent standardized evaluation on a scale of 0 to 6. To determine retest reliability each assessment was repeated at two-weekly intervals. The Global Deterioration Scale, Mini-mental State Examination (MMSE) and Nurses' Observations Scale for Geriatric Patients (NOSGER) were used to assess construct validity. Spearman's rank correlation coefficient was applied. Forty-six patients (42 women and 4 men) with clinically diagnosed dementia, who were resident in nursing homes, took part in the validation study. Their average age was 86.

Results: The E-ADL-Test revealed good inter-individual differentiation ability, particularly in cases of moderate to severe dementia. Cronbach's α was 0.77, retest reliability 0.73. The correlation coefficients were −0.47 with GDS, 0.60 with NOSGER and 0.72 with MMSE.

Conclusions: The E-ADL-Test is a suitable performance test for measuring activities of daily living as it is easy to use, reliable, valid and well accepted.

The authors regret that they omitted to include an acknowledgment of financial support in the original publication. The acknowledgment should have read:

This work was funded by a grant from the Thomas Pocklington Trust.

Background: A third of family members caring for people with dementia report acting abusively towards them, but there are currently no evidence-based interventions to reduce or prevent such behavior. Family carers who act abusively have not previously been consulted about what may help to reduce abuse.

Method: We prospectively recruited a consecutive sample of 220 family carers of people with dementia referred to secondary psychiatric services. We asked carers who reported any abusive behavior in the previous three months to select from a list of services and potential interventions those that they thought might help to reduce or prevent this abusive behavior. Carers were also asked to suggest other interventions that might help prevent abuse.

Results: 113/115 carers who reported any abusive behavior answered questions about possible interventions. The three most frequently endorsed interventions were: medication to help the care recipient's memory (n = 54; 48.2%); written advice on understanding memory problems and what to do (n = 48; 42.9%) and more information from professionals caring for the person with dementia (n = 45; 40.2%). When asked which interventions were most important, medication to help memory (n = 21; 18.6%), home care (n = 17; 15.0%), residential respite and sitting services (both n = 12; 10.6%) were most frequently endorsed.

Conclusion: To prevent abuse, family carers prioritized medication for memory, good communication from professionals, written advice on memory problems, home care, residential respite and sitting services. As no interventions to reduce abuse by family carers have yet been formally evaluated, a good starting point may be the expressed wishes of family carers.

Background: At least for a subset of patients, the clinical diagnosis of mild cognitive impairment (MCI) may represent an intermediate stage between normal aging and dementia. Nevertheless, the patterns of transition of cognitive states between normal cognitive aging and MCI to dementia are not well established. In this study we address the pattern of transitions between cognitive states in patients with MCI and healthy controls, prior to the conversion to dementia.

Methods: 139 subjects (78% women, mean age, 68.5 ± 6.1 years; mean educational level, 11.7 ± 5.4 years) were consecutively assessed in a memory clinic with a standardized clinical and neuropsychological protocol, and classified as cognitively healthy (normal controls) or with MCI (including subtypes) at baseline. These subjects underwent annual reassessments (mean duration of follow-up: 2.7 ± 1.1 years), in which cognitive state was ascertained independently of prior diagnoses. The pattern of transitions of the cognitive state was determined by Markov chain analysis.

Results: The transitions from one cognitive state to another varied substantially between MCI subtypes. Single-domain MCI (amnestic and non-amnestic) more frequently returned to normal cognitive state upon follow-up (22.5% and 21%, respectively). Among subjects who progressed to Alzheimer's disease (AD), the most common diagnosis immediately prior conversion was multiple-domain MCI (85%).

Conclusion: The clinical diagnosis of MCI and its subtypes yields groups of patients with heterogeneous patterns of transitions between one given cognitive state to another. The presence of more severe and widespread cognitive deficits, as indicated by the group of multiple-domain amnestic MCI may be a better predictor of AD than single-domain amnestic or non-amnestic deficits. These higher-risk individuals could probably be the best candidates for the development of preventive strategies and early treatment for the disease.

Background: The Mental Capacity Act 2005 (MCA) was fully implemented in October 2007 in England and Wales. The experience of clinicians working in Old Age Psychiatry, who are likely to have greater experience in the use of MCA, in the early implementation of the MCA was examined.

