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Biomedical subjects

J Teresi

Publications and source records attributed to J Teresi.

At least 19 recordsLinked to original sources
PubMed2001

Prevalence of depression and depression recognition in nursing homes.

BACKGROUND: The aim of this study was to estimate the prevalence of depression among nursing home residents, and the extent of depression recognition among nursing home staff. Random samples totaling 319 nursing home residents, drawn from a simple random sample of six downstate New York nursing homes were evaluated psychiatrically for depression. Samples of nurse aides, nurses and social workers also assessed the same residents for the presence of depressive symptomatology. METHOD: Psychiatrists assessed residents using the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria. Depression measures used were the Cornell Scale for Depression in Dementia, the Feeling Tone Questionnaire, the Hamilton Depression Rating and the Structured Clinical Interview for DSM-III-R Personality Disorders Scale. Nursing and social services staff assessed residents using Depression Recognition Measures. RESULTS: Based on psychiatric evaluation, the prevalence estimate for probable and/or definite major depressive disorder among testable subjects was 14.4% (95% CI of 10.6%-19.3%); 15.4% were not able to be assessed due to their refusal, impairment of consciousness, or severe physical illness. The estimate for minor depression was 16.8% (95% CI of 12.6%-21.9%). The prevalence of significant depressive symptomatology (including the category of possible depression) was 44.2% (95% CI of 38.2%-50.3%). The corresponding estimates of any depression were 19.7% for social workers, 29% for nurses and 32.1% for nurse aides. CONCLUSIONS: The prevalence of depressive disorders among nursing home residents is high; depression recognition is relatively low, with only 37%-45% of cases diagnosed by psychiatrists recognized as depressed by staff. A structured Depression Recognition Scale increased the rates of recognition (sensitivity of staff ratings) to 47%-55%, demonstrating the utility of the scale in increasing awareness of symptomatology.

Age Distribution↗
PubMed2000

Decision-making capacity to execute a health care proxy: development and testing of guidelines.

OBJECTIVE: To evaluate the reliability and validity of guidelines to determine the capacity of nursing home residents to execute a health care proxy (HCP). DESIGN: A cross-sectional study. SETTING: A 750-bed not-for-profit nursing home located in New York City. PARTICIPANTS: A random sample of 200 nursing home residents: average age, 87; 99% white; 83% female; average length of stay, 3.05 years; mean Mini-Mental State Exam (MMSE) score, 15.9. MEASUREMENTS: Demographic characteristics (Minimum Data Set (MDS)); function and cognitive status (Institutional Comprehensive Assessment and Referral Evaluation (INCARE)); Reisberg Dementia Staging; MMSE; Minimum Data Set-Cognitive Performance Scale (MDS-COGS)); an investigator-developed measure of a nursing home resident's capacity to execute a health care proxy (Health Care Proxy (HCP) Guidelines.) RESULTS: The internal consistency of the decision-making scales in the HCP Guidelines, paraphrased recall and recognition, reached acceptable levels, alphas of .85 and .73, respectively. Interrater reliability estimates were .92 and .94, respectively, for the recall and recognition scales; test-retest reliability estimates were .83 and .90. The discriminant validity of these scales is promising. For example, the MMSE correlation was .51 with the Recall scale and .57 with the Recognition scale. Of residents with severe cognitive impairment (MMSE < 10), 71% completed 50% or more of the scaled items in the HCP guidelines and 95% consistently named a proxy. CONCLUSIONS: Seventy-three percent of testable residents, approximately three-quarters of whom were cognitively impaired, evidenced sufficient capacity to execute an HCP. Of residents with severe cognitive impairment, the HCP guidelines are potentially useful in identifying those with the capacity to execute a HCP. The guidelines are more predictive than the MMSE in identifying residents able to execute a HCP.

Activities of Daily Living↗
PubMed1997

Predictors of becoming redomiciled among older homeless women.

The authors test a model to predict residential outcome among 201 homeless women aged 50 and over. On two-year follow-up, 47% were successfully domiciled. Of 12 variables examined using logistic regression analysis, only 2 variables, perceived support and number of community facilities attended were significant predictors of being domiciled on follow-up. Three additional variables-absence of psychosis, a lifetime history of less than one year of homelessness, and number of entitlements-attained near-significance. Although residential outcome is predicted by a few individual characteristics, what is most striking is the lack of suitable housing options.

