Delirium is a serious neuropsychiatric syndrome affecting mainly elderly participants with acute medical diseases. The pathophysiology of delirium remains poorly understood as it involves complex dynamic interactions between a diversity of risk factors. Exploring how etiological factors interact with each other can clarify the pathophysiological mechanisms and facilitate the early identification of this syndrome. The aim of this study was to explore how different risk factors co-occur in medically ill elderly patients with delirium with cluster analysis and identify clinically meaningful sub-groups in this population.

A cross-sectional study was developed. Ninety-nine elderly inpatients admitted to acute medical wards diagnosed with delirium during hospitalization were selected. For each patient sociodemographic characteristics, acute and chronic medical conditions, laboratory parameters, and current medication were collected.

The cluster analysis extracted three distinct subgroups of participants with delirium. Patients in cluster 1 (n = 28) had higher rates of medication with anticholinergic proprieties. Cluster 2 (n = 29) included participants with cardiac and pulmonary comorbidities associated with both chronic and acute reduction of blood flow and/or oxygenation to the brain. Cluster 3 (n = 42 patients) comprised patients with simultaneous deregulation of different organs/systems, such as electrolytic disturbances, metabolic disturbances, and acute renal failure. Known predisposing factors of delirium, such as age and pre-existing dementia, were similar between groups.

The results reveal different patterns of clinical characteristics in elderly patients with delirium. This is relevant to clinical care of acute medically ill patients and suggests that different pathways are implicated in delirium pathophysiology.

This 12 month, Australian study sought to compare the Capabilities Model of Dementia Care (CMDC) with usual long-term care (LTC), in terms of (1) the effectiveness of the CMDC in assisting care staff to improve Quality Of Life (QOL) for older people with dementia; and (2) whether implementation of the CMDC improved staff attitudes towards, and experiences of working and caring for the person with dementia.

A single blind, non-randomized controlled trial design, involving CMDC intervention group (three facilities) and a comparison usual LTC practice control group (one facility), was conducted from August 2010 to September 2011. Eighty-one staff members and 48 family members of a person with dementia were recruited from these four LTC facilities. At baseline, 6 and 12 months, staff completed a modified Staff Experiences of Working with Demented Residents questionnaire (SEWDR), and families completed the Quality of Life – Alzheimer's Disease questionnaire (QOL-AD).

LTC staff in the usual care group reported significantly lower SEWDR scores (i.e. less work satisfaction) than those in the CMDC intervention group at 12 months (p = 0.005). Similarly, family members in the comparison group reported significantly lower levels of perceived QOL for their relative with dementia (QOL-AD scores) than their counterparts in the CMDC intervention group at 12 months (p = 0.012).

Although the study has a number of limitations the CMDC appears to be an effective model of dementia care – more so than usual LTC practice. The CMDC requires further evaluation with participants from a diverse range of LTC facilities and stages of cognitive impairment.

Emotional distress associated with Parkinson's disease (PD) increases disease burden and decreases functioning. The literature supports the benefits of psychological interventions for amelioration of emotional distress in persons with PD. The objective of this study is to apply the Contextual Adult Lifespan Theory for Adapting Psychotherapy (CALTAP) to enhancing psychological treatment for persons with PD.

This paper uses case examples to demonstrate the usefulness of the CALTAP model in helping patients and clinicians separate disease symptoms from the aging process. The examples also illustrate how working in this way can be beneficial in reducing emotional distress in persons with PD.

CALTAP contributes to helping persons with PD and persons treating them understand the effects of the disease, separate disease effects from aging processes, and think through the influences of social context, cohort effects, and cultural differences.

The CALTAP model can guide adaptations to psychological interventions for emotional distress in PD and potentially improve their effects.

Neuropsychiatric Symptoms (NPS) are ubiquitous in dementia and are often treated pharmacologically. The objectives of this study were to describe the use of psychotropic, anti-cholinergic, and deliriogenic medications and to identify the prevalence of polypharmacy and psychotropic polypharmacy, among older hospitalized patients in Ireland, with and without dementia.