Methods: Case-notes of 37 patients in seven different Old Age Psychiatry services in two mental health trusts in west London, who had received at least one assessment of decision-making capacity (DMC) for a specific issue, were examined. A qualitative thematic analysis pertaining to the criteria used for the assessment of DMC, determination of best interests, least restrictive option and unwise decision was used for data analysis.

Results: The main findings were: the criteria used for the assessment of DMC and the determination of best interests were those described in the MCA and the accompanying Code of Practice; and clinicians were developing the concepts of least restrictive option and unwise decision with face validity despite the absence of their definitions in the MCA.

Conclusion: Caution should be exercised in extrapolating the findings of this study, which is confined to two Mental Health Trusts in one geographical area and the speciality of Old Age Psychiatry, to other localities and other specialties. Nevertheless, there was evidence that clinicians were following the basic principles of the MCA correctly.

Background: This study investigates discrepancies between the confidence expressed by Korean elders in their balance and their actual physical performances according to sex and age. It also attempts to identify the factors responsible for such gaps or discrepancies.

Methods: The Korean Longitudinal Study on Health and Aging (KLoSHA) was designed as a population-based prospective cohort study on the health and aging of Korean adults aged 65 years and over. We evaluated 1000 of 1118 randomly selected subjects in terms of activities-specific balance confidence (ABC) and performance in regard to balance and gait (POMA). Activities of daily living (ADL) and instrumental activities of daily living (IADL) were assessed to measure disability. Pain-related dysfunctions, depression and cognitive functions were assessed. Next, we assessed the relationship between balance confidence and physical performance and functioning by sex and age.

Results: The balance confidence of elderly women was lower than that of elderly men, although the physical performances of men and women under the age of 80 were similar. Women showed increased functional disability related to lower extremity pain and closely associated with balance confidence. However, psychological variables such as depression and cognitive functioning did not affect balance confidence.

Conclusion: We found a discrepancy between balance confidence and physical performance according to sex and age among Koreans elders. Low balance confidence among women elders was correlated with pain-related dysfunctions other than those reflected in POMA scores. Therefore, enhancing confidence and controlling pain as a means of preventing disability should be emphasized when developing models for maintaining and promoting health in elders.

Background: Eating problems occur frequently in patients with dementia, and almost half of all patients with Parkinson's disease have such problems. It has therefore been assumed that eating problems are also common in patients with dementia with Lewy bodies (DLB). However, few systematic studies have investigated eating problems in DLB patients. The aim of this study was to clarify the frequency and characteristics of eating problems in patients with DLB.

Methods: We examined 29 consecutive patients with DLB and 33 with Alzheimer's disease (AD) in terms of age, sex, education, Mini-mental State Examination, clinical dementia rating (CDR), neuropsychiatric inventory (NPI), Unified Parkinson disease rating scale (UPDRS), fluctuations in cognition, and usage of neuroleptic drugs / antiparkinsonian drugs. We employed a comprehensive questionnaire comprising 40 items and compared the scores between the two groups.

Results: DLB patients showed significantly higher scores than AD patients for “difficulty in swallowing foods,” “difficulty in swallowing liquids,” “coughing or choking when swallowing,” “taking a long time to swallow,” “suffering from sputum,” “loss of appetite,” “need watching or help,” and “constipation”. Only the UPDRS score significantly affected the scores for “difficulty in swallowing foods,” “taking a long time to swallow” and “needs watching or help” score, whereas only the NPI score affected the score for “loss of appetite.” The scores for UPDRS, NPI and CDR significantly affected the scores for “difficulty in swallowing liquids.” No significant independent variables affected the scores for “coughing or choking when swallowing,” “suffering from sputum” and “constipation.”

Conclusion: Although DLB patients show many eating problems, the causes of each problem vary, and the severity of dementia or Parkinsonism is not the only determinant.

Background: Although antipsychotic treatment of behavioral problems in dementia is common, studies investigating the course of these symptoms in nursing homes are scarce. Our primary objective is therefore to describe the course of behavioral problems during antipsychotic treatment in a large sample of elderly nursing home patients with dementia.

Methods: The course of behavioral problems during antipsychotic treatment was studied by comparing the characteristics of patients before, during and after antipsychotic treatment. The study was conducted using the VURAIDB, a database with over 40,000 assessments of over 10,000 nursing home residents in the Netherlands. We used the Challenging Behavior Profile (CBP) to measure an overall behavior score.

