International Journal of Geriatric Psychiatry
1099-1166
0885-6230
Anh Quốc
Cơ quản chủ quản: WILEY , John Wiley and Sons Ltd
Lĩnh vực:
Geriatrics and GerontologyPsychiatry and Mental Health
Phân tích ảnh hưởng
Thông tin về tạp chí
The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers. The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.
Các bài báo tiêu biểu
Personality of late‐ and early‐onset elderly suicide attempters Objectives While suicidal behavior often manifests in adolescence and early adulthood, some people first attempt suicide in late life, often with remarkable lethal intent and determination. Given these individuals' more adaptive functioning earlier in life, they may possess traits that hinder adjustment to aging, such as high conscientiousness, rather than impulsive‐aggressive traits associated with suicidal behavior in younger adults. Methods A cross‐sectional case‐control study was conducted in older adults aged ≥50 (mean: 65), divided into early‐ and late‐onset attempters (age at first attempt ≤ or >50, mean: 31 vs 61), suicide ideators as well as non‐suicidal depressed and healthy controls. Personality was assessed in terms of the five‐factor model (FFM, n = 200) and five DSM personality disorders analyzed on the trait level as continuous scores (PDs, n = 160). Given our starting hypothesis about late‐onset attempters, the FFM dimension conscientiousness was further tested on the subcomponent level. Results All clinical groups displayed more maladaptive profiles than healthy subjects. Compared to depressed controls, higher neuroticism, and borderline traits characterized both suicide ideators and early‐onset attempters, while only early‐onset attempters further displayed lower extraversion and higher antisocial traits. Late‐onset attempters were similar to depressed controls on most measures, but scored higher than them on orderliness, a conscientiousness subcomponent. Conclusions While neuroticism, introversion, and cluster B traits are prominent in early‐onset suicidal behavior, late‐onset cases generally lack these features. In contrast, higher levels of orderliness in late‐onset suicidal behavior are compatible with the age‐selective maladjustment hypothesis. Key points
Personality of elderly attempters differed between those with early‐ and late‐onset first attempts. Early‐onset attempters possessed personality traits generally found in younger suicidal populations (high neuroticism, low extraversion, antisocial, and borderline PD traits), supporting that constitutional suicide risk factors persist into late life in some individuals. Late‐onset suicide attempters had higher levels of orderliness than non‐suicidal depressed participants, suggesting that this generally adaptive trait may facilitate suicidal behavior in a subset of depressed elderly.
Tập 35 Số 4 - Trang 384-395 - 2020
Association of life events and psychosocial factors with early but not late onset depression in the elderly: implications for possible differences in aetiology Abstract Background Depression occurring for the first time in later life (after age 60, late onset depression (LOD)) may have a different, more organic, aetiology from early onset depression (EOD). We investigated the possible role of life events, the presence of a confidante and personality factors in the aetiology of depression in the elderly, testing the hypothesis that these factors would be associated with EOD but not LOD. Methods Subjects consisted of 66 elderly patients (aged over 60) with DSM‐IV Major depression (30 EOD, 33 LOD; groups matched for age) and 38 age and sex matched controls. Life events in the 12 months prior to onset of depression (or prior to interview for controls) were recorded using a previously validated 12‐item scale. Personality was assessed using the Eysenck Personality Questionnaire (EPQ). Results Subjects with EOD reported having a close confidente significantly less frequently (52%) than controls (82%, p < 0.05) or LOD (80%, p < 0.05). Bereavement life events occurred significantly more frequently in EOD (52%) than LOD (16%, p < 0.01) and were also more frequent in controls (42%) than LOD (p < 0.05). Higher EPQ ‘extraversion’ and ‘neuroticism’ were found in both EOD and LOD compared to controls, with no differences between EOD and LOD. Conclusions LOD was associated with fewer bereavement life events and more frequent presence of a confidente than EOD. This supports a greater role for psychosocial factors in the aetiology of EOD and different, probably neurobiological, factors in LOD. Personality attributes may have a greater relevance for both EOD and LOD than previously recognized. Copyright © 2003 John Wiley & Sons, Ltd.