All older patients (≥ 70 years old) that had elective or emergency admissions to six Irish study hospitals were eligible for inclusion in a longitudinal observational study. Of 676 eligible patients, 598 patients were recruited and diagnosed as having dementia, or not, by medical experts. These 598 patients were assessed for delirium, medication use, co-morbidity, functional ability, and nutritional status. We conducted a retrospective cross-sectional analysis of medication data on admission for 583/598 patients with complete medication data, and controlled for age, sex, and co-morbidity.

Of 149 patients diagnosed with dementia, only 53 had a previous diagnosis. At hospital admission, 458/583 patients experienced polypharmacy (≥ 5 medications). People with dementia (PwD) were significantly more likely to be prescribed at least one psychotropic medication than patients without dementia (99/147 vs. 182/436; p < 0.001). PwD were also more likely to experience psychotropic polypharmacy (≥ two psychotropics) than those without dementia (54/147 vs. 61/436; p < 0.001). There were no significant differences in the prescribing patterns of anti-cholinergics (23/147 vs. 42/436; p = 0.18) or deliriogenics (79/147 vs. 235/436; p = 0.62).

Polypharmacy and psychotropic drug use is highly prevalent in older Irish hospitalized patients, especially in PwD. Hospital admission presents an ideal time for medication reviews in PwD.

The aim of this study is to develop and try out an approach for personalized nature activities for people with dementia.

A qualitative descriptive study using focus group interviews with people with dementia was conducted. Based on the results of the focus groups and the relevant literature, the approach was developed. In a qualitative descriptive pilot study with a one-group design, we tried out the approach regarding acceptability and experience of the intervention among people with dementia, and satisfaction with the approach among healthcare professionals. Additionally, we investigated the organizational feasibility.

From the focus groups, eight key aspects of experiencing nature were identified as being important for quality of life (e.g. relaxation, freedom), as well as six categories of preferred activities (e.g. active, passive, and social activities). Based on these themes and categories, an approach was developed to design nature activities according to the personal wishes, needs, and experiences of people with dementia. During the intervention, participants in the pilot study showed high levels of positive behaviors and low levels of negative behaviors. As regards, organizational feasibility, eight themes for successful implementation of nature activities were identified.

This exploratory study contributes to the knowledge regarding the development and implementation of person-centered nature activities for people with dementia. The implementation of the activities could be improved by training professionals in person-centered care. The effect of the person-centered nature activities approach should be investigated.

Neuropsychiatric symptoms (NPS) have a high prevalence among patients with dementia, up to 80%. NPS can be grouped by type and stage of dementia. However, NPS have not previously been grouped by gender. Our objective was to investigate whether NPS cluster differently in men or women in the nursing home patients.

Factor analysis to assess the clustering of items in the Cohen-Mansfield Agitation Inventory (CMAI) and Neuropsychiatric Inventory-Nursing home version (NPI-NH) into components, for both scales and for gender. Differences in symptom clustering between male and female patients were assessed using a three-step procedure: (1) identifying a gender specific distinctive item, (2) describe the correlation between the distinctive item with any other item in this cluster, (3) testing whether the correlation between a distinctive item and any other item in the cluster (which is present in both sexes) is different for males and females using a general linear model.

Our database consisted of 1,609 patients. There were five male and three female clusters for NPI-NH and eight male and seven female clusters for CMAI. There were three distinctive items in the NPI-NH and ten in the CMAI.

There are other clusters of NPS in males and females. Our analysis revealed more significant relations in female than male patients. This might have an implication on the clinical course.

The growth among older prisoner populations, including in Australia, necessitates an understanding of this group in order to generate effective management strategies. One particular concern is the mental well-being of older prisoners. This study aimed to determine the level of psychological distress among sentenced prisoners aged 50 years and older, to compare this level to that seen among younger prisoners and older people in the community, and to investigate which mental health history, cognitive functioning, socio-demographic, and criminal justice characteristics were associated with psychological distress.

A cross-sectional survey of 173 older (M = 63 years) and 60 younger prisoners (M = 34 years) in two Australian jurisdictions was conducted. The Kessler Psychological Distress (K10) scale was administered with prisoners and additional data were collected from interviews and participant health and corrections files. K10 scores were compared to community norms using data from the Australian Health Survey.

Average K10 scores of the older prisoners were significantly lower than the younger prisoners’ (p = 0.04), though the effect size was small (r = 0.1). Significantly, higher distress levels were observed in comparison to the general population (p < 0.001), with older prisoners being three times more likely to display very high levels of distress (12.3% vs. 3.7%). Higher psychological distress scores among older prisoners were significantly associated with female gender (p = 0.002) and a history of mental health issues (p = 0.002).

