Objective: To describe the prevalence of cognitive impairment among elderly primary care patients and to compare diagnostic evaluations and use of health services among patients with and those with...

Documentation and evaluation of cognitive impairment in elderly primary care patients

Background: The population of older adults in long-term care (LTC) is expected to increase considerably in the near future. An understanding of the prevalence of psychiatric disorders in LTC will help in planning mental health services for this population. This study reviews the prevalence of common psychiatric disorders in LTC populations. Methods: We searched electronic databases for studies on the prevalence of major psychiatric disorders in LTC using medical subject headings and key words. We only included studies using validated measures for diagnosing psychiatric disorders or psychiatric symptoms. Our review focused on the following psychiatric disorders: dementia, behavioral and psychological symptoms of dementia (BPSD), major depression, depressive symptoms, bipolar disorder, anxiety disorders, schizophrenia, and alcohol use disorders. We also determined the prevalence of psychiatric disorders in the U.S. LTC population using data from the 2004 National Nursing Home Survey (NNHS). Results: A total of 74 studies examining the prevalence of psychiatric disorders and psychological symptoms in LTC populations were identified including 30 studies on the prevalence of dementia, 9 studies on behavioral symptoms in dementia, and 26 studies on depression. Most studies involved few LTC facilities and were conducted in developed countries. Dementia had a median prevalence (58%) in studies while the prevalence of BPSD was 78% among individuals with dementia. The median prevalence of major depressive disorder was 10% while the median prevalence of depressive symptoms was 29% among LTC residents. There were few studies on other psychiatric disorders. Results from the 2004 NNHS were consistent with those in the published literature. Conclusions: Dementia, depression and anxiety disorders are the most common psychiatric disorders among older adults in LTC. Many psychiatric disorders appear to be more prevalent in LTC settings when compared to those observed in community-dwelling older adults. Policy-makers and clinicians should be aware of the common psychiatric disorders in LTC and further research into effective prevention and treatments are required for this growing population.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/3424575EA5F22DBEE79FBE39132BF511/S1041610210000608a.pdf/div-class-title-prevalence-of-psychiatric-disorders-among-older-adults-in-long-term-care-homes-a-systematic-review-div.pdf

Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review.

Transmitter deficits in Alzheimer's disease.

• To evaluate whether serotonin reuptake inhibition is critical to the treatment of obsessive-compulsive disorder, 40 outpatients with a principal diagnosis of obsessive-compulsive disorder were randomized in a double-blind fashion to 8 weeks of treatment with either the serotonin reuptake inhibitor fluvoxamine maleate (n = 21) or the norepinephrine reuptake inhibitor desipramine hydrochloride (n =19). Fluvoxamine was significantly better than desipramine in reducing the severity of obsessive-compulsive symptoms, as measured by the Yale-Brown Obsessive Compulsive Scale and by the global response rate ("responder" equaling "much improved"). Eleven of 21 patients were responders with fluvoxamine compared with 2 of 19 patients with desipramine. Fluvoxamine, but not desipramine, was also effective in reducing the severity of "secondary" depression. Fluvoxamine-induced improvement in symptoms of obsessive-compulsive disorder was not correlated with the severity of baseline depressive symptoms. This study provides additional evidence that the acute serotonin reuptake properties of a drug are predictive of its anti—obsessive-compulsive efficacy. It is hypothesized that the mechanism of action of serotonin reuptake inhibitors in obsessive-compulsive disorder may be related to chronic treatment-induced adaptive changes in presynaptic serotonin receptor function (eg, autoreceptor desensitization) and/ or indirect influences on dopaminergic function (eg, in the basal ganglia).

Specificity of Serotonin Reuptake Inhibitors in the Treatment of Obsessive-Compulsive Disorder: Comparison of Fluvoxamine and Desipramine

Biochemical changes in dementia disorders of Alzheimer type (AD/SDAT).

The prevalence of dementia disorders was determined among 3,523 institutionalized patients aged 65 years or more in the county of Vasterbotten. Approximately one-third of the clientele were considered demented. The prevalence was calculated to be 3.7 % of the population in the county. The frequency of dementia disorders among the patients in the somatic long-stay wards, the nursing homes, and the mental hospital was rather similar (55–65 %). A surprisingly high percentage of demented (17.1 %) was found in the homes for the aged. The work load was nighest in the somatic long-stay wards and in the nursing homes. Patients in the mental hospital, however, differed markedly from those in other institutions with higher scores for aggressive and disturbing behaviour, which accounted for the large number of patients in the mental hospital with maximal work load. The findings are discussed with regard to future institutional care of demented patients and point out the need for better education in psychiatric care for the staff.

Prevalence of dementia disorders in institutionalized Swedish old people THE WORK LOAD IMPOSED BY CARING FOR THESE PATIENTS

Summary: Purpose: We sought to investigate mortality risk in an adult cohort with newly diagnosed unprovoked epileptic seizures.



Methods: One hundred seven patients who were at least 17 years old and had newly diagnosed unprovoked epileptic seizures were prospectively identified during a period of 20 months between 1985 and 1987. Patients were followed until the date of death or the end of 1996. The standard mortality ratio (SMR) was analyzed in the whole cohort and in the portion of the cohort with recurrent seizures at inclusion. The influences on the SMR of time since diagnosis, sex, age at diagnosis, seizure cause, seizure type, and cause of death were also investigated.