Results: In total, 556 patients starting with antipsychotics were studied. Of these, 101 (18.2%) improved and 260 (46.8%) deteriorated at three months on the behavior score, compared with their scores before therapy (z = −7.955; P<0.0001). Patients with severe challenging behavior showed improvement more often than patients with mild disturbances. The course of behavioral symptoms after withdrawal was evaluated in 520 patients. Of these patients, 352 (68%) remained stable or improved at 3 months compared with their scores before withdrawal (z = −0.697; p = 0.486), this figure was 58% at 6 months after withdrawal (z = −2.77; p = 0.006).

Conclusions: During treatment of nursing home residents with dementia with antipsychotics the severity of most behavioral problems continues to increase in most patients, with only one out of six patients showing improvement. After withdrawal of antipsychotics, behavioral problems remained stable or improved in 58% of patients.

Background: Socioeconomic status (SES) has been identified as a possible risk factor for the development of dementia, with low SES shown to be associated with a higher prevalence of dementia, increased psychiatric comorbidity and worse baseline cognitive functioning. Few studies have actually looked at the impact of SES within a clinical population using multiple measures of SES and cognition.

Methods: Data on 217 patients seen in an Inner City Memory Disorders Clinic were analyzed with respect to demographic status, clinical status and SES. Correlations were then examined looking at the relationship of SES to clinical variables and neurocognitive status. Regression analysis was undertaken to examine the relative contribution of individual sociodemographic factors to a diagnosis of dementia.

Results: In general, there was wide variation in the sample examined with respect to most measures of SES. Approximately one third (36%) of the sample had a diagnosis of dementia, the mean age was 66.1 years and the mean Mini-mental State Examination score was relatively high (25.4). There was a strong association between age, individual annual income range, education, medical comorbidity and a diagnosis of dementia, with increased age and medical comorbidity being the strongest predictors.

Conclusion: Increased age, low education, high medical comorbidity and low annual income are all associated with a diagnosis of dementia in an inner city setting. Age and medical comorbidity appear to be more strongly associated with a diagnosis of dementia than SES in an inner city setting.

Background: The Mini-mental State Examination (MMSE) is widely used in Japan and the U.S.A. for cognitive screening in the clinical setting and in epidemiological studies. A previous Japanese community study reported distributions of the MMSE total score very similar to that of the U.S.A.

Methods: Data were obtained from the Monongahela Valley Independent Elder's Study (MoVIES), a representative sample of community-dwelling elderly people aged 65 and older living near Pittsburgh, U.S.A., and from the Tajiri Project, with similar aims in Tajiri, Japan. We examined item-by-item distributions of the MMSE between two cohorts, comparing (1) percentage of correct answers for each item within each cohort, and (2) relative difficulty of each item measured by Item Characteristic Curve analysis (ICC), which estimates log odds of obtaining a correct answer adjusted for the remaining MMSE items, demographic variables (age, gender, education) and interactions of demographic variables and cohort.

Results: Median MMSE scores were very similar between the two samples within the same education groups. However, the relative difficulty of each item differed substantially between the two cohorts. Specifically, recall and auditory comprehension were easier for the Tajiri group, but reading comprehension and sentence construction were easier for the MoVIES group.

Conclusions: Our results reaffirm the importance of validation and examination of thresholds in each cohort to be studied when a common instrument is used as a dementia screening tool or for defining cognitive impairment.

Background: Identification of caregiver risk factors associated with psychological elder abuse is crucial for preventing and managing such abuse. The aim of this study was to test the most effective model for explaining caregiver factors contributing to caregiver psychological abuse behavior. We hypothesized that caregiver hours worked each day, years of education, age, geriatric care-giving training, gerontological care knowledge, social resources, and self-reported work stress are factors contributing to psychological abuse behavior of caregivers.

Methods: A cross-sectional study design was used. The sample included a total of 183 caregivers recruited from seven long-term care facilities in southern areas of Taiwan. Instruments included the Caregiver Psychological Elder Abuse Behavior (CPEAB) scale, the Work Stressors Inventory Chinese version (WSI-C), the Personal Resources Questionnaire (PRQ-2000), and Knowledge of Gerontological Nursing Scale (KGNS). The structural equation modeling (SEM) procedure was used to analyze the data.

