IPA - International Psychogeriatrics - Volume 11, Number 3 - September
1999 - Table of Contents
Guest Editorial
Is
Female Gender a Risk Factor for Alzheimer’s Disease?, p219
Gregory Swanwick and Brian A. Lawlor (Ireland)
Psychotropic Drug Utilization in Long-Term-Care
Facilities for the Elderly in Ontario, Canada, p223
David K. Conn, Ian Ferguson, Krystyna Mandelman,
and Carol Ward (Canada)
Elders With Dementia Living in the Community
With and Without Caregivers: An Epidemiological Study, p235
Krista L. Prescop, Hiroko H. Dodge, Richard K.
Morycz,
Richard M. Schulz, and Mary Ganguli (USA)
The Role of Referrals in Diagnosing Dementia at the Primary Care Level, p251
Steffi G. Riedel-Heller, Astrid
Schork,
Herbert Matschinger, and Matthias C. Angermeyer (Germany)
Personality Change in Dementia, p263
Lucy Aitken, Stephen Simpson, and Alistair Burns
(UK)
Quality-of-Life Assessment in the Old Using the WHOQOL 100:
Differences Between Patients With Senile Dementia and Patients With Cancer,
p273
Tobias Struttmann, Michel Fabro, Gilles Romieu,
Guilhem de Roquefeuil,
Jacques Touchon (France), Thomas Dandekar
(Germany), and Karen Ritchie (France)
A Naturalistic Study Comparing the Efficacy of
a Memory Enhancement Course to a General Academic Course, p281
Meirav Ivgi, Michal Schnaider
Beeri,
Jonathan Rabinowitz, and Michael Davidson (Israel)
Predicting Response of Older Adults to Mnemonic Training:
Who Will Benefit?, p289
Leslie A. McKitrick, Leah F. Friedman, John O.
Brooks III,
Ann Pearman, Helena C. Kraemer, and Jerome A. Yesavage (USA)
An Empirical Test of Language-Relevant
Interventions for Dementia, p301
Susannah Runci, Colleen Doyle, and Jenny Redman
(Australia)
Physicians’ Decision-Making in Incompetent Elderly Patients:
A Comparative Study Between Austria,
Germany (East, West), and Sweden, p313
Martin Eisemann (Sweden), Jörg Richter (Germany),
Barbara Bauer (Germany), Rainer
Bonelli (Austria), and Franz Porzsolt (Germany)
Psychotic Late-Life Depression: A 376-Case Study, p325
Franco Benazzi (Italy)
Caregiving Across Cultures: Working With Dementing Illness and Ethnically
Diverse Populations
by Ramón Valle, p333
Reviewed by Anne Hassett (Australia)
Hospice Care for Patients With Advanced Progressive Dementia
by Ladislav Volicer and Ann Hurley, p334
Reviewed by Benny Katz (Australia)
The Little Black Book of Geriatrics
by Karen Gershman
and Dennis M. McCullough, p335
Reviewed by Dina LoGiudice (Australia)
Complementary/Alternative Therapies in Nursing (3rd ed.)
by
Mariah Snyder and Ruth Lindquist (Eds.), p336
Reviewed by Maree Mastwyk (Australia)
Letter to the Editor, p339
Psychotropic
Drug Utilization in Long-Term-Care Facilities for the Elderly in
Ontario, Canada
David K. Conn, Ian
Ferguson, Krystyna Mandelman, and Carol Ward
Abstract.Objective:
Despite considerable data from a number of countries regarding psychotropic
utilization in long-term-care facilities for the elderly, there has been a lack
of similar data from Canada. The purpose of this study was to gather
prescription data from a series of institutions in Ontario and to compare the
results to those of other international studies. Method: Single-day
surveys were carried out in six homes for the aged, four nursing homes, two
retirement homes, and a veterans’ center. The results were compared to those
of recent studies from other countries. Results: The data revealed
considerable differences in rates of prescription between different classes of
institutions and between similarly classified institutions. The prescription
rate of neuroleptics ranged from 11.8% (of patients) in retirement homes to
29.8% in nursing homes. Antidepressant use ranged from 12.2% in nursing homes to
24.6% in homes for the aged, and benzodiazepine use ranged from 22.5% in nursing
homes to 36.4% in retirement homes. Conclusions: The overall rate of
prescription for psychotropic medications was somewhat lower than in most
international studies. The rate of prescription of neuroleptics in nursing homes
fell in the midrange of studies, somewhat higher than in recent studies from the
United States and an earlier Italian study, but lower than in recent reports
from Sweden, Austria, and Australia. The rate of neuroleptic use in homes for
the aged was comparable to the rate in the U.S. studies. The overall rate of
prescription of antidepressants and benzodiazepines appears to be comparable to
that in recent studies from other countries.
