Research Article
Hippocampal and amygdala volumes in an older bipolar disorder sample
- Chanaka Wijeratne, Sonal Sachdev, Wei Wen, Olivier Piguet, Darren M. Lipnicki, Gin S. Malhi, Phillip B. Mitchell, Perminder S. Sachdev
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- Published online by Cambridge University Press:
- 29 August 2012, pp. 54-60
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Background: Brain volumetric magnetic resonance imaging (MRI) studies of adult bipolar disorder samples, compared with healthy controls, have reported conflicting results in hippocampal and amygdala volumes. Among these, few have studied older bipolar samples, which would allow for examination of the effects of greater duration in mood episodes on brain volumes. The aim of this study was to compare hippocampal and amygdala volumes in older bipolar patients with controls.
Methods: High-resolution MRI scans were used to determine hippocampal and amygdala volumes that were manually traced using established protocols in 18 euthymic patients with DSM-IV bipolar I disorder (mean age 57 years) and 21 healthy controls (mean age 61 years). Analysis of covariance (ANCOVA) was used to explore group differences while controlling for intracranial volume (ICV), age, sex, and years of education.
Results: While gray matter, white matter, and cerebrospinal fluid volumes did not differ between the groups, bipolar disorder patients had smaller ICV (t = 2.54, p = 0.015). After correcting for ICV, the bipolar group had smaller hippocampal (left hippocampus F = 13.944, p = 0.001; right hippocampus F = 10.976, p = 0.002; total hippocampus F = 13.566; p = 0.001) and right amygdala (F = 13.317, p = 0.001) volumes. Total hippocampal volume was negatively associated with the duration of depressive (r = −0.636; p = 0.035) and manic (r = −0.659; p = 0.027) episodes, but not lithium use. Amygdala volumes were not associated with the duration of mood episodes.
Conclusions: Older bipolar disorder patients had smaller hippocampal and amygdala volumes. That smaller hippocampal volume was associated with the duration of mood episodes may suggest a neuroprogressive course related to the severity of the disorder.
Clinical outcomes of older depressed patients with and without comorbid neuroticism
- David C. Steffens, Douglas R. McQuoid, Moria J. Smoski, Guy G. Potter
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- 13 August 2013, pp. 1985-1990
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Background:
Neuroticism is a psychological construct that includes tendency to exhibit negative affect (NA), having poor stress tolerance and being at risk for depression and anxiety disorders. The consequences of neuroticism in the elderly adults are understudied. We hypothesized that older depressed patients with comorbid neuroticism at baseline would have worse mood and cognitive outcomes compared with older depressed patients without neuroticism.
Methods:One hundred and ten older depressed adults completed baseline self-reports of depression and the NEO-Personality Inventory as a measure of neuroticism, were administered a battery of cognitive tests annually and were seen by a study psychiatrist who assessed patients using the Montgomery Åsberg Depression Rating Scale (MADRS) and treated patients with antidepressants using an established treatment guideline. Patients were followed as clinically indicated for up to three years. We measured remission (defined as MADRS score ≤ 6) rates at one year as a categorical outcome. In addition, we used Cox proportional hazard models to examine the relationship between neuroticism and change in MADRS and cognitive score over time.
Results:Non-remitters (30%) at one year had higher scores in total neuroticism (TN), vulnerability to stress (VS), and NA. Over three years, time to achieve remission was associated with higher TN, higher VS, and greater NA. In analyses controlling for baseline cognitive score, age, sex, and education, VS was associated with baseline to two-year change in cognition.
Conclusions:Presence of neuroticism in older depressed patients treated with medication is associated with poor mood outcomes and may indicate increased risk of cognitive decline.
Adaptation and analysis of psychometric features of the Caregiver Risk Screen: a tool for detecting the risk of burden in family caregivers
- Silvia Martinez-Rodriguez, Nuria Ortiz-Marqués, Ioseba Iraurgi, María Carrasco, José J. Miguel
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- 07 February 2013, pp. 755-764
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Background: There are a limited number of scales available in the Spanish language that can be used to detect burden among individuals who care for a dependent family member. The purpose of this work was to adapt and validate the Caregiver Risk Screen (CRS) scale developed by Guberman et al. (2001) (Guberman, N., Keefe, J., Fancey, P., Nahmiash, D. and Barylak, L. (2001). Development of Screening and Assessment Tools for Family Caregivers: Final Report. Montreal, Canada: Health Transition Fund).