Tập 18 Số 6 - Trang 473-478 - 2003
Preoperative risk factors for postoperative delirium following hip fracture repair: a systematic review Objective Systematically identify preoperative clinical risk factors for incident postoperative delirium in individuals undergoing hip fracture repair in order to guide clinicians in identifying high risk patients at admission. Methods This is a systematic review of prospective observational studies with estimation of association between preoperative risk factors and incident postoperative delirium in multivariate models. Electronic searches were conducted in PubMed, Embase, PsycINFO, CINAHL, Cochrane Library, Proquest Dissertations and Theses, and WorldCatDissertations. Hand searches were conducted in selected journals and their supplements. Results Search yielded 6380 titles and abstracts from electronic databases and 72 titles from hand searches, and 10 studies met inclusion criteria. The following risk factors were significant in bivariate models: cognitive impairment, age, gender, institutionalization, functional impairment, body mass index (BMI), albumin, comorbidities, American Society of Anesthesiologist classification, acute medical conditions, polypharmacy, and vision impairment. Among all of these risk factors, cognitive impairment most consistently remained statistically significant after adjusting for other risk factors in multivariate models, followed by BMI/albumin and multiple comorbidities. Conclusion In our systematic review, cognitive impairment was one of the strongest preoperative risk factors for postoperative delirium after hip fracture surgery. Preoperative cognitive assessment may be one of the most useful methods of identifying those who are at high risk for postoperative delirium and prioritizing delivery of delirium prevention measures. Copyright © 2014 John Wiley & Sons, Ltd.
Tập 30 Số 9 - Trang 900-910 - 2015
Identifying the causes, prevention and management of crises in dementia. An online survey of stakeholders Background Crisis situations in dementia can lead to hospital admission or institutionalisation. Offering immediate interventions may help avoid admission, whilst stabilising measures can help prevent future crises. Objective Our objective was to identify the main causes of crisis and interventions to treat or prevent crisis in persons with dementia based on different stakeholder perspectives. Methods An online questionnaire was developed to identify the causes of crisis and appropriate interventions in a crisis. Participants included people with dementia, family carers and staff working in health and social care, including emergency and voluntary sectors, and academia. Results The results ranked the main causes of crisis, interventions that can prevent a crisis and interventions that can be useful in a crisis. Wandering, falls and infection were highly rated as risk factors for crises across all stakeholder groups. Consumers rated aggression as less important but severity of memory impairment as much more important than the other groups did. Education and support for family carers and home care staff were highly valued for preventing crises. Well‐trained home care staff, communication equipment, emergency contacts and access to respite were highly valued for managing crises. Conclusions We identified triggers and interventions that different stakeholders see as important for crisis in dementia. Recognition of these may be critical to planning effective and accepted support and care for people with dementia. Copyright © 2015 John Wiley & Sons, Ltd.
Tập 31 Số 6 - Trang 638-647 - 2016
Neuroimaging and neurocognitive abnormalities associated with bipolar disorder in old age Objectives Cognitive dysfunction is prevalent in older adults with bipolar disorder (BD). High white matter hyperintensity (WMH) burden, a marker of white matter disease, detected on T2/fluid‐attenuated inversion recovery brain magnetic resonance imaging (MRI) has been consistently reported in BD across all age ranges, including older adults. Yet, whether high WMH burden is related to the excess cognitive impairment present in older adults with BD is unknown. Therefore, we examine whether higher WMH burden is related to worse cognitive function in older adults with BD. Methods This is a cross‐sectional study of 27 non‐demented BD patients aged ≥50 years and 12 similarly aged mentally healthy comparators (controls). Subjects underwent both brain MRI and comprehensive neurocognitive assessment. We employed correlational analyses to evaluate the burden of WMH and the relationship between WMH and cognitive function. Results Although BD subjects had worse performance in all cognitive domains, BD subjects had less total WMH burden (t [13.4] = −3.57, p = 0.003). In control subjects, higher WMH was related to lower global cognitive function (ρ = −0.57, n = 12, p = 0.05). However, WMH did not correlate with neuropsychological performance in BD subjects. Further, BD and control subjects did not differ with respect to total gray and hippocampal volumes. Conclusions Cognitive dysfunction in late‐life BD does not appear to be due primarily to processes related to increased WMH or reduced gray matter volume. Future longitudinal studies should examine other potential neuroprogressive pathways such as inflammation, mitochondrial dysfunction, serum anticholinergic burden, and altered neurogenesis. Copyright © 2013 John Wiley & Sons, Ltd.