Elders
With Dementia
Living in the Community With and Without Caregivers: An Epidemiological Study
Krista L. Prescop, Hiroko
H. Dodge, Richard K. Morycz, Richard M. Schulz, and Mary Ganguli
Abstract.
Background: Previous studies of dementia and family caregiving have
focused on individuals seeking diagnosis and treatment, and have rarely been
conducted in representative community samples. Identifying demented individuals
participating in a community survey, we determined (a) the factors associated
with demented elderly living alone; (b) the factors associated with the demented
elderly having caregivers; (c) the factors associated with increased levels of
burden among caregivers of persons with dementia. Population and Methods: During
an epidemiological survey of a mostly rural U.S. community, the authors
identified 116 noninstitutionalized elderly individuals with dementia. These
individuals were classified into those living alone and those living with
others; both groups were further classified into those with and without
identifiable family caregivers. Characteristics of both caregivers and care
recipients were examined. Results: Approximately a third of the subjects
with dementia lived alone, and only half of them had caregivers. The average age
of the caregivers was 67.4 years, and 73% of them were women. Almost half of the
caregivers were spouses, whereas almost a third were offspring, of the demented
individuals. Over two thirds of caregivers lived with the subjects. Female
caregivers were significantly younger than male caregivers. Multivariate
analyses revealed that subjects with dementia who were living alone were
independently and significantly more likely to be women and to have dementias of
shorter duration, lesser severity, and lesser functional impairment than those
living with others. Demented subjects with caregivers were more likely to have
greater dementia severity, functional impairment, and cognitive impairment and
more current cognitive and behavioral symptoms than those without caregivers.
Demented subjects whose caregivers reported higher levels of burden were more
likely to be women and to have greater dementia severity, functional impairment,
and cognitive impairment and more current symptoms than those whose caregivers
had no/minimal burden. Conclusions: These results draw attention to the
problems of persons with dementia living alone, particularly those without
caregivers.
The Role of Referral in Diagnosing Dementia at the Primary Care Level
Steffi G. Riedel-Heller,
Astrid Schork, Herbert Matschinger, and Matthias C. Angermeyer
Abstract.
Background: Demographic changes indicating a general aging of the
population suggest that the key role of general practitioners (GPs) in the
diagnosis and management of dementia becomes more salient. The encouragement of
GPs to collaborate with specialists is one chance to support GPs in performing a
variety of functions associated with the diagnosis and management of dementia. Method:
We used a questionnaire to investigate the role of referrals in diagnosing
dementia at the primary care level and variables potentially influencing the
referral behavior of German GPs (n = 563). Results: Only 31% of
the GPs stated that the diagnosis of dementia was made predominantly in the
context of referral to a specialist. The chance that referrals were made was
increased for those GPs who entertained extensive cooperative relationships with
self-help groups, psychologists, or the “Alzheimer Society”/“Brain
League” (odds ratio [OR] 1.74) and for those GPs who perceived a great
preparedness on the part of the relatives of the patient to comply with a
referral (OR 2.29) as well as who noticed a great readiness among specialists to
accept patients for the diagnosis of dementia (OR 2.55). GPs whose therapeutic
orientation was shaped by further training and scientific literature were more
likely to refer (OR 3.54). Discussion: Enhancing the liaison between GPs
and specialist physicians by improving the psychogeriatric competence of GPs as
well as the connection to nonmedical services is discussed.
Personality
Change in Dementia
Lucy Aitken, Stephen
Simpson, and Alistair Burns
ABSTRACT.