While the levels of distress seen among older prisoners were significantly lower than that of younger prisoners, their higher levels of distress in comparison to community norms demonstrate a need for correctional services to be attuned to the mental health of the expanding older prisoner population.

Few studies have estimated care burden in large, representative, multi-ethnic Asian population-based informal caregivers of older adults with care needs. This study describes informal caregivers’ care participation for a population-based sample of older adults with care needs in Singapore, investigates differences by dementia status, and examines correlates of caregivers’ burden.

Data collected from 693 pairs of older adults, aged 60 to 100 years, having any care needs, and their informal caregivers, who were aged 21 to 88 years, closely involved in their care and “knew the older resident best,” and were interviewed during a cross-sectional national survey, were used. Clinical characteristics of older adults, including behavioral and psychological symptoms of dementia (BPSD) and dementia diagnosis, care needs, and socio-demographic characteristics of participants were obtained. Care burden was assessed with the Zarit Burden Interview.

Informal caregivers’ participation was highest in activities related to communication (35.1%), feeding (32%), and bathing (21.1%). Among the older adults with any care need, 356 (51.4%) had dementia. Care burden was significantly associated with married caregivers (odds ratio (OR) 2.4 vs. never married), when their relative belonged to a younger cohort (OR 2.5 vs. >84 years), needed care much of the time (OR 2.5 vs. no care needed), exhibited BPSD (OR 3.5 vs. no BPSD), and had dementia (OR 2.52 vs. no dementia).

Factors related to older adults – more care needs, presence of BPSD, and dementia – were significant contributors to informal caregivers’ burden, and these should be considered while planning interventions to alleviate care burden.

Falls are highly frequent in older adults and are associated with increased morbidity and mortality. The present study was designed to assess the role of satisfaction with one's aging process as a predictor of the risk for falling over a four-year period and to identify potential mediators of this relationship.

The Health and Retirement Study (HRS) is a US nationally representative sample of individuals over the age of 50 years and their spouse of any age. The present study was based on the 2008–2012 waves of the HRS. Analyses were restricted to 4,121 respondents over the age of 50 years, who had fall data in 2008 and 2012 and were eligible to complete the satisfaction with aging measure as part of the 2008 psychosocial questionnaire.

Overall, 38.1% of the sample reported having fallen at least once between 2006 and 2008 and 40.7% reported having fallen at least once between 2010 and 2012. Higher levels of satisfaction with aging in 2008 were found to be protective against falls assessed in 2012 (OR[95%CI] = 0.88[0.79–0.98]) even after adjustment for age, gender, education, ethnicity, medical status, functional status, cognitive functioning, walking speed, balance, vision, depressive symptoms, physical activities, and past falls. Bootstrap procedures have shown that the effect of satisfaction with aging on falls is partially accounted for through its effect on functional decline.

The findings point to the important role of satisfaction with aging as a potential protective mechanism against falls. The results call for the development of psychosocial interventions to reduce falls in older adults.

Studies have shown higher healthcare utilization and costs associated with post-traumatic stress syndrome (PTSS) in veterans and community adult populations. Given the aging population and the impact on health system resources, it is important to understand the economic consequences of PTSS.

The data retained came from 1,456 older adults aged 65 years and over recruited in primary medical clinics in the province of Quebec. PTSS was measured with the PTSS scale. Healthcare services (outpatient, emergency department (ED) visits, and inpatient stay) and medication use were captured separately from provincial administrative databases. Healthcare costs incurred in the past year included costs related to outpatient and ED visits, physician fees, inpatient stay, and medication use. Costs were calculated using a healthcare system perspective. χ2 and Mann–Whitney analyses were used to assess healthcare use. Generalized linear models (GLM) with a gamma distribution (Log Link) were used to evaluate the healthcare costs associated with PTSS.

Results showed a significant difference in the number mental health outpatient visits, the number of total prescriptions and the use (presence of at least one prescription) of antidepressants (ADs) and benzodiazepines (BZDs). The multivariate analyses showed that costs associated with outpatient visits, ED visits, mental health inpatient stays, physician fees, and medication use were significantly associated with the presence of PTSS. The total adjusted healthcare cost difference between groups was significant and reached $838 CAN.