Female↗
PubMed1997

Sexual expression and dementia. Views of caregivers: A pilot study.

OBJECTIVE: To measure the attitudes of health professionals in nursing homes towards sexuality and sexual expression in cognitively impaired and cognitively intact residents. DESIGN: Postal survey. PARTICIPANTS: The staff (administrators, clinicians, social workers and others) of 300 randomly selected nursing homes located in three states. Of these, 114 representatives responded. MAIN OUTCOME MEASURE: A measure of attitudes towards resident sexuality developed during a prior study. RESULTS: Results suggest that respondents held a generally positive orientation towards residents' sexual expression which was expressed with respect to cognitively impaired residents as well as to those who were cognitively intact. Possibly because of the small sample size and resulting low statistical power, statistical analyses failed to demonstrate any significant differences among the groups of residents: administrators, clinicians, social workers, and undifferentiated 'others'. However, while non-significant, there was a consistent tendency for administrators to be relatively more conservative than were the other groups. Almost all respondents agreed that additional staff training should focus specifically on dealing with resident sexual expression. CONCLUSIONS: Overall, the sample reported generally positive attitudes towards resident sexuality and sexual expression.

Aged↗
PubMed1997

Measurement choices in multi-site studies of outcomes in dementia.

This paper summarizes the measurement choices made by selected current or recently completed multi-site projects with a common emphasis on measuring outcomes in dementia. Information on number of items and scoring, reason(s) for selecting the measure, and reliability and validity of the measure (either citations providing this information or a report of pertinent unpublished findings) is presented for eight domains: cognition, behavioral symptoms, physical health status, physical functioning and self-care abilities, quality of life, family/staff caregiver outcomes, service use, and cost. We found considerable reliance on the published literature as a guide to measurement choice, motivated largely by measures' superior psychometric properties, their ubiquity in the literature, and/or their brevity or ease of use. There is still evidence of "starting from scratch" in some domains, however. To the extent that these projects reflect the state of the art in dementia-relevant outcomes research, we conclude that comparison of outcomes across studies will continue to be problematic. However, as long as dissemination of methodological as well as substantive findings continues to characterize outcome studies in dementia, there is hope that a more congruent view of how to assess key outcomes in dementia will emerge.

Caregivers↗
PubMed1994

The role of caregiver social networks in Alzheimer's disease.

Although the theoretical importance of social networks in alleviating caregivers' mental distress when a family member has Alzheimer's disease is well-established, empirical support has been less definitive. For 58 patient-spouse caregiver dyads, we used an array of network variables within a causal model of stress. We found that: caregiver networks are associated with severity of illness but not duration; increased illness severity was associated with network members assuming new roles; social networks had indirect effects but no direct or buffering effects on caregiver psychological distress; religious attendance had direct and indirect effects on caregiver psychological distress. These findings point to the important, but complex, role that social networks play in affecting caregivers. However, because of its cross-sectional nature and the relatively small sample size, this study will require replication on larger samples using longitudinal analyses.

Adaptation, Psychological↗
PubMed1994

Overview of methodological issues in the study of chronic care populations.

The intent of the methodology section of this volume was to provide an overview of recent thinking about analytic techniques that can be used to study chronic care populations, particularly dementia SCUs. As discussed earlier in this article, although not unique to these populations, longitudinal analysis of chronic care populations frequently involves several problems: nonequivalent comparison groups, unbalanced designs, censoring and attrition, autocorrelation (correlated repeated measures) and heterogeneous correlations across repeated measures. The last 5 years has witnessed considerable change and growth in the development of longitudinal modelling methodologies. Although developments in modelling cut across disciplines, there has been a focus on certain types of methods in several fields of applied statistics: psychometrics (e.g., analysis of change, item response theory, Rasch modelling of binary outcomes), mathematical sociology (e.g., structural equation modelling), demography (e.g., transition modelling), epidemiology (e.g., risk modelling), and biostatistics (e.g., examination of intervention effects using marginal and random effects modelling of repeated measures). An important issue is the interrelationship between measurement and outcome assessment. Source of measurement error must be considered (see Zimmerman and Magaziner in this volume), as must bias in assessments (see Teresi and Golden in this volume). While it has long been known that poor measurement can attenuate and bias estimates of longitudinal effects, the answer is not to attempt artificial solutions through use of corrections for attenuation (unreliability). Design and sampling issues are also critical to the correct conduct of any longitudinal study. Otherwise, estimates of prevalence, incidence, and intervention effects will be in error (see Beckett and Evans, in this volume). Several modelling approaches have been reviewed. Different points of view regarding change analysis have been presented; controversy remains regarding the "best" methods for examining change (see the commentary by Rogosa in this volume). Theory building using methods such as structural equation modelling remains a staple of longitudinal analysis, although several caveats have been discussed. New or revisited methodologies (random effects modelling, of which growth curve analysis can be viewed as a special case and event history modelling) offer promise in dealing with the knotty problems inherent in the longitudinal study of chronic care populations, namely, censoring, attrition, and unbalanced designs resulting in missing data (see the commentary by Nesselroade, in this issue). However, it remains clear that no one model or approach will be optimal for all applications.