This study examined the prevalence and nature of personality change in 99
patients with dementia of the Alzheimer type and multi-infarct dementia.
Personality was assessed using an informant-rated inventory of the patient’s
personality before and after the onset of dementia, with the difference equating
to a change in personality. Personality characteristics were related to the
patients’ age and sex, duration of illness, degree of cognitive impairment,
the presence of a grasp reflex, and extrapyramidal signs. Personality change was
found to be almost universal and negative in nature and was particularly
associated with severity of cognitive impairment, longer duration of illness,
and neurological signs. The findings reflect those from other studies and
emphasize the biological basis of personality changes in dementia.
Quality-of-Life
Assessment in the Old
Using the WHOQOL 100: Differences Between Patients With Senile Dementia and
Patients With Cancer
Tobias Struttmann, Michel
Fabro, Gilles Romieu, Guilhem de Roquefeuil, Jacques Touchon, Thomas Dandekar,
and Karen Ritchie
Abstract. Introduction: The measurement of quality of life is an
increasingly important issue, particularly in regard to treatment of severe and
chronic diseases. The aim of this pilot study was to assess potentially
divergent profiles of quality of life in persons with two different pathologies:
moderate dementia and cancer. Method: This pilot study was carried out in
the neurology and cancer services of the medical school in Montpellier, France
(Hôpital Gui de Chaulliac and CRLC Val d’Aurelle). The cumulative
self-reporting test WHOQOL 100 (World Health Organization Quality of Life with
100 questions) was administered in 57 patients with either moderate senile
dementia (27 cases with a Mini-Mental State Examination score >15; mean age
of 73) or cancer (30 cases, mainly women with breast cancer; mean age of 53).
The stability of responses was tested in a 2-week period. Results:
Results of the study showed clear and significant differences between the two
groups in the domains of mobility and psychology. Further, eight questions and
six facets with a significant difference in responses were found. Responses
seemed more stable in the domains of autonomy, social relationship, and religion
for the cancer group, and in autonomy and psychology for the dementia group. The
age difference may be an important factor in the different quality of life
measured but did not significantly influence responses to the test questions. Conclusion:
The WHOQOL 100 seems a powerful instrument to assess quality of life in diseases
such as cancer and moderate dementia. In this study, interesting differences in
responses to the test questions between the two pathologic conditions were
identified. Items that were unreliable on retesting are singled out. These
results will be applied and reevaluated in the development of future,
illness-specific and shorter versions of the WHOQOL 100.
A
Naturalistic Study Comparing
the Efficacy of a Memory Enhancement Course to a General Academic Course
Meirav Ivgi, Michal
Schnaider Beeri, Jonathan Rabinowitz, and Michael Davidson
Abstract. Objective: The goal of this study was to compare the effectiveness
of a memory improvement course to a course in general psychology. Methods: Thirty-four
healthy elderly persons enrolled in a college memory improvement course for
senior citizens, and 33 who enrolled in a parallel course, Introduction to
Psychology, were tested on verbal and visual memory prior to and after
completing the course. Before they took the course, they were also assessed on
subjective memory (self-assessment scale of memory efficacy) and psychological
distress (General Health Questionnaire). Changes within and between groups were
examined using multivariate analysis of covariance to control for baseline
scores. Results: Both groups had similar improvements on all cognitive
measures. The memory improvement course group showed very significant
correlations between objective and subjective memory. Conclusions: It
appears that participation in academic courses is associated with improvement in
certain aspects of cognitive functioning. Awareness of objective memory
functioning may be a natural selection factor or a significant motivating factor
for healthy elderly to enroll in memory enhancement courses.
Predicting
Response of Older Adults to
Mnemonic Training: Who Will Benefit?
Leslie A. McKitrick, Leah
F. Friedman, John O. Brooks III, Ann Pearman, Helena C. Kraemer, and Jerome A.
Yesavage
Abstract.
Objectives: To identify profiles of subjects who respond to mnemonic
training for serial word and proper name recall. Design: Analysis of J.