Respondents with PTSS were more likely to be prescribed psychotropic medications and to have higher ambulatory costs but not inpatient services related costs, more research is required to better understand whether the mental health needs of individuals with a probable PTSS are being met.

Despite growing numbers of older-adult illicit drug users, research on this topic is rare. This study examined the relationship between marijuana and/or other illicit drug use and major depressive episode (MDE) and serious suicidal thoughts among those aged 50+ years in the USA.

The public use files of the 2008 to 2012 US National Survey on Drug Use and Health (NSDUH) provided data on 29,634 individuals aged 50+ years. Logistic regression analysis was used to test hypothesized associations between past-year marijuana and/or other illicit drug use and MDE and serious suicidal thoughts.

Nearly 6% of the 50+ years age group reported past-year marijuana and/or other illicit drug use. Compared to non-users of any illicit drug, the odds of past-year MDE among those who used marijuana only, other illicit drugs only, and marijuana and other illicit drugs were 1.54 (95% CI = 1.17–2.03), 2.75 (95% CI = 1.75–4.33), and 2.12 (95% CI = 1.45–3.09), respectively. Those who used marijuana and other drugs also had higher odds (2.44, 95% CI = 1.58–3.77) of suicidal thoughts than non-users of any illicit drug. However, among users of any illicit drug, no difference was found among users of marijuana only, marijuana and other illicit drugs, and other illicit drugs only. Among marijuana users, marijuana use frequency was a significant correlate of suicidal thoughts only among those with MDE.

Health and mental health (MH) service providers should pay close attention to the potential reciprocal effects of marijuana and other illicit drug use and MDE and suicidal thoughts among late middle-aged and older adults.

The purpose of the study was to investigate the relationship between dual task walking, cognition, and depression in oldest old people living in the community.

We conducted an observational cross-sectional study at Federal University of São Carlos (Brazil). We assessed 67 community-dwelling older adults aged 80 years and over, who were able to walk alone and did not present with a risk of dementia (assessed by Mini-Mental State Examination, MMSE). The assessment consisted of anamnesis, dual task using the Timed Up and Go test associated with a motor task (TUGT-motor) and a cognitive task (TUGT-cognitive); cognitive measures using MMSE, Montreal Cognitive Assessment (MoCA), Clock Drawing test (CDT) and verbal fluency, and depressive measures by the Geriatric Depression Scale (GDS).

There was a correlation with higher magnitude between cognitive tests and TUGT-cognitive, compared to TUGT-motor. For TUGT-motor, the highest correlations with cognitive tests were found between time and MMSE, MoCA (total score), and MoCA visuospatial/executive domain. For TUGT-cognitive, the highest correlations with cognitive tests were between number of steps and MMSE and between time and MMSE. GDS showed a significant weak correlation with number of steps taken in TUGT-motor, wrong words, and correct/time of TUGT-cognitive.

Dual task performances are associated with cognition in oldest old. Furthermore, dual task tests have less influence of educational level, are functional, fast, and easily applicable in clinical practice. Future studies are needed to confirm if dual task test is useful for cognitive screening in oldest old.

Sleep disturbances are commonly observed in older nursing home residents, mainly in combination with dementia. However, sleep-associated circadian motor activity patterns have not been thoroughly investigated in Japanese nursing homes. The present study aimed to respectively clarify the effect of community living and the presence of dementia on sleep disturbances and interrupted activity rhythm of older nursing-home residents with or without dementia and older community-dwelling people without dementia.

Actigraph devices worn on the participants’ non-dominant wrists for seven days were used to collect objective measurements of the sleep/awake status throughout the night and the circadian motor activity patterns. The presence of dementia was assessed by a trained medical doctor using the residents’ records and the Clinical Dementia Rating (CDR). The functional capacity of the participants was determined using the Barthel Index (BI).

Fifty-one older people in Akita prefecture were included in the current study, consisting of 17 residents with dementia (mean age: 82.2 years), 17 residents without dementia (84.5 years), and 17 community-dwelling people (83.6 years). The results showed that older nursing-home residents with dementia had significantly a lower rate of sleep efficiency and a longer awake time throughout the night than the other groups. Older nursing-home residents with and without dementia had more fragmented rhythm than community-dwelling people without dementia.