Results: All the model-fit indexes (χ2 = 87.84, df = 70, p = 0.073; CMIN/DF = 1.26; GFI = 0.94, AGFI =0.91, TLI = 0.96, RMSEA = 0.037) of the final model exceeded their respective common acceptance levels except for the normed fit index (NFI) value (0.88). The study results suggest that caregivers who work fewer hours, received fewer years of education, lack social resources, and had more work stress showed higher levels of psychological abuse behavior in caring for the elderly (p = 0.000–0.037).

Conclusions: These findings should be incorporated into practice by intervening to reduce caregiver stress and reduce elder abuse behaviors. To help reduce elder psychological abuse, caregivers would benefit from stress management and social resource interventions provided by employers or government programs.

Background: General practitioners (GPs) play an important role in dementia care. Sufficient knowledge is one of the prerequisites for adequate dementia management, and educational activities do include knowledge transfer. There is no up-to-date measure of GPs' knowledge of dementia, resulting in the use of unreliable ad hoc questionnaires in recent studies, thus increasing the risk of biased results.

Methods: In a cross-sectional, observational questionnaire study, 292 German GPs answered 37 questions regarding factual dementia knowledge. For the purpose of cross-validation, the psychometric properties of the test and its associations with GP characteristics were analyzed in independent samples with item and regression analyses.

Results: Twenty questions constituted a reliable questionnaire (Cohen's α = 0.733) with a normal distribution of test scores. Linear regression analysis revealed significant associations of the knowledge test score with the GPs' age and their attitudes towards dementia.

Conclusions: The newly developed dementia-knowledge test for GPs can be used in observational studies, in which a rough and easy to use instrument is required.

Objective: The study aimed to assess the clinical utility of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) in patients referred to memory clinics, alone and in combination with the Addenbrooke's Cognitive Examination-Revised (ACE-R) and the Mini-mental State Examination (MMSE).

Methods: This pragmatic prospective study was based on consecutive referrals attending with an informant (n = 144) to two memory clinics over a 12-month period. Patients were diagnosed using standard clinical diagnostic criteria for dementia (DSM-IV) as gold standard (dementia prevalence = 59%). The IQCODE was administered to informants, and the ACE-R and/or MMSE to most patients.

Results: The IQCODE proved acceptable to informants, and was quick and easy to use. Using traditional parameters of diagnostic utility (sensitivity, specificity, positive predictive value, likelihood ratios), the performance of the IQCODE at optimal test accuracy was highly sensitive (0.86) for the diagnosis of dementia but specificity was poor (0.39) with suboptimal positive predictive value (0.67) and small or unimportant likelihood ratios. Overall diagnostic accuracy based on area under the receiver operating characteristic (ROC) curve was 0.71. Combining the IQCODE with either ACE-R or MMSE greatly improved accuracy, specificity and positive predictive value when the tests were used in series, but not when used in parallel.

Conclusion: In a memory clinic based population, the IQCODE proved sensitive for the diagnosis of dementia but overall diagnostic accuracy was suboptimal. Combining the IQCODE in series with the ACE-R or MMSE greatly improved diagnostic utility.

Background: The Mini-mental State Examination (MMSE) is a globally used instrument for cognitive screening, which nevertheless has a bias with respect to education and language. The Indo-U.S. Cross National Epidemiology Study developed a modified version of MMSE, the Hindi Mental State Examination (HMSE), to counter this bias in India among rural and illiterate elderly. Thus, two parallel tests are available for screening the population. This study was conducted to explore and compare the applicability of MMSE and HMSE when scanning for cognitive impairment among urban elderly people.

Methods: The sample consisted of 40 subjects (20 illiterate and 20 literate) aged 60 years and above drawn from the urban community who met the inclusion criteria. A systematically translated Hindi version of MMSE (HVMMSE) was administered to both groups. After one month, HMSE was administered to the same groups. χ2 with Yate's correction, percentage, rank order correlation and qualitative analysis were used to analyze data.

Results: All illiterate subjects scored below the cut-off on translated HVMMSE while only four of them scored below the cut-off on HMSE. Among literate subjects, the translated HVMMSE and HMSE classified three subjects and one subject respectively as having possible cognitive impairment among urban elderlies.

