9 results
P119: The Valladolid Multicenter Study: The Use of Benzodiacepines in the Elderly and Falls Reported By a Liaison Psychiatry Units
- Mª Desamparados D. Perez Lopez, Elena Alonso, Alejandro Compared Sanchez, Eduardo Delgado Parada, Miguel Alonso Sánchez, Leire Narvaiza Grau, Monica Prat Galbany, Andrea Santoro, Maria Iglesias Gonzalez, Cristina Pujol Riera, Eduardo Fuster Nacher
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- Journal:
- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, pp. 172-173
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Objective:
The objective of this study is to describe the prevalence of benzodiazepine in a sample of patients (≥65 years) attended by liaison psychiatry units (LPU) in Spain and its possible relation to falls.
Methods:This is an observational., cross-sectional, multicenter study. We obtained data from a sample of 165 patients (≥65 years) admitted to 7 general hospitals in Spain referred from different departments to each liaison psychiatry unit. Data was collected for a month and a half period. Psychiatric evaluations were performed while the patients were on wards.
Results:We obtained a sample of 165 patients (78 women, 88 men) with a mean age of 76,03 years old (42.10% <75 years, 57,83% ≥ 75 years). Most of them were married and they lived accompanied (67,27%). Only 5,45% lived in a nursing home. 65,45% of patients had prescribed at least one psychotropic drug before LPU intervention; mainly (50,9%) benzodiazepines (60%women/40%men). 70,9% of these group of patients had more than one psychotropic drug prescribed before LPU. After LPU intervention in 39,39% at least one drug was withdrawn (in 50,81 % of cases benzodiazepines). Falls in the past 6 months were reported in 24.8% of total patients. Patients under benzodiazepine treatment had fallen in 29% of cases. After LPU intervention benzodiazepines were withdrawn in 56,25% % of them.
Conclusions:Benzodiazepines are widely used in our sample and frequently is associated with polypharmacy. LPU intervention might be a useful tool to reduce the use of them, specially for those who reported falls.
Longitudinal studies might be carried out to study these factors and their possible relationship with falls, given that Benzodiazepines are consistently associated with a higher risk of falls. It is unclear whether specific subgroups such as short-acting benzodiazepines and selective serotonin reuptake inhibitors are safer in terms of fall risk. Ppropriate prescription of medications such as BZDs is an important public health issue.
P112: Valladolid Multicenter Study: Diagnostic agreement between physicians and liaison psychiatry units in an elderly population in 7 hospitals in Spain.
- Leire Narvaiza, Monica Prat Galbany, Ferran Vilalta, Andrea Santoro, Maria Iglesias Gonzalez, Cristina Pujol Riera, Eduardo Fuster Nacher, Mª Desamparados Perez Lopez, Eduardo Delgado Parada, Miguel Alonso Sánchez
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- Journal:
- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, pp. 212-213
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Objective:
The objective of this study is to describe the diagnostic agreement between physicians and liaison psychiatry units (LPU) in 7 general hospitals of Spain for elderly patients and to analyze possible factors related to it.
Methods:This is an observational., cross-sectional, multicenter study. We obtained data from a sample of 165 patients (≥65 years) admitted to 7 general hospitals in Spain referred from different departments to each liaison psychiatry unit. Data was collected for a month and a half period. Psychiatric evaluations were performed while the patients were on wards.
Results:We obtained a sample of 165 patients (78 women, 88 men) with a mean age of 76,03 years old (42.10% <75 years, 57,83% ≥ 75 years). Most of them were married and they lived accompanied (67,27%). Only 5,45% lived in a nursing home.
In 55.15% the main reason to referral was anxiety/depression symptoms. 42,42% had no psychiatry medical background. After LPU visit a new diagnosis was done in 56.96%. Main diagnoses were adjustments disorders (26,66%), delirium (20,6%) and no psychiatric pathology (14,54%)
Cohen’s kappa statistics were used to estimate the agreement between the diagnoses made by LPU and the diagnoses considered by the referring doctors. We obtained a moderate global agreement (kappa= 0,4971) between observers (0,424 for <75 years, 0,557 for ≥65 years) Moderate agreement was found for alcohol or substance abuse (kappa= 0,41) and low agreement was found for affective disorders (kappa= 0,3278) and delirium/ psychological and behavioral symptoms in dementia (Kappa= 0,2341).
We analyzed factors which might affect de agreement between physicians and LPU such is group of age, functional impairment, comorbidity by Charlson index and previous diagnosis of dementia.
Conclusions:Further longitudinal studies might help in the future to analyze the factors related to agreement between doctors and might help to establish educational programs
P128: The Valladolid Multicentre Study: Delirium characteristics in patients attended in seven liaison psychiatry services in Spain.
