Biomedical subjects

Lee-Fay Low

Publications and source records attributed to Lee-Fay Low.

10 recordsLinked to original sources

PubMed2004

Characteristics of the GPCOG, a screening tool for cognitive impairment.

BACKGROUND: Early dementia diagnosis is aided by the use of brief screening tests; scores can be biased by patient and informant characteristics such as age, gender and education. OBJECTIVE: To assess whether the General Practitioner's Assessment of Cognition (GPCOG), a brief screening tool for detecting cognitive impairment comprising a patient cognitive test and questions to an informant, is biased by patient and informant characteristics. DESIGN: Sixty-seven general practitioners recruited consecutive patients (with informants). Patients were subsequently assessed by a research psychologist, and DSM-IV diagnoses assigned following a case-conference. SETTING: Primary Care. SUBJECTS: Two hundred and eighty three home-dwelling individuals, 11.3% of whom were aged 50-74 years with suspected memory problems and the rest aged 75 or more. METHODS: The GPCOG, Cambridge Mental Disorder of the Elderly Examination cognitive scale (CAMCOG), Geriatric Depression Scale (GDS), and the SF-12 Health Survey (SF-12) were administered and demographic data were collected and consensus DSM-IV diagnoses of dementia made. Relationships between patient and informant characteristics and the GPCOG measure were examined using Pearson correlations and linear regression analyses. RESULTS: There were correlations in GPCOG-patient scores with age, education and depression scores but on regression analysis only age was associated with the GPCOG-patient section. The GPCOG-informant section was free of bias. CONCLUSIONS: The GPCOG has advantages for use in primary care and is free of many biases common in other scales.

Age Factors↗

PubMed2004

Normal cognitive changes in aging.

BACKGROUND: Cognitive abilities decline with normal aging. Fluid abilities such as speed and problem solving show declines from early adulthood, and crystallised abilities such as knowledge and expertise increase until old age. OBJECTIVE: This article reviews changes in normal cognitive aging a nd associated risk factors. It aims to provide a framework for approaching the differentiation of normal cognitive aging from dementia through awareness of mental status screening and changes from previous functioning. DISCUSSION: Understanding normal cognitive aging is essential for assessing older patients presenting with memory and other cognitive complaints. Many of the risk factors for cognitive aging are modifiable such as hypertension, diabetes, and levels of physical, mental and social activity. At a population level, primary prevention or reduction of cognitive aging is possible through addressing modifiable risk factors. This in turn may reduce population levels of dementia.

Adult↗

PubMed2003

Behavioural and psychological symptoms of dementia: a seven-tiered model of service delivery.

People with dementia usually experience behavioural and psychological symptoms of dementia (BPSD) during the course of their illness. Currently, in Australia, there is a lack of comprehensive planning for managing and preventing BPSD, and the resources required for optimal care are inadequate and unevenly distributed. We propose a seven-tiered model of service delivery based on severity and prevalence of BPSD, ranging from no dementia through tiers of increasingly severe behavioural disturbance to the propensity for extreme violence in a small number of individuals. Each tier is associated with a different model of intervention. People with dementia may move up or down between tiers depending on their condition, their care and the intervention provided. Lower-level interventions may prevent the need for the more intensive interventions needed when disturbance becomes more severe.

Aged↗

PubMed2003

Prediction of mortality in nursing home residents: impact of passive self-harm behaviors.

OBJECTIVE: The aim of this study was to determine whether indirect self-destructive behaviors predict mortality in nursing home residents. METHOD: This cross-sectional study with follow-up after 2 years and 3 months surveyed 593 residents in 10 nursing homes in the eastern suburbs of Sydney, Australia. The following instruments were used: Harmful Behaviors Scale (HBS), Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), Functional Assessment Staging Scale, Resident Classification Index, Cumulative Illness Rating Scale, Even Briefer Assessment Scales for Depression, and the suicide item from the Structured Hamilton Depression Rating Scale. Diagnoses of depression, dementia, and psychosis were obtained from nursing home records. Mortality data were obtained in August 1999. RESULTS: At follow-up, 297 (50.1%) residents were still alive with a mean survival time of 565.4 days. Survival analyses found that mortality was predicted by older age, male gender, lower level of functioning, lower levels of behavioral disturbance on the BEHAVE-AD, and higher scores on the HBS "passive self-harm" factor-based subscale, which includes refusal to eat, drink, or take medication. DISCUSSION: These results suggest that passive self-harm behaviors predict mortality in nursing home residents.