Conclusion: The two instruments are not in agreement with regard to classifying elderly people as having possible cognitive impairment or not. This disagreement is more pronounced in the case of illiterate subjects. The study emphasizes the need to develop a fair cognitive screening instrument for elderly people in India.

Background: The End-of-Life in Dementia (EOLD) scales comprise the most specific set of instruments developed for evaluations of patients' end of life by their families. It is not known whether the EOLD scales are useful for cross-national comparisons.

Methods: We used a mortality follow-back design in multi-center studies in the Netherlands (pilot study 2005–2007) and the U.S.A. (1999), and we compared EOLD Satisfaction With Care (SWC; last three months of life), Symptom Management (SM; last three months) and Comfort Assessment in Dying (CAD) scores for 54 Dutch and 76 U.S. nursing home residents.

Results: SWC total scores did not differ significantly between the Dutch and U.S. studies (31.9, SD 4.7 versus 30.4, SD 6.1), but three of ten items were rated more favorable for Dutch residents, as were SM total scores (29.1, SD 9.2 versus 20.4, SD 10.6). CAD total scores did not differ (32.0, SD 5.4 versus 30.5, SD 5.9, respectively), but the “well-being” subscale was rated more favorably for Dutch residents. Results were similar after adjustment for demographics and dementia severity.

Conclusion: The Dutch families rated end of life with dementia in nursing homes as somewhat better than did U.S. families. Although differences were small, the observed patterns were consistent. This suggests validity of the SM and CAD to assess differences in quality of dying and possible sensitivity to differences between countries or time frames. Larger, simultaneous, cross-national studies are needed to confirm usefulness of the scales and to detect areas which need improvement in the respective countries.

Background: People with a dementia disorder often live in institutional care facilities, particularly when the dementia disorder becomes severe or complicated by various behavioral disturbances. The aim of the present study was to analyze and compare the one-week prevalence of various behavioral symptoms and psychotropic drug treatment among people with cognitive impairment living in institutional care, in two large, comparable samples from 1982 and 2000.

Methods: A comparison was made between two cross-sectional samples, collected in 1982 and 2000 respectively, comprising 3404 participants with cognitive impairment living in geriatric care units in the county of Västerbotten, Sweden. Behavioral symptoms were measured using the Multi-Dimensional Dementia Assessment Scale (MDDAS) and cognition was measured using Gottfries’ cognitive scale.

Results: Eight out of 25 behavioral symptoms had become less common, and six more common, after controlling for demographic changes. Regressive behavior, resistance to care and passiveness became less common, while certain aberrant motor behaviors showed an increased prevalence. Antidepressant drug use increased from 6.8% to 43.2%, antipsychotic drug use decreased from 38.0% to 26.2% and anxiolytics, hypnotic and sedative drug use increased from 12.7% to 38.5%.

Conclusion: One-week prevalence of regressive symptoms and resistance to care had decreased and there were signs of a generally increased activity level among old people with cognitive impairment living in institutional geriatric care in 2000 compared to 1982. These changes may be an effect of the extensive changes in pharmacological treatments and in the organization of institutional geriatric care.

Background: The effects of traumatization among the elderly is a neglected topic in research and clinical settings. Forced displacement of civilians is one of the main traumatic features of modern armed conflict. Roughly 12 million German people were displaced in World War II (WWII) and to our knowledge there has been no representative study investigating the mental health outcomes of such trauma in the elderly population. The survey assessed whether current depression, anxiety, resilience and life satisfaction were significantly associated with forced displacement in WWII.

Methods: A nationwide representative face-to-face household survey was conducted in Germany. A representative sample of the German population aged 61 years or older (N = 1513 participants, N = 239 displaced in WWII) was approached using 258 sample points. Measurements included depressive symptoms (PHQ-2), anxiety (GAD-7), resilience (RS-11), general and domain-specific life satisfaction (FLZM) and sociodemographic variables.

Results: Forced displacement in WWII is significantly associated with higher levels of anxiety and lower levels of resilience and life satisfaction 60 years later. In regression analyses, forced displacement in WWII significantly predicted current anxiety (β 0.07; p < 0.01), life satisfaction (β −0.06; p < 0.05) and resilience (β −0.07; p < 0.01).

