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Biomedical subjects

B W Rovner

Publications and source records attributed to B W Rovner.

48 records · Page 3Linked to original sources
PubMed1990

Association between family history of affective disorder and the depressive syndrome of Alzheimer's disease.

For each of 41 index patients with probable Alzheimer's disease and a first episode of major depression and 71 nondepressed Alzheimer's disease patients, two first-degree relatives were interviewed by a rater blind to presence or absence of depression in the proband. The depressed patients had significantly more first- and second-degree relatives with depression than did control subjects. The lifetime risk for major depression, adjusted for differences in age distribution, was significantly greater in first-degree relatives of index patients, suggesting that depression in Alzheimer's disease is genetically related to primary affective disorder. Alzheimer's disease may be useful for studying aspects of depressive pathophysiology.

Age Factors↗
PubMed1990

Alzheimer's disease research at Johns Hopkins.

The emergence of Alzheimer's disease from relative obscurity to front-page news is related to the increased life expectancy and increased proportion of the population over 65 years old. About 8 percent of the US elderly population suffer from the disease.

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PubMed1989

Prescribing efficiently in nursing homes.

Giving medications in nursing homes is time consuming and expensive. The orders for medications in a community nursing home were examined to determine if nursing time could be saved by consolidating the administration of medications. Nineteen percent of the medication administration visits could be eliminated by this method according to the independent judgments of two physicians. This could save up to $19,000 in nursing time per year, and the time could be redirected to other nursing activities that could improve the quality of care in nursing homes.

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PubMed1989

Depression and Alzheimer's disease.

In his classic case, Alzheimer described cognitive symptoms such as amnesia, aphasia, and apraxia and noncognitive symptoms such as delusions and agitation. Recent studies have suggested that depression also occurs in Alzheimer's disease. In this study, 144 patients who met criteria for Alzheimer's disease were examined for depression on a modified version of the Present State Examination. The prevalence rate of major depression was 17%. The depressed Alzheimer's disease patients were more cognitively impaired and more disabled than the nondepressed patients. Studies are needed to clarify the etiology and treatment of depression in Alzheimer's disease.

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PubMed1987

The use of mental health measures in nursing home research.

To examine the quality of mental health research in nursing homes, 130 articles published in six geriatric specialty and health care delivery journals were reviewed. Thirty-nine (30%) articles used a mental health measure. Measures of cognitive function were most common, being used in 32 (25%) of the articles reviewed. Twenty-three (18%) studies measured abnormal mental experiences and 17 (13%) articles measured behavioral disorder. Many articles used measures or determinations with no established reliability. Twenty-six of the articles which used a mental health measure also used a measure of activities of daily living or physical function. Retrospective and prospective studies were similar in number. A minority of articles used control groups, random samples, or prepost measures while a majority (64%) identified an outcome measure. We conclude that nursing home research can be improved by the increased use of reliable measures of cognition and abnormal mental experiences and by the development of reliable measures of behavioral disorder. Study design can be improved by identifying a priori hypotheses and by the increased use of random sampling and control/comparison groups.

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PubMed1986

Prevalence of mental illness in a community nursing home.

A research psychiatrist using a standardized interview found that 94% of a random sample of residents at a large, intermediate-care nursing home had mental disorders according to DSM-III criteria. Primary degenerative dementia and multi-infarct dementia were the most common diagnoses. In addition, the majority of demented patients also had noncognitive symptoms such as delusions and hallucinations, and these residents were significantly more likely to have an associated behavioral disorder than were residents without delusions or hallucinations. Replications of these results would point out the need for major revisions in the funding and delivery of psychiatric care for nursing home residents.

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PubMedDate not supplied

Benzodiazepine use in the elderly prior to psychiatric hospitalization.

The objective of this study was to assess benzodiazepine use and the treatment of depression before admission to an inpatient geriatric psychiatry unit in a sample of elderly patients. The study design was a retrospective chart review, and the setting was a university hospital inpatient geriatric psychiatry unit. The subjects included 131 consecutively admitted patients. Preadmission benzodiazepine drug regimens were reviewed in relation to the Health Care Financing Administration (HCFA) guidelines for benzodiazepine use in nursing homes and in relation to psychiatric diagnoses. Psychiatric diagnoses were made based on DSM-III-R criteria. The preadmission benzodiazepine regimens of 38 of 59 patients receiving benzodiazepines (64.0%) were outside the HCFA guidelines. Also, 30 of 76 patients (39.5%) with depressive disorders received benzodiazepines as sole treatment of depression prior to their admission. This study suggests that benzodiazepines may be misused in the elderly and indicates the need for education and research on the appropriate use of benzodiazepines in the treatment of depression.

Activities of Daily Living↗
PubMedDate not supplied

Psychiatric diagnosis and uncooperative behavior in nursing homes.

The prevalence of psychiatric disorders and behavioral disturbances in nursing homes is high, but the relationship between the two is unknown. We studied 454 new admissions who were diagnosed by research psychiatrists using DSM-III-R criteria and compared patients who nursing staff designated as cooperative or uncooperative by psychiatric diagnosis and use of restraints and neuroleptics. Uncooperative patients (n = 79; 17.4%) had a variety of psychiatric disorders (total, 87.3%) but particularly had dementia syndromes complicated by delusions, depression, or delirium (44.3%). Uncooperative patients were more frequently restrained and prescribed neuroleptics. Determining the origins of behavior disorders in patients with psychiatric disorders in nursing homes may reduce behavior disturbances.

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PubMedDate not supplied

Prevalence of advance directives and guardianship in nursing home patients.

The Patient Self-Determination Act (PSDA) now requires federally funded nursing homes to inform newly admitted patients of their right to determine their future medical care. Many nursing home patients may not be able to understand these rights, given the high prevalence of mental disorders, particularly dementia, in this population, and well need family members for assistance. Prior to the onset of the PSDA we surveyed the families of all residents of a large, proprietary nursing home to determine whether family members understood the concept of advance directives and guardianship. We also ascertained the rate of use of these instruments in the population studied. We found that the majority of family member respondents understood these concepts, but that substantial proportions of both competent and incompetent patients lacked surrogate decision-making authority, either in the form of a court-appointed guardian or a written advance-directive instrument. Informing newly admitted patients and their families about advance directives is warranted because many lack these plans. However, the high proportion of incompetent patients among nursing home patients indicates the need to encourage currently competent patients to formulate advance directives prior to nursing home placement.

Advance Directives↗