Tập 29 Số 4 - Trang 421-427 - 2014
Population projection of US adults with lifetime experience of depressive disorder by age and sex from year 2005 to 2050 Abstract Objective To estimate the projected population of US adults aged 18 years or older with lifetime experience of doctor‐diagnosed depressive disorder from 2005–2050. Methods Based on nationally representative survey data from the year 2006 Behavioral Risk Factor Surveillance Survey (BRFSS), prevalence estimates of doctor‐diagnosed depression (minor or major, and dysthymia) were weighted to incorporate the complex sampling design and increase generalizability of the findings. The weighted prevalence data by age and sex in 2006 were then used to estimate the projected adult population with lifetime experience of depressive disorder based on the sex‐specific US Census national population projections from year 2005–2050. Results In year 2006 the (weighted) prevalence of lifetime experience of depressive disorder was 15.7% among 188,292 respondents aged 18 years or older. Female prevalence was 20.6%, which was about twice as high as the prevalence among males (11%). From year 2005–2050, the total number of US adults with depressive disorder will increase from 33.9 million to 45.8 million, a 35% increase. The increase is projected to be greater in the elderly population aged ≥65 years (3.8–8.2, a 117% increase) than in the young population aged <65 years (30.1–37.7, a 25% increase). Conclusions By year 2050, approximately 46 million US adults aged 18 years or older will be diagnosed with a depressive disorder. The increase will be more pronounced in adults aged 65 or older. Prevention, detection, and treatment of depressive disorders might attenuate the magnitude of this estimate. Copyright © 2008 John Wiley & Sons, Ltd.
Tập 23 Số 12 - Trang 1266-1270 - 2008
The impact of sensory impairment on cognitive performance, quality of life, depression, and loneliness in older adults Objectives The objective of this study was to evaluate the relationship between sensory impairment (hearing loss only, vision loss only, and dual sensory impairment [DSI]) and depression, loneliness, quality of life, and cognitive performance in older adults. Methods A total of 229 community‐dwelling older adults aged 60 years or older participated in this study. Variables were measured using the Geriatric Depression Scale (GDS‐15), Revised University of California at Los Angeles Loneliness Scale (R‐UCLA), Satisfaction with Life Scale (SWLS), and Mini‐Mental State Examination (MMSE). Results There was an independent association between DSI and quality of life (P < .05) and between DSI and hearing loss alone and cognitive function (P < .05) in older adults. In addition, higher education was associated with better quality of life and cognitive function. Conclusions DSI is a significant factor affecting the quality of life and cognitive function in older adults. Sociodemographic factors such as education play an important role in improving quality of life and cognitive function. Thus, increasing the awareness of this disability is important to ensure that older adults receive the necessary support services and rehabilitation to improve their level of independence.
Tập 35 Số 4 - Trang 358-364 - 2020
The effects of single and dual sensory loss on symptoms of depression in the elderly Abstract Objectives The primary purposes of this study were to determine the effect of dual sensory loss (i.e. combined hearing and vision loss) on depressive symptoms, to determine whether dual sensory loss has an effect on depressive symptoms when controlling for common covariates of depression, and to determine whether persons with dual sensory loss were more likely than those with a single sensory loss to experience depressive symptoms. Design Secondary analyses of 2001 National Health Interview Survey data. Participants Nine thousand eight hundred and thirty‐two people aged 55 and older residing in the community in the US. Measurements Self‐report answers to questions about hearing and vision status, depressive symptoms, health, education level, poverty, social activities, social support, and functional disability (ADL and IADL status). Results Dual sensory loss had a significant effect on depressive symptoms (OR: 3.2, 95% CI: 2.8–4.0), which was lowered but still significant after controlling for covariates of depression (OR: 2.2, 95% CI: 1.7–2.9). Those with dual sensory loss were not significantly more likely than those with vision loss, but were significantly more likely than those with hearing loss, to experience symptoms of depression. Conclusion Experiencing depressive symptoms is a problem that needs to be addressed with elderly persons with dual sensory loss. Not only is this population more likely to experience these symptoms, because of their sensory losses treatment for them may be problematical. Professionals working with the elderly should be aware of the increased risks of depressive symptoms in those with single or dual sensory loss, and should screen for them. If present, rehabilitation for sensory losses may help decrease them. Copyright © 2005 John Wiley & Sons, Ltd.