Aged↗

PubMed2003

Nursing home staff attitudes towards residents with dementia: strain and satisfaction with work.

BACKGROUND: Occupational and resident characteristics affect levels of staff stress and satisfaction in nursing homes, and levels of staff turnover are high. Working with more cognitively impaired residents, especially on day shift, is associated with high levels of stress in nursing home staff. Workload is highly predictive of the experience of burden and job pressure, while these outcomes vary according to whether staff work full- or part-time. AIMS: To investigate the attitudes of nursing home staff towards residents, strain related to dementia care and satisfaction with work and their associations with demographic, occupational and behavioural disturbance in the home. METHODS: A cross-sectional design was adopted, using a self-completion questionnaire survey of 253 nursing home staff from 12 nursing homes in Sydney's eastern suburbs, and behavioural assessment of all 647 residents from 11 of the 12 homes. Staff attitudes and strain were measured using the Swedish Strain in Nursing Care Assessment Scale and satisfaction using the Swedish Satisfaction with Nursing Care and Work Assessment Scale. RESULTS: Staff members' five most prevalent perceptions of residents with dementia were that they are anxious, have little control over their difficult behaviour, are unpredictable, lonely and frightened/vulnerable. The five attributes staff found most difficult to cope with were being aggressive/hostile, having little control over their difficult behaviour, being stubborn/resistive, deliberately difficult, and unpredictable. Although 91% of staff reported that they were happy in their job, a quarter reported that residents provided no job satisfaction. The five satisfaction statements most agreed with were "The patients/residents at work nearly always receive good care", "It is important to try and enter into the way patients experience what happens to them", "Relatives are given enough information about care and treatment", "I enjoy my current work situation" and "Our work organisation is good". There were significant differences between homes in levels of strain related to dementia care that were not accounted for by the level of behavioural disturbance. CONCLUSIONS: Nursing home staff tended to perceive residents in more negative than positive ways. Staff were generally satisfied with their work. Factors other than resident behavioural disturbance are important influences in nursing staff strain.

Adolescent↗

PubMed2003

Randomized controlled trial of different models of care for nursing home residents with dementia complicated by depression or psychosis.

OBJECTIVE: To compare the outcomes of 3 interventions for the management of dementia complicated by depression or psychosis: psychogeriatric case management, general practitioners with specialist psychogeriatric consultation, and standard care for nursing home residents. METHOD: The sample for this 12-week randomized controlled trial consisted of 86 subjects with dementia from 11 Sydney, Australia, nursing homes, of whom 34 had depression, 33 had depression and psychosis, and 19 had psychosis. All participants received full psychiatric assessments and physical examinations. Information was obtained from the residents' families and nursing home staff. Depression measures included the Even Briefer Assessment Scale for Depression, Hamilton Rating Scale for Depression, Cornell Scale for Depression in Dementia, and Geriatric Depression Scale. Psychosis measures included the Behavioral Pathology in Alzheimer's Disease Rating Scale, Neuropsychiatric Inventory, and Scale for the Assessment of Positive Symptoms. Data were obtained from nursing home records on prescription of psychotropic medication and demographic information. Management plans were formulated by a multidisciplinary team before random assignment to interventions. RESULTS: All 3 groups improved from pretreatment to posttreatment on depression scales for depression groups and psychosis scales for psychosis groups. Mode of management appeared to make no difference in rate or amount of improvement; neither of the treatment group-by-time interactions were significant. Neither use of antidepressants nor use of antipsychotics predicted depression or psychosis outcomes. CONCLUSION: Participation in the study was associated with improvement in depression and psychosis, perhaps because of the presence of a psychogeriatric team, the increased attention focused on residents, or the generalization of active intervention techniques to control subjects. A formula-driven psychogeriatric team case management approach was not significantly more effective than a consultative approach or standard care. This study demonstrates the difficulties and feasibility of conducting service-oriented research in nursing homes.

Aged↗

PubMed2003

Aggression in the elderly.

