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Biomedical subjects

Martin G Cole

Publications and source records attributed to Martin G Cole.

At least 19 recordsLinked to original sources
PubMed2006

The prognosis of major and minor depression in older medical inpatients.

BACKGROUND: Major and minor depression is frequent in older medical inpatients, but the prognosis of these two disorders is not clear. The current study proposed to determine the prognosis of major and minor depression in this population. METHOD: This prospective, observational cohort study, conducted in Montreal, Quebec, Canada, involved assessment of 380 elderly medical inpatients with major, minor, or no depression at three, six, and 12 months after enrollment using the Diagnostic Interview Schedule and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Information on suicide attempts, completed suicides, and potential prognostic factors was also collected. Analysis of outcomes and potential prognostic factors involved descriptive statistics and multiple logistic regression. RESULTS: Among patients with major depression at enrollment, 13% were recovered, 14% were partially recovered, and 73% remained depressed with a protracted stable or protracted fluctuating course. Among patients with minor depression, 28% were recovered and 72% had a protracted course. Patients diagnosed with major depression at enrollment often had minor depression at follow up and vice versa. CONCLUSION: The prognosis of both major and minor depression in older medical inpatients is poor and worse than previously thought.

Activities of Daily Living↗
PubMed2006

Influence of prior cognitive impairment on the severity of delirium symptoms among older patients.

Delirium is common among hospitalized elderly patients with prior cognitive impairment. Detecting delirium superimposed on dementia is a challenge for nurses and doctors. As a result, delirium among demented elderly patients is of increasing interest to healthcare professionals. So far, studies have failed to describe how symptoms of delirium are altered by severity of dementia. This would be valuable information to improve the rate of detection by nurses of delirium among demented patients. However, until now no research has examined the effect of severity of prior cognitive impairment on the severity of delirium symptoms among institutionalized older patients. This study describes the effect of severity of prior cognitive impairment on the severity of delirium symptoms among institutionalized older patients with delirium at the time of their admission to an acute care hospital. One hundred four institutionalized elderly people were included in this study and screened for delirium using the confusion assessment method. Patients with delirium (n = 71) were evaluated with the delirium index to determine the severity of the symptoms of delirium. The results showed that the severity of prior cognitive impairment influences the severity of most of the symptoms of delirium, particularly disordered attention, orientation, thought organization, and memory. Thus, taking into account the severity of prior cognitive impairment could help nurses to detect delirium among older patients.

Aged↗
PubMed2006

Androgen treatment of depressive symptoms in older men: a systematic review of feasibility and effectiveness.

OBJECTIVE: To determine the feasibility and effectiveness of androgen treatment of depressive symptoms in older men. METHOD: We searched MEDLINE, PsycINFO, Eric, HealthStar, and the Cochrane Database of Systematic Reviews for potentially relevant articles. The bibliographies of relevant articles were searched for additional references and experts were consulted. Seventeen reports (8 open and 12 randomized trials; 3 articles reported studies of 2 designs) met the following inclusion criteria: original investigation; published in English or French, use of acknowledged criteria or scale for depression, and open or randomized trial of androgen treatment. Four criteria assessed study validity: randomization, double blinding, comparability of treatment and control groups at baseline, and description of dropouts. We abstracted, tabulated, and compared information from each article. RESULTS: Most studies had methodological limitations. With regard to feasibility, there were few reported withdrawals due to adverse events. With regard to effectiveness, 6 of 8 open trials had positive results, and 5 of 12 randomized trials had positive results, although 1 was equivocal. However, testosterone was combined with antidepressant medication in 3 of these positive randomized trials. Only 2 open trials enrolled subjects whose mean age was 60 years or over. One had positive results, and the other had negative results. CONCLUSION: Androgen therapy may be feasible in the short term, but there is little evidence that it is an effective treatment for depressive symptoms in older men.

Dehydroepiandrosterone↗
PubMed2006

Prevalence and symptoms of delirium superimposed on dementia.

Delirium is a frequent syndrome among patients who are elderly. People who are older with cognitive impairment who are institutionalized are at increased risk of developing delirium when hospitalized. In addition, their prior cognitive impairment makes detecting their delirium a challenge. This study goal was to describe the effect of severity of prior cognitive impairment on delirium prevalence and symptom presentation among patients who were older and were newly admitted to an acute care hospital. A total of 104 were included in this descriptive study and screened for delirium. The results showed that the prevalence of delirium increased according to the severity of the patients' prior cognitive impairment. Except for disorganized thinking, all symptoms of delirium were similar among patients with mild, moderate, and severe prior cognitive impairment. The study concluded that training nurses to recognize subtle changes in mental status among those patients who were older with prior cognitive impairment may prevent the underdetection of delirium.

Activities of Daily Living↗
PubMed2005

Systematic detection and multidisciplinary care of depression in older medical inpatients: a randomized trial.