Tập 20 Số 9 - Trang 855-861 - 2005
Are the care levels of people with dementia correctly assessed for eligibility of the Japanese long‐term care insurance? Abstract Background A new long‐term care insurance system was launched in Japan in April 2000. Objectives We performed the first national survey on special units of psychiatric hospitals for dementia patients to examine whether their disabilities were well reflected in the eligibility assessment. Methods Of all 248 dementia special units of psychiatric hospitals in Japan, 180 units (72.6%) participated in the survey. Five patients were randomly selected in each unit, and we used data of 802 (89.1%) of 900 patients whose care levels were obtained by the primary computer assessment. These patients were assessed using the Mini‐Mental State Examination (MMSE), dementia rating scale by Gottfries et al . (1982 ) (GBS), and Activities of Daily Living (ADL). The mean score (SD) of the MMSE was 9.3 (6.9). Results Multiple regression analysis revealed that the scores of motor function in GBS, ADL, MMSE, and the degree of bedridden explained 73% of the variation of care level. The higher care levels were inversely related to lower MMSE scores. In the group of people who were not bedridden, the MMSE score sharply decreased even though their physical functions were maintained. There were no significant differences in the MMSE scores among the care level 1 and 5 groups except between care level 1 and 3 after controlling for the motor function scores in GBS. Conclusions Our results suggest that care level and cognitive impairment are generally correlated in the primary assessment, but some adjustment measure for cognitive impairment is needed in mildly or moderately physically disabled patients. Copyright © 2001 John Wiley & Sons, Ltd.
Tập 16 Số 11 - Trang 1078-1084 - 2001
Diabetes incidence associated with depression and antidepressants in the Melbourne Longitudinal Studies on Healthy Ageing (MELSHA) Abstract Objective Diabetes may be associated with depression and antidepressant medication (ADM) use, but published findings remain equivocal. The authors' aimed to determine the risk of diabetes incidence associated with baseline depression exposures (symptoms and/or ADM use). Methods A prospective cohort study was conducted in a regionally representative sample of non‐institutionalised older Australian people (N = 1000, aged 65 + year), who were followed up biennially between 1994 and 2004 (attrition was ≈24%). Analyses excluded participants for prevalent diabetes at baseline, determined by self‐report or specific medications. Diabetes incidence was ascertained by first self‐report at any follow‐up wave. Depression exposures (baseline predictors) were defined by the Psychogeriatric Assessment Scales (PAS) depression scale and ADM use, and classified as: (1) ‘symptomatic’ (PAS score 5+); (2) ‘ADM use’; (3) ‘symptomatic or ADM use’; (4) ‘symptomatic and no ADM use’; (5) ‘asymptomatic (PAS score <5) and ADM use’ and (6) ‘symptomatic and ADM use’. Covariates were demographic, lifestyle, functional health and chronic disease factors. Cox regressions were used to determined hazard ratios with 95% confidence intervals (HR [95% CI]) for diabetes incidence according to depression exposures, adjusted for significant covariates. Results Baseline response rate was 70.3%. Depression predictors of diabetes incidence were ‘symptomatic’ (2.29 [1.28,4.10]), ‘symptomatic or ADM use’ (2.13 [1.32,3.44]) and ‘symptomatic and no ADM use’ (2.38 [1.28,4.45]), after adjustment for significant covariates. Being asymptomatic was not a protective factor among those prescribed antidepressants. Conclusions Older people with depressive symptoms are at least twice more likely to develop diabetes than those without depressive symptoms, regardless of antidepressants. Copyright © 2009 John Wiley & Sons, Ltd.
Tập 25 Số 7 - Trang 688-696 - 2010