- Maria Iglesias González, David Sanagustín, Mikel Etxandi, Paola Punsoda Puche, Cristina Pujol Riera, Eduardo Fuster Nácher, Mª Desamparados Perez Lopez, Eduardo Delgado Parada, Leire Narvaiza Grau, Monica Prat Galbany, Andrea Santoro
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- Journal:
- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, p. 133
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Introduction and objective:
Delirium is an acute and fluctuating disorder characterized by a disturbance in attention and cognition that is commonly observed in hospitalized older adults; being present in up to 23% of patients admitted to a general medical service and as many as 85% of patients in the intensive care unit. Delirium causes complications such as increased morbidity, persistent functional decline, mortality, increased frailty and increased length of hospital stay. Nonetheless, it is often underdiagnosed, especially when it occurs in its hypoactive form. The objective of this study is to describe characteristics and factors associated with the presence of delirium in patients ≥65 years treated by the liaison psychiatric units in seven general hospitals.
Methods:This is an observational, cross-sectional, multicentre study. We obtained data from a sample of 165 patients (≥65 years) admitted to seven general hospitals in Spain referred from different departments to each liaison psychiatry unit. Data was collected for a month and a half period. Psychiatric evaluations were performed while the patients were on wards.
Results:We obtained a sample of 165 patients (78 women, 88 men) with a mean age of 76,03 years old (42.10% <75 years, 57,83% ≥ 75 years). Most of them were married and they lived accompanied (67,27%). Delirium was diagnosed in 20% of the consultations. A multivariate analysis was developed with the presence of delirium as the independent variable. The nature of the underlying pathology, the presence of a previous mental disorder, functionality using the Barthel and Lawton Brody Indexes and the prescribed pharmacological treatments were used as dependent variables. Cohen’s kappa statistics were used to estimate the agreement between delirium diagnose made by psychiatrists and the diagnoses considered by the referring doctors. Low agreement was found for the presence of delirium (Kappa= 0,2341). We also explored the relationship between the presence of delirium and the mean length of stay, as well as the discharge destination of these patients.
Conclusions:There are still many difficulties in the diagnosis and treatment of patients with delirium. Better knowledge of the factors associated with its appearance would improve the management of these patients.
P41: Valladolid Multicenter Study: Factors related to time to referral and length of hospital stay in old psychiatry patients in seven general hospitals in Spain
- Cristina Pujol Riera, Anna Barnés Andreu, Eduardo Fuster Nacher, Mª Desamparados Perez Lopez, Miguel Alonso Sánchez, Eduardo Delgado Parada, Leira Narvaiza Grau, Monica Prat Galbany, Andrea Santora, Maria Iglesias Gonzalez
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- Journal:
- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, p. 201
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Objective:
Older patients (≥65yo) admitted to general hospitals have increased in the past years. This resulted in an increase in hospitalization periods, health costs, and morbi-mortality rates in this group of patients.
Previous evidence points that the reduced time to referral (TTR) to Consultation-Liaison Psychiatry Units (CLP) leads to a reduced length of stay (LOS) in GH improving long-term prognosis of medical conditions.
This study aims to explore whether a prior disability in older patients leads to delay the search for psychiatric help. And to explore whether early referral to CLP is associated with reduced LOS in general hospitals.
Methodology:This is an observational, cross-sectional, multicentre study. We obtained a complete data set from a sample of 152 patients (≥65 years old) admitted to 7 general hospitals in Spain referred to CLP unit for 1,5 months.
Results:Mean age of the sample was 76.3 (±6.4). TTR was 14.5 (±18.0) days. LOS was 26.7 (±22.4) days, and length of stay after consultation was 12.3 (±10.3) days. Barthel Index before admission was 87.3 (±18.0) and Lawton&Brody Index before admission was 5.3 (2.7). We found a significant positive association of Barthel Index (r=0.17, p=0.042) and Lawton&Brody Index (r=0.20, p=0.014) before admission with TTR, which indicates that patients with a worse clinical status were attended earlier. Similarly, antecedents of both falling episodes (r=-0.2, p= 0.013) and walking difficulties (r=-0.24, p= 0.003) were associated with shorter TTR. TTR in Medical Departments was 11.7 (±15.0) days and in Surgical Departments was 24.0 (±22.8) days (t=-3.5, p= 0.001). TTR showed a highly significant positive correlation with LOS (r=0.89, p<0.0001) and a more discrete positive correlation with length of stay after consultation (r=0.20, p=0.016).
Conclusion:We confirm that a shorter TTR to CLP was related to a shorter LOS. Also, patients in medical wards had shorter TTR. In contrast to our hypothesis, we found that a higher disability prior to hospitalization led to earlier referral to CLP, meaning that these patients were assessed and treated earlier leading to better long- term prognosis and lower health costs.