Methods: The sample was made up of 302 informal caregivers of dependent family members (average age 57.3 years, and 78.9% were women). Scale structure was subjected to a confirmatory factor analysis. Concurrent and convergent validity were assessed by correlation with validated questionnaires for measuring burden (Zarit Burden Inventory (ZBI)) and psychological health (SCL-90-R).
Results: The results show a high level of internal consistency (Cronbach's alpha = 0.86), suitable fit of the one-dimensional model tested via confirmatory factor analysis (GFI = 0.91; CFI = 0.91; RMSEA = 0.097), and appropriate convergent validity with similar constructs (r = 0.77 with ZBI; and r-values between 0.45 and 0.63 with SCL-90-R dimensions).
Conclusions: The findings are promising in terms of their adaptation of the CRS to Spanish, and the results enable us to draw the conclusion that the CRS is a suitable tool for assessing and detecting strain in family caregivers. Nevertheless, new research is required that explores all the psychometric features on the scale.
Quality of life in dementia: the role of non-cognitive factors in the ratings of people with dementia and family caregivers
- Maria Fernanda Barroso Sousa, Raquel Luiza Santos, Cynthia Arcoverde, Pedro Simões, Tatiana Belfort, Isabel Adler, Camila Leal, Marcia Cristina Nascimento Dourado
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- 08 April 2013, pp. 1097-1105
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Background: The validity of self-reported quality-of-life (QoL) assessments of people with dementia (PWD) is a critical issue. We designed this study to determine the non-cognitive factors that are associated with self-reported QoL and PWD QoL as rated by family caregivers.
Methods: Using a cross-sectional study, we assessed QoL of 41 people with mild Alzheimer's disease (AD). The individuals with AD and their family caregivers completed the Quality of Life in Alzheimer's Disease Scale (QoL-AD), the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), the Mini-Mental State Examination (MMSE), the Clinical Dementia Rating (CDR) scale, the Cornell Scale for Depression in Dementia (CSDD), the Pfeffer Functional Activities Questionnaire (FAQ), and the Zarit Burden Interview (ZBI). Univariate and multivariate regression analyses were conducted to examine the contribution of the various cofactors.
Results: We observed a significant difference (t = 3.292, p < 0.01, d = 0.727) in the QoL measures of PWD after comparing self-reported assessments with the assessments of family caregivers. Linear regression analysis demonstrated that awareness of disease was related to PWD QoL-AD scores. Both the education levels of family caregivers and the depressive symptoms in PWD were related to the family caregivers’ ratings of PWD QoL.
Conclusions: The difference between self-reported QoL and family caregivers’ ratings of QoL in people with mild dementia indicated that cognitive impairment was not the primary factor that accounted for the differences in the QoL assessments. Our findings suggested that non-cognitive factors, such as awareness of disease and depressive symptoms, played an important role in the differences between the self-reported AD QoL ratings and the caregivers’ AD QoL ratings. A major implication is that discrete measures such as cognition or level of function are likely to miss important factors that influence QoL.
Clinical and demographic covariates of chronic opioid and non-opioid analgesic use in rural-dwelling older adults: the MoVIES project
- Jordan F. Karp, Ching-Wen Lee, Jonathan McGovern, Gary Stoehr, Chung-Chou H. Chang, Mary Ganguli
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- 24 July 2013, pp. 1801-1810
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Background:
To describe covariates and patterns of late-life analgesic use in the rural, population-based MoVIES cohort from 1989 to 2002.
Methods:Secondary analysis of epidemiologic survey of elderly people conducted over six biennial assessment waves. Potential covariates of analgesic use included age, gender, depression, sleep, arthritis, smoking, alcohol, and general health status. Of the original cohort of 1,681, this sample comprised 1,109 individuals with complete data on all assessments. Using trajectory analysis, participants were characterized as chronic or non-chronic users of opioid and non-opioid analgesics. Multivariable regression was used to model predictors of chronic analgesic use.