Activities of Daily Living↗
PubMed1993

A primary care nursing model in long-term care facilities: evaluation of impact on affect, behavior, and socialization.

A primary care model of delivery of nursing aide care was implemented and evaluated in one small, rural nursing home and one large, urban facility. Experimental unit residents received primary care consisting of permanent assignment of nursing aide, a team approach and enhanced communication. The urban experimental residents improved significantly in behavior and affect as measured across several sources, while the comparison group declined or remained the same. Significant improvements in behavior and social activities were observed among the experimental rural nursing home residents as contrasted with the comparison group after implementation of primary care nursing. It was concluded that primary care nursing as applied to nursing attendants in long-term care is beneficial to residents in terms of decreasing disturbed behavior and improved affect.

Affect↗
PubMed1993

Serendipity and pseudoscience. A look at health-related program evaluation.

This article presents a discussion of the pitfalls of sloppy science as it is applied to the evaluation of human service programs. The differences are examined between use of the scientific method and trial-and-error approaches to assessment. The major requirements for sound research are presented, as are the pitfalls and shortcomings associated with a less rigorous approach.

Health Services Research↗
PubMed1992

Contribution of family, cognitive and clinical dimensions to long-term outcome in schizophrenia.

A multivariate approach incorporating both biological and psychosocial factors was used in a cross-sectional study of schizophrenic inpatients and outpatients selected to represent opposite ends of the outcome spectrum. Twenty-six RDC-diagnosed chronic schizophrenic patients hospitalized continuously for 18 months or longer, and 26 patients with a history of at least three years of community tenure without rehospitalization were matched for sex, age, ethnicity, SES and chronicity, and assessed on a structured family interview (Social Behavior Assessment Schedule), neuropsychological test battery, Brief Psychiatric Rating Scale and Premorbid Asociality Scale. Stepwise discriminant function analysis was performed; family ratings of patients' problem behaviors was the most powerful discriminator between the two groups and a composite measure of neuropsychological functioning ranked second. Other significant discriminators were BPRS scores, availability of social support to the family and age of onset. Family ratings of patient behavior were related to ratings of family burden and to BPRS scores. Further research is needed to understand the complex interactions between the diverse sets of social, clinical and neurobiological factors that determine long-term outcome in schizophrenia.

Activities of Daily Living↗
PubMed1992

Gender differences in cognition in schizophrenia.

Gender differences in cognition were investigated in schizophrenic inpatients and outpatients using the Dementia Rating Scale. Females displayed greater impairment on Attention and Conceptualization than males. Gender interacted with patient group for construction: females performed worse than males among inpatients and better among outpatients. Results may be related to the atypically early age of onset of females relative to males; attention to sampling and selection biases is needed in evaluating gender differences in cognition in schizophrenia.

Adult↗
PubMed1992

Special care units in nursing homes: prevalence in five states.

As part of a five-state study of the impact of special care units for demented residents, the authors surveyed (with telephone follow-up) nursing homes to identify those facilities that maintained some form of special care unit. The estimated prevalence was 11%; this finding suggests that special care units are far more numerous than had previously been reported. This difference is due in part to definitional considerations: many facilities maintain "cluster units" that do not differ appreciably from segregated units. However, more often than not, facilities did not regard these units as special care units.

Activities of Daily Living↗