FC6: The Valladolid Multicenter Study: ¿Is there ageism in liaison psychiatry? Referrals of patients over 65 years to 7 Liaison Psychiatric Units (LPU) in Spain
- Miguel Alonso Sanchez, Eduardo Delgado Parada, Leire Narvaiza Grau, Monica Prat Galbany, Andrea Santoro, Maria Iglesias Gonzalez, Cristina Pujol Riera, Eduardo Fuster Nacher, Mª Desamparados Perez Lopez
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- Journal:
- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, p. 69
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Introduction and objective:
Ageism is defined by the World Health Organization as stereotypes, prejudice, and discrimination towards others or oneself based on age. Ageism is thought to pose a risk to the physical and mental health of older adults, but little is known about how to measure it in LPUs. We propose that a form of ageism can be detected by comparing the referrals made by liaison psychiatry services among patients over age 65 at discharge with functional status and medical comorbidity. Our hypothesis is that the worse the functional index and medical comorbidity, the fewer referrals to psychiatric services and the more referrals to primary care physicians.
Methods:This is an observational, cross-sectional, multicenter study. We obtained data from a sample of 165 patients (≥65 years) admitted to seven general hospitals in Spain referred from different departments to each LPU. Data was collected over a period of one and a half months. Psychiatric evaluations were performed while the patients were in the wards. Sociodemographic, clinical, and care variables were collected. Functional status was measured with the Barthel and Lawton index and comorbidity with the Charlson index.
Results:We obtained a sample of 165 patients with a mean age of 76,03 years old. The mean Barthel index was 87,18 previous admission and 61,15 at the time of our first visit. The mean Lawton index was 5,266667 and the Charlson index was 6,03. The different options for referral were primary care physician, psychiatric facilities, nursing homes, substance use centers, or exitus. Statistical analysis was performed using the nonparametric Kruskal-Wallis test to determine if there were significant differences (p < 0,05) between the indices and referrals. Contrary to our hypothesis, statistical significance was observed only for the Lawton index, but with more referrals to psychiatric facilities among patients with the worst functional scores. No other statistical significance was observed.
Conclusions:Functional status and medical comorbidity did not play a role in the referral of inpatients managed by LPUs. Further studies are needed to clarify whether there is any form of ageism in the referral of elderly inpatients attended by Psychiatric Liaison Units.
End-of-life conversations about death and dying from volunteer perspectives: A qualitative study
- Andrea Rodríguez-Prat, Donna M. Wilson
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- Palliative & Supportive Care , First View
- Published online by Cambridge University Press:
- 22 January 2024, pp. 1-9
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Objectives
Although often unrecognized, volunteers fulfill many essential roles in hospices and other end-of-life care settings. Volunteers complement the actions of professionals in fulfilling many extra care needs, such as delivering newspapers and tidying bedsides. We explored end-of-life conversations about death and dying between hospice volunteers and terminally ill people, with a particular emphasis on any expressed desire to die. Our 2 research questions were as follows: (1) What is the nature of end-of-life conversations between hospice patients and hospice volunteers? and (2) How do hospice volunteers experience conversations about death and dying with patients who are at the end-of-life?
MethodsWe conducted semi-structured interviews using an interpretive phenomenological analysis. We recruited hospice volunteers from 4 hospices in Calgary, Edmonton, and Red Deer; 3 larger cities in the province of Alberta, Canada.
ResultsWe interviewed 12 participants to saturation. Four themes emerged: (1) trusting conversations about death and dying in the context of a safe place; (2) normalcy of conversations about death and dying; (3) building meaningful relationships; and (4) end-of-life conversations as a transformative experience. Our results emphasize the importance of preparing volunteers for conversations about death and dying, including the desire to die.
Significance of resultsThe safe environment of the hospice, the commitment to patient confidentiality, and the ability of volunteers to meet the basic and emotional needs of dying people or simply just be present without having formal care duties that need to be completed contribute to volunteers being able to participate in timely and needed conversations about death and dying, including the desire to die. In turn, hospice experiences and end-of-life conversations provide a transformative experience for volunteers.
Autonomy and control in the wish to die in terminally ill patients: A systematic integrative review
- Andrea Rodríguez-Prat, Donna M. Wilson, Remei Agulles
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- Journal:
- Palliative & Supportive Care / Volume 19 / Issue 6 / December 2021
- Published online by Cambridge University Press:
- 07 July 2021, pp. 759-766
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Background/Objective
Personal autonomy and control are major concepts for people with life-limiting conditions. Patients who express a wish to die (WTD) are often thought of wanting it because of loss of autonomy or control. The research conducted so far has not focused on personal beliefs and perspectives; and little is known about patients’ understanding of autonomy and control in this context. The aim of this review was to analyze what role autonomy and control may play in relation to the WTD expressed by people with life-limiting conditions.