Aggression is a common behavioral symptom of dementia. Aggression is associated with frontotemporal dementia, greater dementia severity, cognitive decline, and other behavioral and psychological disturbances. It is influenced by the environment and has been correlated with neuropathologic changes and certain polymorphisms. Aggression in dementia patients results in higher psychotropic use and distress to family caregivers and nursing home staff; it is predictive of institutionalization. There is empirical evidence for the efficacy of pharmacotherapy and more limited evidence for psychosocial interventions in the successful management of aggression in persons with dementia. Management of aggression should include comprehensive assessment of medical, psychological, and environmental variables.

Aged↗

PubMed2002

Types of nursing home residents with self-destructive behaviours: analysis of the Harmful Behaviours Scale.

OBJECTIVE: To investigate the types of self-destructive behaviours identified by the Harmful Behaviours Scale (HBS) and the variables associated with them. METHOD: A cross sectional survey involving 647 residents in 11 nursing homes in the eastern suburbs of Sydney, Australia. The following instruments were used: Harmful Behaviours Scale (HBS); Behavioural Pathology in Alzheimer's Disease Rating Scale; Functional Assessment Staging Scale; Resident Classification Index; Health of the Nation Outcome Scale; Even Briefer Assessment Scales for Depression; Abbreviated Mental Test Scale; and the suicide item from the Structured Hamilton Depression Rating Scale. Diagnosis of dementia was obtained from nursing home records. RESULTS: Latent class analysis of the HBS identified four groups of residents, described as 'aggressive resistant' (34.9%), 'food refusal' (26.8%), 'behaviourally disturbed' (5.4%) and a 'non-symptomatic' group (33.0%) with little self-destructive behaviour. The behaviourally disturbed group engages in a widespread combination of direct and indirect self-destructive behaviours and displays other behavioural and psychological symptoms of dementia. In contrast, the food refusal group whose only behavioural symptom was refusal to eat and drink had the most cognitive impairment and did not show higher levels depression or suicidal ideation. CONCLUSIONS: We have found three groups of residents with self-destructive behaviours and each group is associated with a different pattern of variables.

Adult↗

PubMed2002

A study of premorbid personality and behavioural and psychological symptoms of dementia in nursing home residents.

OBJECTIVE: to investigate the relationship between pre-morbid personality and behavioural and psychological symptoms of dementia (BPSD). METHODS: we studied 58 subjects with dementia and depression and/or psychosis residing in 11 Sydney nursing homes cross-sectionally. Informal caregivers completed ratings of residents' pre-morbid personality on the NEP Five-Factor Inventory (NEO-FFI). Information on BPSD was obtained using the BEHAVE-AD. RESULTS: higher neuroticism was predictive of delusions; higher agreeableness of hallucinations, aggressiveness, affective disturbance and overall behavioural disturbance; and higher openness of affective disorder. CONCLUSION: our findings are inconsistent with previous research and clinical experience. Prospective studies are needed to clarify the association between personality and behavioural disturbance in dementia.

Aged↗

PubMed2002

Self-destructive behaviors in nursing home residents.

OBJECTIVES: To validate the Harmful Behaviors Scale (HBS) as a measure of direct and indirect self-destructive behaviors in nursing home residents and to determine the prevalence of self-destructive behaviors and their relationship to other variables. DESIGN: A cross-sectional study. SETTING: Eleven nursing homes in the eastern suburbs of Sydney, Australia. PARTICIPANTS: Six hundred ten nursing home residents aged 65 and older. MEASUREMENTS: Instruments used were the HBS, Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), Functional Assessment Staging Scale (FAST), Even Briefer Assessment Scale for Depression (EBAS-Dep), and the suicide item from the structured Hamilton Depression Rating Scale. Data on diagnoses of dementia, depression, or psychotic disorder; prescription of psychotropic medication; and demographics were obtained from nursing home records. RESULTS: On the HBS, indirect harmful behaviors occurred at least weekly in 61% of subjects, and direct harmful behaviors occurred in 14% of subjects. The HBS total score was significantly positively correlated with the BEHAVE-AD score (Pearson's r=0.679, P <.001) but not with the EBAS-Dep "wish for death" item and total score. HBS scores were significantly higher in residents scoring greater than zero on the Hamilton suicide item (F=1.380, df=3,325, P=.249). Stepwise multiple linear regression indicated that younger age, chart diagnosis of dementia, greater incapacity as measured by FAST, and a higher Hamilton suicide item score predicted a higher HBS total score. CONCLUSIONS: Self-destructive behaviors are common in nursing home residents and are mostly related to dementia. There was little evidence of a relationship between depression and self-destructive behaviors.

Aged↗