Results:The cohort was followed for mean (SD) 7.3 (2.7) years. Chronic use of opioid analgesics was reported by 7.2%, while non-opioid use was reported by 46.1%. In the multivariable model, predictors of chronic use of both opioid and non-opioid analgesics included female sex, taking ≥2 prescription medications, and “arthritis” diagnoses. Chronic opioid use was also associated with age 75–84 years; chronic non-opioid use was also associated with sleep continuity disturbance.
Conclusions:These epidemiological data confirm clinical observations and generate hypotheses for further testing. Future studies should investigate whether addressing sleep problems might lead to decreased use of non-opioid analgesics and possibly enhanced pain management.
COST: Cognitive State Test, a brief screening battery for Alzheimer disease in illiterate and literate patients
- Gulsen Babacan-Yildiz, Ahmet T. Isik, Emel Ur, Emine Aydemir, Can Ertas, Merve Cebi, Pinar Soysal, Esra Gursoy, Mehmet Kolukisa, Gulsen Kocaman, Arif Celebi
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- 09 November 2012, pp. 403-412
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Background: The aim was to develop a brief screening battery, Cognitive State Test (COST), for detecting the presence of dementia in both illiterate and literate patients and to assess its validity and reliability.
Methods: COST is a cognitive screening tool that consists of almost all cognitive domains. It takes 5–7 minutes to administer, and has a maximum score of 30. Data were obtained from 114 healthy volunteers and 74 Alzheimer dementia (AD) patients. Subjects’ age divided into two groups: A1: <65 years; and A2: ≥65 years and their education level divided into three groups: E1: illiterate; E2: 1–5 years; and E3: ≥6 years. For assessing concurrent validity, total COST score was compared to the Clinical Dementia Rating (CDR), the Mini Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and Basic Activities of Daily Living (BADL). Sensitivity and specificity were determined through a discriminant analysis using the Receiver Operating Characteristic (ROC) curves. Internal consistency was measured using Cronbach's coefficient α.
Results: For normal and AD subjects, mean age was 64.9±9.8 years (50 women and 64 men) and 67.2±13.2 years (55 women and 19 men), respectively. Schooling ranged from 0–15 years (mean 5.7±4.2 and 3.3±3.8 years, respectively), and 21 and 37 subjects were illiterate, respectively. The COST significantly and positively correlated with MMSE and MoCA, and significantly and inversely correlated with CDR, the Geriatric Depression Scale (GDS), and BADL. In the E1, E2, and E3 education groups, the optimal cut-off points of COST chosen for diagnosis of AD were 23/24 (sensitivity: 81%, specificity: 99%), 24/25 (sensitivity: 75%, specificity: 86%), and 26/27 (sensitivity: 77%, specificity: 84%), respectively. When illiterate and literate subjects were then pooled, the optimal cut-off score of COST was 24/25, which yielded a sensitivity of 81% and a specificity of 87%. Reliability of the COST was good (0.86).
Conclusion: The COST is a valid and reliable screening battery for detection of dementia both in the illiterate and the literate Alzheimer patients.
Special Issue Research Articles
Framing abuse: explaining the incidence, perpetuation, and intervention in elder abuse
- Yuliya Mysyuk, Rudi G. J. Westendorp, Jolanda Lindenberg
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- 07 January 2013, pp. 1267-1274
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Background: The role of individual characteristics in incidences of elder abuse has long been highest on research and policy agendas. Now, it is timely to discuss factors that go beyond victim and perpetrator. Environmental factors also play an important role in elder abuse. In this paper, we address the framing of elder abuse as a social and health problem. Attention is paid to the factors that influence societal context and the healthcare system, its organization, structure, and principles.
Methods: Focus groups and in-depth semi-structured interviews were held with different professionals and older people themselves. Qualitative analysis of focus groups and interviews transcripts was performed to analyze how different professional groups and older persons themselves view elder abuse, to determine opinions and attitudes toward elder abuse and the necessary actions that should be taken to prevent or intervene in the problem.
Results: Two main explanatory frameworks emerged in the discourse of older persons and care professionals: social arrangements and healthcare system. The themes within the social arrangements included social taboo, social control and responsibility, and institutional cultures. The fragmentation of care and changes in the financing of healthcare were two aspects distinguished within the framework of the healthcare system.