Conclusion: To our knowledge this is the first nationwide representative survey to examine the late-life effects of forced displacement, particularly of persons displaced during WWII in Germany. Further research is needed to identify mediating variables and to evaluate psychotherapeutic interventions in elderly trauma survivors.

Background: Whilst previous surveys of mental health literacy of general practitioners (GPs) have shown high rates of recognition of common mental disorders, few studies have been carried out into GPs' understanding of presentations in late life. This study aims to determine GPs' recognition of mental disorders in older people, their intentions regarding investigation, specialist referral and treatment, and their beliefs about prognosis.

Methods: Australian GPs who attended an educational seminar were administered questions based on clinical vignettes describing older people with depression, dementia and coronary heart disease.

Results: There was a high rate of recognition of all disorders amongst the 436 respondents. GPs demonstrated a high level of consistency about screening questionnaires, investigations and specialist referral in the dementia vignette. In contrast, less than half of GPs endorsed using a screening questionnaire or neuroimaging, and considered referral to a variety of medical specialties in the depression vignette. For both the depression and dementia vignettes, self-help treatments like walking, dietary advice or alcohol reduction were endorsed more frequently than an antidepressant or cholinesterase inhibitor respectively. Dementia tended to be viewed as having a poor prognosis, and late-life depression a moderate prognosis.

Conclusions: Actual or intended rates of diagnostic recognition, specialist referral and benzodiazepine prescription found in this study may not translate into clinical practice for a number of reasons. Non-specific treatments without a clear evidence base were considered as often as those with a stronger evidence base. There is a need to improve the knowledge of GPs with regard to screening and investigating late life depression and managing dementia.

Background: Alzheimer's drugs are believed to have limited availability and to be unaffordable in low- and middle-income countries compared to high-income countries. The price, availability and affordability of Alzheimer's drugs have not been reported before.

Methods: During 2007 an international survey was conducted in 21 countries in six continents (Argentina, Australia, Brazil, the Dominican Republic, France, India, Japan, Macedonia, Mexico, New Zealand, Nigeria, the Philippines, Portugal, Serbia, South Korea, Switzerland, Taiwan, Thailand, Uganda, the U.K. and the U.S.A.). Prices of Alzheimer's drugs were compared using the affordability index (the total number of units purchasable with one's daily income) derived from purchasing power parity (PPP) converted prices as well as raw prices.

Results: Donepezil is available in all 21 countries, whereas the newer drugs are less available. A 5 mg tablet of branded originator donepezil costs just US$0.26 in India and US$0.31 in Mexico, whereas it costs US$6.64 in the U.S.A. Pricing conditions of rivastigmine, galantamine and memantine appear to be similar to that of donepezil. The cheapest branded originators are from India and Mexico. However, in terms of PPP, Alzheimer's drugs in other low- and middle-income countries are much more expensive than in high-income countries. Most people in low- and middle-income countries cannot afford Alzheimer's drugs.

Conclusions: Alzheimer's drugs, albeit available, are often unaffordable for those who need them most. It is hoped that equitable differential pricing will be applied to Alzheimer's drugs.

Background: The objective of this study was to examine the prevalence and short-term course of depression and anxiety in a sample of hospitalized, medically unwell older adults, using both a symptom measure and a diagnostic instrument.

Methods: One hundred participants were recruited from in-patients in a geriatric hospital in Melbourne, Australia. Anxiety and depression were assessed shortly after admission, and again two months later, using the Hospital Anxiety and Depression Scale (HADS) and the Geriatric Mental Status Schedule/ AGECAT diagnostic system.

Results: At Time 1, 60% of the sample exhibited anxiety symptoms at a sub-case level, while 16% had anxiety symptoms at a syndrome case level, whereas 48% of the participants had depression at syndrome level. The HADS and AGECAT were concordant with respect to anxiety for 78% of participants, but agreement was lower for depression; AGECAT identified a further 36 syndrome cases of depression not deemed depressed by the HADS. There was a significant decrease in overall rates of both depression and anxiety symptoms and syndromes from Time 1 to Time 2.

Conclusion: This study confirms the findings of previous research with respect to the high prevalence of depression in physically unwell older adults, and extends knowledge about anxiety in this group. Symptoms of anxiety are even more common than symptoms of depression in this group, especially around the time of admission to hospital. Over a relatively short time period, there is a marked reduction in symptoms, but levels of anxiety and depression remain high.