Results: The SMR was significantly increased (SMR, 2.5; 95% confidence interval [CI], 1.2–3.2). This significantly increased risk was found during the first 2 years after diagnosis (year 1: SMR, 7.3; 95% CI, 4.4–12.1; year 2: SMR, 3.6; 95% CI, 1.6–8.1) and at years 9–11 (SMR, 5.4; 95% CI, 2.7–11.2). The increased mortality risk was most pronounced when the seizures occurred before the age of 60 years. Mortality risk was elevated among patients with remote symptomatic epilepsy (SMR, 3.3; 95% CI, 2.4–4.5) but not idiopathic epilepsy.



Conclusions: There is increased mortality risk in an adult cohort with newly diagnosed unprovoked epileptic seizures. This increase is found in symptomatic patients, young patients, and during the first 2 years after the diagnosis.

Mortality risk in an adult cohort with a newly diagnosed unprovoked epileptic seizure: a population-based study.

Intimate partner violence (IPV) is a public health problem in Tanzania with limited health care interventions. Objectives: To study the feasibility of using an abuse screening tool for women attending an outpatient department, and describe how health care workers perceived its benefits and challenges. Methods: Prior to screening, 39 health care workers attended training on gender-based violence and the suggested screening procedures. Seven health care workers were arranged to implement screening in 3 weeks, during March-April 2010. For screening evaluation, health care workers were observed for their interaction with clients. Thereafter, focus group discussions (FGDs) were conducted with 21 health care workers among those who had participated in the training and screening. Five health care workers wrote narratives. Women’s responses to screening questions were analyzed with descriptive statistics, whereas qualitative content analysis guided analysis of qualitative data. Results: Of the 102 women screened, 78% had experienced emotional, physical, or sexual violence. Among them, 62% had experienced IPV, while 22% were subjected to violence by a relative, and 9.2% by a work mate. Two-thirds (64%) had been abused more than once; 14% several times. Almost one-quarter (23%) had experienced sexual violence. Six of the health care workers interacted well with clients but three had difficulties to follow counseling guidelines. FGDs and narratives generated three categories Just asking feels good implied a blessing of the tool; what next? indicated ethical dilemmas; and fear of becoming a ‘women’ hospital only indicated a concern that abused men would be neglected. Conclusions: Screening for IPV is feasible. Overall, the health care workers perceived the tool to be advantageous. Training on gender-based violence and adjustment of the tool to suit local structures are important. Further studies are needed to explore the implications of including abuse against men and children in future screening. Keywords: intimate partner violence; health care workers; abuse screening; Tanzania (Published: 21 October 2011) Citation: Global Health Action 2011, 4 : 7288 - DOI: 10.3402/gha.v4i0.7288

/pdf/screening-of-women-for-intimate-partner-violence-a-pilot-55m5elg74q.pdf

Screening of women for intimate partner violence: a pilot intervention at an outpatient department in Tanzania

Twenty-five patients with primary biliary cirrhosis (PBC) in different stages were investigated with respect to pulmonary function abnormalities. The results were compared with a reference sample of 17 sex- and age-matched healthy subjects. A high prevalence of lung function impairment was found in the PBC patients (14/25 [56%]). Bronchial asthma was present in three patients, and severe lung emphysema in one. These four patients had an abnormal lung function, mainly of obstructive type. There was a statistically significant difference between the remaining 21 PBC patients without chronic obstructive lung disease and the reference subjects with respect to diffusion capacity. Almost all abnormal lung function data were found in the symptomatic PBC patients (i.e. symptoms of pruritus, xanthoma, xanthelasmata, jaundice, hyperpigmentation, hepatosplenomegaly), 13 out of 18 (72%), whereas only one out of seven asymptomatic patients was affected. Nine patients (36%) had reduced diffusion capacity compared with none of the reference subjects. The lung function abnormalities in PBC patients are similar to those found in sarcoidosis, another granulomatous disease.

Lung function abnormalities in patients with primary biliary cirrhosis.

The prevalence of dependency on feeding was estimated in 3,607 residents cared for in old people's homes, nursing homes, somatic long-stay clinics, psychiatric long-stay wards and psychogeriatric wards. Ten per cent of the residents were found to be dependent on the staff to eat. The highest proportion was found in nursing homes and somatic long-stay clinics. A considerably larger proportion of the residents with dependency on assisted feeding imposed the highest workload on the staff. Residents who were totally dependent on assisted feeding were more disabled with regard to other ADL functions and also they were demented more often. Loss of the ability to eat was related to an inability in other ADL functions. Support was gained for a hierarchical loss of ADL functions as suggested by Katz & Apkom. Feeding problems seem to be a terminal phenomenon in demented patients.

Lennart Nyström

Papers

Prevalence of dementia disorders in institutionalized Swedish old people THE WORK LOAD IMPOSED BY CARING FOR THESE PATIENTS

Mortality risk in an adult cohort with a newly diagnosed unprovoked epileptic seizure: a population-based study.

Screening of women for intimate partner violence: a pilot intervention at an outpatient department in Tanzania

Lung function abnormalities in patients with primary biliary cirrhosis.

Prevalence and characteristics of persons with dependency on feeding at institutions for elderly.