These results provide evidence of poor sleep/awake status throughout the night and interrupted circadian activity rhythms in nursing-home residents with and without dementia. However, further studies performed according to dementia classifications are needed.

The Family Group Conference (FGC) is an approach to partnership working which brings together service users, their support network and care professionals in a family-led decision making forum. Evidence, though limited, indicates that that FGC can enhance outcomes for service providers and their users. This study aimed to evaluate the impact of the pilot FGC service, delivered to people with dementia and their families, in terms of the experience of care provision by families and care professionals involved in the project.

Focus group interviews were conducted with families and professionals participating in the pilot intervention.

FGC was perceived as having the potential to positively impact service users, their families, service providers and the wider culture of care. However, despite an overall positive evaluation the participants identified a number of challenges related to service implementation. Both the opportunities and challenges identified in this study are discussed in the context of the existing international evidence base.

This study contributes to a better understanding of the applicability of FGC as a strategy to support people with dementia and their families. Although promising in terms of potential outcomes for service users and providers, FGC presents challenges which need to be carefully managed in order to secure maximum benefit to all parties.

Previous research has shown that measuring the size and content of patients’ drawings of their illness can reveal their perceptions and predict recovery. This study aimed to assess the usefulness of analyzing kinematic features of drawings.

A pilot observational study was conducted with 15 patients who had been hospitalized with a stroke 8 to 11 months previously. They were asked to draw a picture of what they thought had happened to their brain and describe the drawing using an electronic inking pen and digitizing tablet. Analysis of kinematic data (time to draw/write, drawing/writing speed, and pen pressure) was conducted using MovAlyzeR® software. Evaluations of physical functioning, quality of life, illness perceptions, and emotional well-being were administered, and correlations with kinematic measures assessed.

Stronger pen pressure was associated with perceptions of greater control over the stroke. Faster drawing was correlated with greater worry about a recurrent stroke and the perception that the effects of the stroke would last longer. Needing more time to write was associated with perceptions of fewer consequences of the stroke. No associations between kinematic measures and indicators of stroke severity, physical, or emotional well-being were shown.

Kinematic measures of stroke patients’ drawings of their brain and comments were associated with illness perceptions and not measures of physical or emotional health status. The addition of kinematic analysis may add further utility to the assessment of patients’ drawings of their illness. More studies need to be performed with larger sample sizes and other patient groups.

To examine the role of meaningful relationship characteristics, defined here as social network type, in relation to the association between functional impairment and depressive symptoms.

The sample included respondents aged 65 years and older (n = 26,401) from the fourth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). Respondents were classified into one of seven relationship network types (Distal Children (living at a distance), Proximal Family (living nearby), Spouse, Other Family, Friend, Other, and No Network) according to the predominant characteristics of their most meaningful relationships. A two-stage regression analysis was performed in which the number of depressive symptoms was first regressed on the extent of functional impairment and network type, controlling for sociodemographic characteristics, cognition, health, and country. In the second stage, variables representing the interactions between functional impairment and network type were considered.

The compositional characteristics of respondents’ relationships in later life, as defined by social network type, were associated with depressive symptoms. In particular, when experiencing functional impairment, those without any meaningful relationships were found to have more depressive symptoms when compared to all other network types. The findings underscore the importance of meaningful relationships for the mental health of older adults experiencing functional impairment as well as the risk of experiencing depression among those who maintain no personal social network.

The study shows that differing constellations of meaningful relationships in later life yield different associations with mental health, especially when taking functional limitations into account.

Depression is closely associated with quality of life (QOL) in older adults. Being elderly and exhibiting mild depressive symptoms may not lead to a depression diagnosis, but these attributes are clinically important. However, the extent to which these factors influence QOL and its determinants in older adults remains unclear.

Questionnaires were administered to people aged 65 years or older at community senior centers in Taiwan to collect socio-demographic information and to assess results from the brief version of the World Health Organization's Quality of Life instrument (WHOQOL-BREF), Modified Barthel Index (MBI), 15-item Geriatric Depression Scale (GDS), and Mini-Mental State Examination (MMSE). Levels of depressive symptoms were classified as no depressive symptoms (NDS), lower level of depressive symptoms (LLDS), and higher level of depressive symptoms (HLDS), corresponding to GDS = 0, 1≦GDS≦5, and GDS>5, respectively. Multiple linear regression analyses were conducted to assess associations between the WHOQOL-BREF and its covariates for different levels of depressive symptoms.