Conclusion: Two explanatory frameworks showed elder abuse as both a social and health problem. The environmental factors through social arrangements and healthcare system have an influence on framing of abuse. The different ways of framing abuse impact the understanding of abuse, ways of intervention, and prevention measures.
Research Article
Venous thromboembolism in psychogeriatric in-patients – A study of risk assessment, incidence, and current prophylaxis prescribing
- Xinsheng Liu, Fintan O'Rourke, Huong Van Nguyen
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- 21 February 2013, pp. 913-917
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Background: While venous thromboembolism (VTE) risk assessment and prophylaxis is well established for medical and surgical in-patients, there is a paucity of evidence, and therefore guidelines, in this area for psychogeriatric in-patients. We wished to determine VTE incidence, risk, and use of prophylaxis, in a psychogeriatric in-patient population.
Methods: Retrospective audit of consecutive psychogeriatric patients aged 65 years and over admitted to Bankstown Hospital over a 3-year period, 2007–2009. Using an adapted VTE risk scoring system, patients were assigned as low, medium, or high VTE risk.
Results: A total of 192 patients were included in the study. Mean age was 79.1 ± 7.0 years. Out of the total, 55.2% of patients had diagnosis of dementia, and 33.3% had depression. Overall, 81.8% (157/192) were assessed as low risk, and 18.2% (35/192) as medium risk. Also, 16.7% (32/192) received VTE prophylaxis.
Four new VTE events occurred in medium-risk group, and one in low-risk group (p = 0.004). Overall VTE incidence was 10.5/10,000 patient-days, but 44.2 per 10,000 in medium-risk group. VTE risk score was predictive of VTE events – IRR 6.02 (95% Confidence Intervals (CI) = 1.76–20.7, p = 0.004) for every one-point increment in risk. Depression was associated with significantly higher VTE occurrence (6.3% in those with diagnosis vs. 0.8% without, p = 0.043).
Conclusion: Using a VTE risk scoring system adapted for psychogeriatric in-patients, those assessed to be at medium risk had a significantly increased rate of VTE. On this basis, we would recommend VTE prophylaxis be prescribed for psychogeriatric in-patients assessed to be at medium and high level of risk.
Predictors of agreement between general practitioner detection of dementia and the revised Cambridge Cognitive Assessment (CAMCOG-R)
- C. Dimity Pond, Karen E. Mate, Jill Phillips, Nigel P. Stocks, Parker J. Magin, Natasha Weaver, Henry Brodaty
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- 26 June 2013, pp. 1639-1647
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Background:
Dementia is a complex and variable condition which makes recognition of it particularly difficult in a low prevalence primary care setting. This study examined the factors associated with agreement between an objective measure of cognitive function (the revised Cambridge Cognitive Assessment, CAMCOG-R) and general practitioner (GP) clinical judgment of dementia.
Methods:This was a cross-sectional study involving 165 GPs and 2,024 community-dwelling patients aged 75 years or older. GPs provided their clinical judgment in relation to each of their patient's dementia status. Each patient's cognitive function and depression status was measured by a research nurse using the CAMCOG-R and the 15-item Geriatric Depression Scale (GDS), respectively.
Results:GPs correctly identified 44.5% of patients with CAMCOG-R dementia and 90% of patients without CAMCOG-R dementia. In those patients with CAMCOG-R dementia, two patient-dependent factors were most important for predicting agreement between the CAMCOG-R and GP judgment: the CAMCOG-R score (p = 0.006) and patient's mention of subjective memory complaints (SMC) to the GP (p = 0.040). A higher CAMCOG-R (p < 0.001) score, female gender (p = 0.005), and larger practice size (p < 0.001) were positively associated with GP agreement that the patient did not have dementia. Subjective memory complaints (p < 0.001) were more likely to result in a false-positive diagnosis of dementia.
Conclusions:Timely recognition of dementia is advocated for optimal dementia management, but early recognition of a possible dementia syndrome needs to be balanced with awareness of the likelihood of false positives in detection. Although GPs correctly agree with dimensions measured by the CAMCOG-R, improvements in sensitivity are required for earlier detection of dementia.