O. Brooks et al.’s (1999) mnemonic training data using Quality Receiver
Operating Characteristic (QROC) and longitudinal regression analyses (LRA). Setting:
Community. Participants: 224 community-dwelling adults 55 years of age
and older who wished to improve their memory. Measurements: Performance
on serial word and proper name tests; performance on cognitive ability tests. Results:
Although the QROC and LRA identified several common predictors (baseline
performance, mental rotation ability, and paired associate learning), the QROC
identified additional predictors and cognitive ability profiles associated with
successful response. Conclusions: Similar degrees of response to mnemonic
training are associated with heterogeneous cognitive profiles. This finding
highlights the fact that participants rely on a variety of abilities to derive
benefit from mnemonic training and thus suggests different avenues from which to
approach this training.
An
Empirical Test of
Language-Relevant Interventions for Dementia
Susannah Runci, Colleen
Doyle, and Jenny Redman
Abstract. The focus of this report is the treatment of persons with dementia who
are of a non-English-speaking background (NESB). Noisemaking is one behavioral
manifestation associated with severe dementia. It can have devastating effects
on persons with dementia by limiting their access to activity programs and
social interaction, and is also very distressing for professionals and family
carers. It can be especially difficult for carers when they do not speak the
first (non-English) language of the person with the noisemaking problem, when
the person has lost his or her ability to speak English as the dementia
progresses. Behavioral interventions have been found to be successful in
decreasing the occurrence of noisemaking in some people with severe dementia.
This article reports on a study of an elderly Italian woman with dementia. The
study used a randomized, alternating-treatments design in order to determine
whether an Italian-language intervention would be more effective in reducing her
noisemaking than the same intervention given in English. The main result of the
study was that the Italian intervention was found to be significantly more
effective in reducing noisemaking than the English intervention. Therefore, this
exploratory study provides empirical evidence for the increased effectiveness of
an intervention program in the patient’s original language. The study also
demonstrates the need for individualized intervention programs, particularly for
NESB patients living in predominantly English-speaking institutions.
Physicians’
Decision-Making in
Incompetent Elderly Patients: A Comparative Study Between Austria, Germany
(East, West), and Sweden
Martin Eisemann, Jörg
Richter, Barbara Bauer, Rainer Bonelli, and Franz Porzsolt
Abstract.
In order to investigate to what extent various determinants in the
decision-making process for the treatment of severely ill incompetent patients
are influenced by cultural and sociopolitical factors, 540 physicians in
Austria, Germany (East and West), and Sweden, countries representing different
healthcare systems, were surveyed using a self-administered questionnaire. It
provided three case vignettes with different levels of information about the
patient’s treatment wishes in case of incompetence in a life-threatening
situation. We found a general trend to a lower level of treatment in line with
the patient’s wishes when the information provided was more detailed.
Remarkably, a substantial number of doctors did not comply with the patient’s
wishes. Ethical concerns and patient’s wishes appeared as the most important
factors whereas religious beliefs of the physician and hospital costs scored
lowest. Because of the variability of treatment decisions and the importance of
various factors determining the decision-making, an advance directive may be a
feasible way of reducing the number of conflicts in critical situations. We
recommend that ethical issues of clinical practice should be emphasized in the
medical curriculum and in the training of physicians.
Psychotic
Late-Life Depression: A
376-Case Study
Franco Benazzi
Abstract.
The aim of the report was to study clinical differences between psychotic
late-life depression and psychotic depression in younger patients, to determine
if differences were age-related or specific for psychotic late-life depression.
Three hundred seventy-six consecutive outpatients, presenting for treatment of
unipolar or bipolar depression (with or without psychotic features), were
assessed by means of the Structured Clinical Interview for DSM-IV, the
Montgomery and Asberg Depression Rating Scale, and the Global Assessment of
Functioning Scale. Results showed that psychotic late-life (50 years or more)
depression, versus psychotic depression in younger patients, was associated with
significantly higher age at study entry/onset, longer duration, and lower
comorbidity. Psychotic depression versus nonpsychotic late-life depression, in
late-life and in younger patients, was associated with significantly greater
severity, lower comorbidity, more patients with bipolar I disorder, and fewer
patients with unipolar disorder. Findings were related to psychosis or to age,
and not to specific features of psychotic late-life depression. These results
support a unitary view of psychotic depression.