A total of 454 older adults participated. The GDS and MBI scores significantly affected the WHOQOL-BREF physical and psychological domain scores in the LLDS group. Gender influenced the WHOQOL-BREF scores in the NDS group, and increased age demonstrated protective effects on the three domains in the HLDS group. Moreover, the association between the WHOQOL-BREF and its covariates varied for different levels of depressive symptoms.

Treatment for depressive symptoms is of high priority, and early recognition of and appropriate intervention for mild depressive symptoms may improve community-dwelling older adults’ QOLs.

Although the incidence of cancer increases with age, elderly patients are often excluded from clinical trials. In addition, elderly patients are frequently undertreated in comparison to younger patients. One explanation for these observations is age stigma (i.e. ageism). In this context, this study has two objectives: (1) to replicate the results of previous studies that reported differential support of medical treatment depending on the patient's age in a different healthcare provider population (nurses rather than physicians); and (2) to determine whether support for expensive immunotherapy, adjuvant chemotherapy, or breast reconstruction is linked to ageism among nurses.

The participants were 76 nurses who specialized in oncology. They received four clinical vignettes: one vignette about an immunotherapy with a high societal cost (age of patient: 40 vs. 70 years), and three vignettes about adjuvant chemotherapy and breast reconstruction (age of patient: 35, 55, or 75 years – age was the only difference). A questionnaire and a fluency task were used to assess the participants’ vision of aging.

Our analyses show that support for immunotherapy, breast reconstruction, and chemotherapy is lower for older patients than for younger patients. Moreover, nurses’ vision of aging influences support for breast reconstruction: nurses with a negative view of age discriminated more between a 75-year-old patient and a 35-year-old patient (less encouragement for the older patient).

These results highlight the need for nurses and other healthcare providers to receive specific training about ageism and its consequences.

The ability to identify biological, social, and psychological issues for people with dementia is an important skill for healthcare professionals. Therefore, valid and reliable measures are needed to assess this ability. This study involves the development of a vignette style measure to capture the extent to which health professionals use “Biopsychosocial” thinking in dementia care (VIG-Dem), based on the framework of the model developed by Spector and Orrell (2010).

The development process consisted of Phase 1: Developing and refining the vignettes; Phase 2: Field testing (N = 9), and Phase 3: A pilot study to assess reliability and validity (N = 131).

The VIG-Dem, consisting of two vignettes with open-ended questions and a standardized scoring scheme, was developed. Evidence for the good inter-rater reliability, convergent validity, and test–retest reliability were established.

The VIG-Dem has good psychometric properties and may provide a useful tool in dementia care research and practice.

The benefit of cognitive stimulation (CS) treatments in dementia is unequal. This study has sought to identify cognitive and functional measurements before and after the treatment which are indicative of a better response to a one-year CS program.

A retrospective observational study was conducted between 2004 and 2012 in a sample of 60 users diagnosed with mild Alzheimer's disease (AD) who followed a one-year CS program and underwent a cognitive and functional assessment before and after the intervention. As a primary measure of treatment response, we used the annual change of the Mini-Mental State Examination (MMSE) scores, which distinguished good responders (R) from non-responders (NR).

51.7% of patients classified as R at baseline had a higher cognitive performance in attention, immediate verbal memory, language, and working memory compared to NR. No initial statistically significant differences were found between R and NR in any sociodemographic variables, medical conditions, anxiety and/or depressive symptoms, treatment with cholinesterase inhibitors (ChEIs), level of insight, global cognitive function (MMSE), or functional capacity. After 12 months of treatment, R had significantly better results than NR on MMSE, temporal orientation, category evocation, and Philadelphia Geriatric Center-Instrumental Activities of Daily Living (PGC-IADL).

The response to a CS treatment of some subjects over others is linked to cognitive and functional capacity. This research contributes to characterize the neuropsychological profile that differentiates subjects who respond better than others before and after the treatment. This should contribute to customize and optimize neuropsychological interventions in patients with AD.