Engagement in social activities and progression from mild to severe cognitive impairment: the MYHAT study
- Tiffany F. Hughes, Jason D. Flatt, Bo Fu, Chung-Chou H. Chang, Mary Ganguli
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- 21 December 2012, pp. 587-595
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Background: It is of considerable public health importance to prevent or delay the progression of mild cognitive impairment (MCI) to more severely impaired cognitive states. This study examines the risk of progression from mild to severe cognitive impairment in relation to engagement in social activities while mildly impaired and the concurrence of subsequent change in engagement with MCI progression.
Methods: Participants were 816 older adults with cognitively defined MCI (mean age 78.0 (standard deviation or SD = 7.4) years) from the Monongahela–Youghiogheny Healthy Aging Team (MYHAT) Study – a prospective cohort study of MCI in the community. Over three years of follow-up, 78 individuals progressed from MCI to severe cognitive impairment, while 738 did not progress. Risk of progression was estimated using discrete time survival analyses. The main predictors were standardized composite measures of the variety and frequency of engagement in social activities.
Results: Lower risk of progression from mild to severe cognitive impairment was associated with both a greater level of frequency of engagement in social activities while mildly impaired (OR = 0.72, 95% CI: 0.55–0.93, p = 0.01) and also with a slower rate of decline in the variety of activities over time (OR = 0.01, 95% CI: <0.001–0.38, p = 0.02).
Conclusions: Greater engagement in social activities may potentially be beneficial for preventing or delaying further cognitive decline among older adults with MCI. Alternatively, lesser engagement in social activities may be a marker of impending cognitive decline in MCI.
Review Article
Do changes in coping style explain the effectiveness of interventions for psychological morbidity in family carers of people with dementia? A systematic review and meta-analysis
- Ryan Li, Claudia Cooper, Allana Austin, Gill Livingston
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- 22 October 2012, pp. 204-214
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Background: Observational studies find that family carers of people with dementia who use more emotional support and acceptance-based coping, and less dysfunctional coping, are less depressed and anxious. We hypothesized that interventions effective in reducing psychological symptoms would increase emotional support and acceptance-based coping, or decrease dysfunctional coping.
Methods: We systematically reviewed randomized controlled trials published up to July 2011, of interventions for carers of people with dementia measuring coping and psychological morbidity. We rated study validity and reported findings. We conducted fixed-effect meta-analyses for interventions where possible.
Results: Eight of 433 papers identified by the search met inclusion criteria. All measured coping immediately after intervention. Two interventions significantly decreased depressive or anxiety symptoms: the smaller study found no change in dysfunctional coping. Neither measured emotional support and acceptance-based coping. Meta-analysis found that both group coping skills interventions alone (SMD = −0.39, 95% CI = −0.75 to −0.03, p = 0.04) and with behavioral activation (SMD = −0.26, 95% CI = −0.48 to −0.04, p = 0.02) significantly increased dysfunctional coping, while significantly reducing depressive symptoms. Positive coping (a mix of emotional and solution-focused strategies) increased (SMD = 0.28, 95% CI = 0.05–0.51, p = 0.02) with group coping skills interventions and behavioral activation.
Conclusions: Contrary to our hypothesis, dysfunctional coping increased when carer depressive symptoms improved. There was preliminary evidence that emotional support and acceptance-based coping increased, as positive coping increased although solution-focused coping alone did not. More research is needed to elucidate whether successful interventions work through changing coping strategies immediately and in the longer term.
Front Cover (OFC, IFC) and matter
IPG volume 25 issue S1 Cover and Front matter
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- 10 January 2014, pp. f1-f2
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Research Article
The impact of neuropsychiatric symptoms on caregiver distress and quality of life in persons with dementia in an Asian tertiary hospital memory clinic
- S. A. Khoo, T. Y. Chen, Y. H. Ang, P. Yap
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- 09 September 2013, pp. 1991-1999
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Background:
This study aims to determine the prevalence, profile, and severity of neuropsychiatric symptoms (NPS) across the dementia continuum and their relative impact on caregiver distress and quality of life (QoL) in persons with dementia (PWD).
