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Biomedical subjects

J Snowdon

Publications and source records attributed to J Snowdon.

At least 37 records · Page 2Linked to original sources
PubMed1997

Epidemiologic questions on mood disorders in old age.

To study factors associated with different mood disorders in old age, researchers need clear and meaningful definitions. "Major depression" is too broad and heterogeneous a category, and the boundaries of "dysthymia" are ill-defined, yet epidemiologic studies have focused on these disorders. Depressions in old age are commonly associated with medical conditions; prevalence rates of depression in cases of stroke, Parkinson's disease, dementia, and disabilities (all much commoner in old age) range upward from about 20%. Depressions are attributed to both psychological and biological reactions. Mania, too, can be precipitated by cerebral and other medical factors. The proportion of psychiatric inpatients who have depressions with melancholic and/or psychotic features is higher among elderly subjects, and this has been linked with white matter lesions and other brain changes that become commoner in old age. The prognostic relevance of these brain changes, and implications for treatment of mood disorders, require clarification.

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PubMed1997

Changes in psychotropic medication use in nursing homes over a 9-month period.

A 1993 survey of nursing home residents in one part of Sydney was repeated 9 months later. Details of psychotropic medication given to the 1433 residents who survived and remained in the same 38 nursing homes were examined. There were modest reductions in the percentage of residents taking neuroleptics, anxiolytics and hypnotics, but there was an increase from 16.0% to 17.6% in the percentage of residents taking antidepressants. About 65% of those taking psychotropic medication at the initial survey remained on exactly the same dose 9 months later. Most of those taking neuroleptic or antidepressant medication were given relatively small daily doses. Intervention studies are desirable to examine how best to improve prescribing practices.

Drug Prescriptions↗
PubMed1995

Psychotropic drug use in Sydney nursing homes.

OBJECTIVE: To determine the pattern of use of psychotropic drugs in Sydney nursing homes. DESIGN: Survey of data from medical records of residents and interviews with residents and staff. SETTING: Central Sydney Health Area, June to December 1993. PARTICIPANTS: All residents of 46 of the 47 nursing homes in the western sector of the health area. MAIN OUTCOME MEASURES: Psychotropic drugs used regularly or as required. Degree of cognitive impairment and depression rated on interview with residents, using Mini-Mental State Examination and Geriatric Depression Scale. Behavioural disturbances reported by staff. RESULTS: Most residents (58.9%) were taking one or more psychotropic drugs regularly and another 7% were prescribed these drugs as required. Neuroleptics were taken regularly by 27.4% and as required by a further 1.4% (at least one dose in the previous four weeks), but doses were equivalent to more than 100 mg/day of chlorpromazine for only 8.8%. Neuroleptics were more likely to be given to residents with greater cognitive impairment and more disturbed behaviour. Other psychotropic drugs in regular use were: benzodiazepines (32.3%); hypnotics (26.6%); antidepressants (15.6%); and anxiolytics (8.6%). At least half of antidepressant doses were subtherapeutic. Of 874 residents who responded to a depression questionnaire, 30% scored as significantly depressed; one-third of these were taking antidepressants. CONCLUSIONS: The percentage of residents in Central Sydney nursing homes who were taking neuroleptics, hypnotics or anxiolytics is among the highest reported from geriatric institutions around the world. Prescribing practices in Australian nursing homes need to be reviewed.

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PubMed1995

A survey of psychiatric services for elderly people in Australia.

In 1992 a postal questionnaire identified 107 psychiatrists in Australia who, for a significant proportion of their time, were providing psychiatric services to elderly people. Only 18% were female. There were 34 psychiatrists working full-time in psychiatry of old age in the public health system. Twenty-three multidisciplinary catchment area psychiatric services for elderly people were identified, but staff to population ratios varied considerably. The ratio of psychiatrists to elderly was 1:30,000--similar to the ratio in a large part of Britain seven years previously. Psychogeriatricians are involved in a broad range of teaching and research activities. The mean number of non-medical staff in a catchment area psychogeriatric service should be increased.

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PubMed1995

Mental health services in Sydney nursing homes.