MethodsA systematic integrative review was conducted. The search strategy used MeSH terms in combination with free-text searching of the EBSCO Discovery Service (which provides access to multiple academic library literature databases, including PubMed and CINAHL), as well as the large PsycINFO, Scopus, and Web of Science library literature databases from their inception until February 2019. The search was updated to January 2021.
ResultsAfter the screening process, 85 full texts were included for the final analysis. Twenty-seven studies, recording the experiences of 1,824 participants, were identified. The studies were conducted in Australia (n = 5), Canada (n = 5), USA (n = 5), The Netherlands (n = 3), Spain (n = 2), Sweden (n = 2), Switzerland (n = 2), Finland (n = 1), Germany (n = 1), and the UK (n = 1). Three themes were identified: (1) the presence of autonomy for the WTD, (2) the different ways in which autonomy is conceptualized, and (3) the socio-cultural context of research participants.
Significance of resultsDespite the importance given to the concept of autonomy in the WTD discourse, only a few empirical studies have focused on personal interests. Comprehending the context is crucial because personal understandings of autonomy are shaped by socio-cultural–ethical backgrounds and these impact personal WTD attitudes.
3 - The Political Economy of Mass Media
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- By Andrea Prat, Columbia University, David Strömberg, Stockholm University
- Edited by Daron Acemoglu, Massachusetts Institute of Technology, Manuel Arellano, Eddie Dekel
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- Advances in Economics and Econometrics
- Published online:
- 05 May 2013
- Print publication:
- 13 May 2013, pp 135-187
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Summary
Introduction
In the last decade, a sizable number of economists have begun to study the behavior and political effects of mass media. In this survey, we propose a way to organize this body of research, we attempt to summarize the key insights that have been learned so far, and we suggest potentially important open questions.
We structure the discussion in sections covering background, transparency, capture, informative coverage, and ideological bias. Section 2.0 begins with an overview of how economics and other disciplines approach this field and defines the scope of this survey. Section 3.0, discusses the benefits and costs of transparency in politics: Under which situations do voters benefit from receiving more information?
Section 4.0 addresses under which conditions the government will prevent the media from performing its information-provision task. Media capture is a present or latent risk in most developing and many developed countries. We present a theory of endogenous capture and survey the growing empirical literature on the extent and determinants of capture. As demonstrated herein, different sources of evidence provide support for the idea that ownership plurality is the most effective defense against capture.
Section 5.0 discusses a crucial theme in media studies – namely, how informative media coverage affects political accountability and government policy. A model of policy choice with endogenous media coverage supplies an array of testable implications, used to organize the existing empirical work. The key questions are: What drives media coverage of politics? How does this coverage influence government policy, the actions and selection of politicians, and the information levels and voting behavior of the public?
11 - Organizational Economics with Cognitive Costs
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- By Luis Garicano, London School of Economics, Andrea Prat, Duke University
- Edited by Daron Acemoglu, Massachusetts Institute of Technology, Manuel Arellano, Eddie Dekel
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- Advances in Economics and Econometrics
- Published online:
- 05 May 2013
- Print publication:
- 13 May 2013, pp 342-388
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Summary
Introduction
Organizations are formed by agents working together for a common purpose. Two sets of obstacles may prevent organizations from reaching their goals. First, incentive problems: Achieving a common goal may be difficult because individuals pursue different objectives. Second, even when all agents share a common purpose, they face coordination problems due to cognitive costs. They must exchange information, coordinate their actions, and make joint decisions. Such activities require talking, writing, reading, and thinking – all tasks that require time and energy.
On the first set of problems, starting with the work of Hurwicz (1973) and Groves (1973), mechanism design and contract theory have made huge progress. Contracts are designed under asymmetric information so that principals can motivate their agents to align their individual goals with those of the organization. The typical contract-theoretic contribution strives to find the optimal contract, holding constant the role of the agent in the organization and the informational environment. For instance, in the classical moral-hazard problem, the set of possible actions that the agent can take is given as is the information that the agent and the principal observe; moreover, the relation between agents also is given exogenously. This corresponds to assuming an exogenous solution to the second problem discussed previously.
However, in practice, organizations can choose – at least partly – how to allocate tasks to agents, which monitoring systems to put in place, and which channels of communication to establish. In a world with cognitive limits, these organizational choices come at a cost. Designing the organization requires choosing between alternative structures given the cognitive limits of its agents (or the agents that could be hired).