Method:Six hundred and sixty-seven PWD and their family caregivers presented to a memory clinic in a tertiary hospital across a 60-month period. Clinicians determined the dementia diagnosis and severity using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition and the Clinical Dementia Rating scale, respectively. The Neuropsychiatric Inventory Questionnaire was administered to assess NPS in PWD and the corresponding distress experienced by the caregiver. QoL for PWD (PWD-QoL) was assessed by the Quality of Life–Alzheimer's Disease scale.
Results:Ninety-six percent of PWD presented with at least one NPS, 18% experiencing mild, 31% moderate, and 47% severe symptoms, respectively. While agitation (63.1%), apathy (61.8%), depression (55.5%), and irritability (55.5%) were the most common NPS; disinhibition (35.2%), hallucination (25.5%), and elation (14.2%) were the least common. NPS increased generally but differentially as dementia progressed and significantly predicted caregiver distress (ηp2 = 0.732, p < 0.0001) and PWD-QoL (ηp2 = 0.066, p < 0.0001). Factor analysis revealed two NPS clusters, disruptive and affective; the former exerting greater impact on caregiver distress and the latter on PWD-QoL.
Conclusion:The results show a high prevalence of NPS which increase caregiver distress and negatively impact PWD-QoL. The differential profile of NPS across the dementia stages warrants stage-specific interventions and due consideration in resource planning and service design for PWD and their caregivers.
Effects of education on the progression of early- versus late-stage mild cognitive impairment
- Byoung Seok Ye, Sang Won Seo, Hanna Cho, Seong Yoon Kim, Jung-Sun Lee, Eun-Joo Kim, Yunhwan Lee, Joung Hwan Back, Chang Hyung Hong, Seong Hye Choi, Kyung Won Park, Bon D. Ku, So Young Moon, SangYun Kim, Seol-Heui Han, Jae-Hong Lee, Hae-Kwan Cheong, Duk L. Na
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- Published online by Cambridge University Press:
- 04 December 2012, pp. 597-606
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Background: Highly educated participants with normal cognition show lower incidence of Alzheimer's disease (AD) than poorly educated participants, whereas longitudinal studies involving AD have reported that higher education is associated with more rapid cognitive decline. We aimed to evaluate whether highly educated amnestic mild cognitive impairment (aMCI) participants show more rapid cognitive decline than those with lower levels of education.
Methods: A total of 249 aMCI patients enrolled from 31 memory clinics using the standard assessment and diagnostic processes were followed with neuropsychological evaluation (duration 17.2 ± 8.8 months). According to baseline performances on memory tests, participants were divided into early-stage aMCI (−1.5 to −1.0 standard deviation (SD)) and late-stage aMCI (below −1.5 SD) groups. Risk of AD conversion and changes in neuropsychological performances according to the level of education were evaluated.
Results: Sixty-two patients converted to AD over a mean follow-up of 1.43 years. The risk of AD conversion was higher in late-stage aMCI than early-stage aMCI. Cox proportional hazard models showed that aMCI participants, and late-stage aMCI participants in particular, with higher levels of education had a higher risk of AD conversion than those with lower levels of education. Late-stage aMCI participants with higher education showed faster cognitive decline in language, memory, and Clinical Dementia Rating Sum of Boxes (CDR-SOB) scores. On the contrary, early-stage aMCI participants with higher education showed slower cognitive decline in MMSE and CDR-SOB scores.
Conclusions: Our findings suggest that the protective effects of education against cognitive decline remain in early-stage aMCI and disappear in late-stage aMCI.
Special Issue Research Articles
The dark side of family communication: a communication model of elder abuse and neglect
- Mei-Chen Lin, Howard Giles
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- Published online by Cambridge University Press:
- 07 February 2013, pp. 1275-1290
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To further address the potential factors that lead up to elder abuse in domestic settings, this paper proposes a model from a communication approach to explain dyadic influences between the family caregiver and the elderly care receiver that give rise to the abuse. That is, dysfunctional communication between the caregivers and care receivers may, therefore, increase the likelihood of elder abuse. Grounded in Bugental and her colleagues’ work (1993, 1999, 2002) on child abuse, we propose a power-oriented communication model based, in part, on research in the fields of family violence and intergenerational communication to explain the likelihood of occurrence of elder abuse in family caregiving situations. We argue that certain risk factors pertaining to caregivers’ characteristics – those who perceive high stress in caregiving, have mental health issues, have a history of substance abuse, and/or display verbal aggressiveness – may be more likely to attribute considerable power to those elderly under their custodianship. At the same time, such caregivers tend to feel powerless and experience loss of control when interacting with their elderly counterparts. When an elderly care receiver displays noncompliant behaviors, caregivers may be prone to employ abusive behaviors (in our model, it refers to physical abuse, verbal abuse, or communication neglect) to seek such compliance. Consequences of such abuse may result in lower self-esteem or lower confidence in one's ability to manage his/her life. It is suggested that researchers and practitioners investigate both parties’ interactions closely and the role of elderly care receivers in order to detect, intervene, and prevent elder abuse.