Senior nursing staff of the 58 nursing homes in one health area of Sydney were interviewed concerning mental health services and staff education. One or more psychiatrically trained staff were employed in 45 per cent of the nursing homes. Most nursing homes received services from a psychiatrist or another mental health professional, but the average time per month provided by them to see residents was less than one hour in 18 (31 per cent), one to two hours in 16 (28 per cent), and three hours or more in only 11 (19 per cent). Forty-four (76 per cent) wanted more mental health services to be provided, especially for advice on management of disturbed behaviour. A substantial number of the nursing homes (at least 28 per cent) provided no ongoing education to their staff about dementia or other psychiatric problems. There is good reason to encourage greater use of mental health professionals in Sydney nursing homes; enhanced funding of area psychiatric services for elderly people is desirable to allow these services to be more readily available.

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PubMed1993

How many bed-days for an area's psychogeriatric patients?

Data were obtained concerning all admissions during a four-year period of persons aged 65 years and over, from a defined catchment area, to the general hospital psychiatric units in the area or to the nearest psychiatric hospital. The mean length of stay was 41.3 days. Of 449 admissions, 55% were diagnosed as having affective disorder or adjustment disorder with depressed mood, but this group accounted for 65% of the bed-days in the acute units with a mean length of stay of 49.2 days. Dementia cases accounted for 24% of admissions and 23% of bed-days. At present, the recommended number of acute psychogeriatric beds to serve this population of 34,000 elderly is 22; development of a comprehensive psychogeriatric service with appropriate community staffing may make it possible to reduce this number.

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PubMed1992

Firearms suicides in Australia.

OBJECTIVE: To examine the rates of suicide by firearms in the five larger Australian States during 1968-1989, and to relate them to differences between those States. We hypothesised that (i) restrictive gun legislation will have reduced the firearms suicide rate in South Australia after 1980, and (ii) firearms suicides would be shown to be more common in States with larger rural:urban population ratios. DESIGN: Data supplied by the Australian Bureau of Statistics were analysed by sex, State and year of suicide. Differences between the firearms suicide rates of capital city and rural dwellers, and of different age-groups, were recorded. RESULTS: Firearms suicide rates in South Australia declined significantly after 1980, following proclamation of gun legislation, in contrast to the four other larger States where an increase in firearms suicides was recorded. The firearms suicide rate in Queensland has remained consistently higher than in the other four larger States during 1968-1989. The number of Australian firearms suicides per year fell by 25% from a peak of 572 in 1987 to 451 in 1989. CONCLUSIONS: Further reductions in the Australian firearms suicide rate might be achieved by tightening gun laws and by a media campaign aimed at reducing easy access by males to guns in rural households.

Adolescent↗
PubMed1991

A retrospective case-note study of bipolar disorder in old age.

In a replication of an earlier published study, case notes of 75 elderly in-patients with bipolar affective disorder were examined. Few of the patients had experienced a manic episode before the age of 40. Mean age of onset of affective disorder was 46 years, and first manic episode at 60 years. Cerebral insults before the first manic attacks were recorded in a substantial number of cases, and a family history of mental illness was less common among this group. Bipolar affective disorder is relatively common as a reason for admission of elderly patients.

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PubMed1991

Bed requirements for an area psychogeriatric service.

Psychiatric services for the elderly are being developed in various areas in Australia, but guidelines on the number of beds needed are largely based on overseas experience. A review of all admissions of elderly people to the three psychiatric units in one part of Sydney over a ten-year period (1977-1987) allows an estimate of acute and medium-stay bed requirements. There were 444 male and 952 female admissions of persons aged 65 or more during the ten years. Mean length of stay was estimated to be 33.5 days, those with depressive disorders staying longest (41.7 days). Caution is needed when drawing conclusions about bed requirements, since they vary according to management practices, alternative support services, demographics, etc. Tentatively it is suggested that for a population of 32,000 persons aged 65 or more a minimum of 22 acute psychiatric beds are required.

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PubMed1987

Uncleanliness among persons seen by community health workers.

Community nurses and other community workers often encounter persons who live in conditions of extreme uncleanliness, but not much attention has been paid to the causes of this behavior. The author surveyed 12 community health centers in Sydney, Australia, to obtain data on specific aspects of personal and home cleanliness for persons under their care. Of the 83 subjects identified as living in unclean conditions, 15 were age 60 or younger. Almost two-thirds had some degree of memory impairment, and 40 percent were or had been heavy drinkers. However, 12 subjects did not have obvious physical or mental disorders, and the author suggests that eccentric personality factors may account for their living conditions. He believes uncleanliness should not be labeled as part of a syndrome, but that it is a sign that may lead to recognition of a causative disorder. He recommends further study of the problem.

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