Research Article
Decision-making deficits in normal elderly persons associated with executive personality disturbances
- Christopher M. Nguyen, Joseph Barrash, Anna L. Koenigs, Antoine Bechara, Daniel Tranel, Natalie L. Denburg
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- 02 August 2013, pp. 1811-1819
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Background:
The problems that some community-dwelling elderly persons develop in real-world decision-making may have disastrous consequences for their health and financial well-being. Investigations across the adult life span have identified personality as an important individual differences variable that is related to decision-making ability. The aim of this study was to investigate the relationship between personality characteristics, as rated by an informant, and complex decision-making performance among elderly persons. It was hypothesized that deficits in decision-making would be associated with personality characteristics reflecting weak executive functioning (Lack of Planning, Poor Judgment, Lack of Persistence, Perseveration, Lack of Initiative, Impulsivity, and Indecisiveness).
Methods:Fifty-eight elderly persons participated. Their health and cognitive status were deemed intact via comprehensive neuropsychological evaluation. The Iowa Scales of Personality, completed by an informant, was used to assess personality characteristics, and the Iowa Gambling Task, completed by the participant, was used to assess complex decision-making abilities.
Results:Longstanding disturbances in executive personality characteristics were found to be associated with poor decision-making, and these disturbances remained predictive of poor decision-making even after taking into consideration demographic, neuropsychological, and mood factors. Acquired personality disturbances did not add significantly to prediction after longstanding disturbances were taken into account. Disturbances in other dimensions of personality were not significantly associated with poor decision-making.
Conclusions:Our study suggests that attentiveness to the personality correlates of difficulties with aspects of executive functioning over the adult years could enhance the ability to identify older individuals at risk for problems with real-world decision-making.
Service-related needs of older people with dementia: perspectives of service users and their unpaid carers
- Sylwia Górska, Kirsty Forsyth, Linda Irvine, Donald Maciver, Susan Prior, Jacqueline Whitehead, Janice Flockhart, Jane Fairnie, Jenny Reid
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- 27 March 2013, pp. 1107-1114
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Background: Dementia is a major cause of disability among older people and constitutes one of the greatest challenges currently facing families and health and social care services in the developed world. In response to trends in dementia prevalence and the impact the condition has on peoples’ lives, dementia care has been placed high on the public and political agenda in the United Kingdom. However, despite significant public resources being allocated to combat the impact of the disease, recent evidence indicates that numerous challenges in relation to service provision remain. This study aimed to develop a deeper understanding of the lived experience of people with dementia regarding their service-related needs.
Method: The study made use of data gathered through individual semi-structured, narrative interviews conducted with persons with experience of dementia and their unpaid carers.
Results: Although participants were generally satisfied with the services they received, a number of unmet needs related to service provision were identified. In terms of diagnostic procedures the findings of this study indicate the need for early diagnosis delivered through a comprehensive assessment package. The participants also highlighted the need for well-coordinated post-diagnostic support, greater continuity of care concerning the personnel involved, and enhanced access to non-pharmacological interventions to support identity and social engagement.
Conclusion: This study contributes to a better understanding of service-related needs of people with dementia in relation to diagnostic procedures and post-diagnostic support.
Perspectives of the community-based dementia care workforce: “occupational communion” a key finding from the Work 4 Dementia Project
- Kate-Ellen J. Elliott, Christine M. Stirling, Angela J. Martin, Andrew L. Robinson, Jennifer L. Scott
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- Published online by Cambridge University Press:
- 25 January 2013, pp. 765-774
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Background: Community care workers’ experience of delivering support to people with dementia is less researched than that of residential workers. The purpose of the study is to explore community-based dementia care workers’ perspectives about their roles and the contextual variables that impact upon their work experiences.
Method: A qualitative design was employed. Twenty-five community dementia care workers (average age 53 years, majority female and employed casually) participated in standardized semi-structured interviews about their job roles, training, employer agenda, organizational support, and intention to stay. A deductive approach to Interpretive Phenomenological Analysis was adopted to identify key themes.
Results: Three themes highlighted workers’ experiences. Occupational communion described strong attachment to clients and a desire for greater connection with colleagues. Job demands described the challenges of work, which varied with intensity. Job resources ranged from positive (strong organizational commitment) to negative (poor pay and conditions). Occupational communion was identified as a concept that exists at the interface between social and organization psychology that was perceived to be essential for adaptive coping. Identifying themes informed a conceptual model for designing intervention components aimed at improving workers’ skills, capabilities, and employer supportive functions.
Conclusion: Occupational communion may be particularly relevant for women's caring careers and future research is needed to explore the relevance of this concept for men. To determine reliable change associated with interventions that target occupational communion, further investigation is required in relation to measurement approaches.
Validation of the General Practitioner Assessment of Cognition – Chinese version (GPCOG-C) in China
- Xia Li, Shifu Xiao, Yuan Fang, Minjie Zhu, Tao Wang, Katrin Seeher, Henry Brodaty
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- Published online by Cambridge University Press:
- 09 July 2013, pp. 1649-1657
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Background:
To assess the reliability, validity, and diagnostic utility of the Chinese version of General Practitioner Assessment of Cognition (GPCOG-C). The GPCOG, which is specifically designed for use in primary care to screen for cognitive impairment, consists of a patient section testing cognition, and an informant section asking about decline in cognitive and functional abilities.
Methods:The English version of GPCOG was translated, back-translated, and subsequently revised to determine the final GPCOG-C. Our sample comprised 253 community-dwelling volunteers with memory concerns aged 50 years and over and 103 outpatients of a psychogeriatric clinic with memory complaints. Participants were assessed by one of the four general practitioners or six psychogeriatricians. The Mini-Mental State Examination (MMSE), the Hasegawa's Dementia Scale (HDS), and the GPCOG-C were compared against the DSM-IV-defined dementia diagnosis.
Results:The internal consistency (Cronbach's α) was 0.68 for the GPCOG patient section. The test–retest was 0.98 for the GPCOG-C total. The sequential administration of both components of GPCOG-C had a sensitivity of 97% and a specificity of 89%, with a positive predictive value of 72% and a negative predictive value of 99%. Both the GPCOG-C total and sequential two-stage scoring methods performed at least well as the MMSE and HDS in detecting dementia. The administration time for the two-stage approach was 4.3 ± 2.4 min.
Conclusions:The GPCOG-C is a valid, time efficient instrument for dementia screening in China.
Assessing mental well-being in family carers of people with dementia using the Warwick–Edinburgh Mental Well-Being Scale
- Vasiliki Orgeta, Elena Lo Sterzo, Martin Orrell
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- Published online by Cambridge University Press:
- 19 June 2013, pp. 1443-1451
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- Article
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Background:
Understanding and measuring mental health and well-being among carers of people with dementia has become an important public health issue.
Methods:In the present study we used the Warwick–Edinburgh Mental Well-Being Scale (WEMWBS) to identify predictors of positive mental health in a convenience sample of family carers of people with dementia using a cross-sectional design.
Results:WEMWBS showed a negative correlation with anxiety and depressive symptoms, and a positive correlation with physical health status. Regression analyses indicated that overall nearly 70% of the variance in mental well-being in carers could be attributed to caregiver's age, physical health, stress specific to caregiving, and social support. Preliminary data show that the WEMWBS demonstrates strong internal consistency. Confirmatory factor analysis demonstrated one underlying factor of positive mental well-being.
Conclusions:WEMWBS is a psychometrically strong measure of mental well-being, and can be used to identify factors that promote positive mental health in family carers of people with dementia. Current results provide preliminary data supporting the usefulness of the scale as an overall indicator of population mental health and well-being for carers of people with dementia.