BACKGROUND: Major depression is a frequent and serious disorder in older medical inpatients. Because the condition goes undetected and untreated in most of these patients, we conducted a randomized clinical trial to evaluate the effectiveness of a strategy of systematic detection and multidisciplinary treatment of depression in this population. METHODS: Consecutive patients aged 65 years or more admitted to general medical services in a primary care hospital between October 1999 and November 2002 were screened for depression with the Diagnostic Interview Schedule (DIS) within 48 hours after admission. Patients found to have major depression were randomly allocated to receive the intervention or usual care. The intervention involved consultation and treatment by a psychiatrist and follow-up by a research nurse and the patient's family physician. Research assistants, blind to group allocation, collected data from the patients at enrollment and at 3 and 6 months later using the Hamilton Depression Rating Scale (HAMD), the Medical Outcomes 36-item Short Form (SF-36), the DIS, the Mini-Mental State Examination (MMSE), the Older Americans Resources and Services (OARS) questionnaire to assess basic and instrumental activities of daily living (OARS-ADL and OARS-IADL) and the Rating Scale for Side Effects. Data on the severity of illness, length of hospital stay, health services and medication use, mortality and process of care were also collected. The primary outcome measures were the HAMD and SF-36. RESULTS: Of 1500 eligible patients who were screened, 157 were found to have major depression and consented to participate (78 in the intervention group and 79 in the usual care group). At randomization, there were no clinically or statistically significant differences between the 2 groups. Sixty-four patients completed follow-up to 6 months, 57 withdrew, and 36 died. At 6 months, there were no clinically or statistically significant differences the 2 groups in HAMD or SF-36 scores or any of the secondary outcome measures. INTERPRETATION: We were unable to demonstrate that systematic detection and multidisciplinary care of depression was more beneficial than usual care for elderly medical inpatients.

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PubMed2005

Psychiatric outpatient consultation for seniors. Perspectives of family physicians, consultants, and patients/family: a descriptive study.

BACKGROUND: Family practitioners take care of large numbers of seniors with increasingly complex mental health problems. Varying levels of input may be necessary from psychiatric consultants. This study examines patients'/family, family practitioners', and psychiatrists' perceptions of the bi-directional pathway between such primary care doctors and consultants. METHODS: An 18 month survey was conducted in an out-patient psychogeriatric clinic of a Montreal university-affiliated community hospital. Cognitively intact seniors referred by family practitioners for assessment completed a satisfaction and expectation survey following their visits with the psychiatric consultants. The latter completed a self-administered process of care questionnaire at the end of the visit, while family doctors responded to a similar survey by telephone after the consultants' reports had been received. Responses of the 3 groups were compared. RESULTS: 101 seniors, referred from 63 family practitioners, met the study entry criteria for assessment by 1 of 3 psychogeriatricians. Both psychiatrists and family doctors agreed that help with management was the most common reason for referral. Family physicians were accepting of care of elderly with mental health problems, but preferred that the psychiatrists assume the initial treatment; the consultants preferred direct return of the patient; and almost 1/2 of patients did not know what to expect from the consultation visit. The rates of discordance in expectations were high when each unique patient-family doctor-psychiatrist triad was examined. CONCLUSION: Gaps in expectations exist amongst family doctors, psychiatrists, and patients/family in the shared mental health care of seniors. Goals and anticipated outcomes of psychogeriatric consultation require better definition.

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PubMed2004

The feasibility and effectiveness of brief interventions to prevent depression in older subjects: a systematic review.

OBJECTIVES: To explore the feasibility and effectiveness of brief interventions to prevent depression in older subjects. METHOD: MEDLINE, PsycINFO and HealthStar were searched for potentially relevant articles published from January 1966 to June 2003, January 1974 to June 2003 and January 1975 to June 2003, respectively. The bibliographies of relevant articles were searched for additional references. Ten studies met the following five inclusion criteria: original research, subjects mean age 50 years or more, controlled trial of a brief (<12 weeks) intervention to prevent depression, determination of depression status 12 months or more after enrolment, use of an acceptable definition of depression. The validity of studies was assessed according to six criteria. To examine feasibility we tabulated study enrolment, completion and compliance rates. To examine effectiveness we tabulated differences in depression symptom outcome scores between intervention and control groups or, when possible, absolute (ARR) and relative (RRR) risk reductions for depression. RESULTS: Only two of the ten trials met all of the validity criteria. Study enrolment rates were 21 to 100% (median 72.5%); study completion rates were 46% to 100% (median 85%); compliance rates were 29% to 100% (median 87%). Five of the ten trials had positive results: in two trials there were statistically significant differences in depression symptom outcome scores favoring the intervention group; in three trials ARRs were 2.3% to 45% (median 17%); RRRs were 45% to 71% (median 61%). CONCLUSIONS: Some types of brief interventions appear to have the potential to prevent depression in older subjects. Despite the methodologic limitations of the trials and this systematic review, these findings may guide efforts to develop and evaluate brief interventions to prevent depression in this population.

Aged↗
PubMed2004

The delirium index, a measure of the severity of delirium: new findings on reliability, validity, and responsiveness.

OBJECTIVES: To assess the reliability, validity, and responsiveness of an instrument for measuring the severity of delirium, the Delirium Index (DI). DESIGN: Prospective cohort study, with repeated patient assessments at multiple points in the hospital, at 8 weeks after discharge, and at 6 and 12 months after admission. SETTING: The medical services of a primary acute-care hospital. PARTICIPANTS: Medical admissions aged 65 and older: 165 with delirium and dementia, 57 with delirium only, 55 with dementia only, and 41 with neither. MEASUREMENTS: Severity of delirium symptoms was measured using the DI. Delirium was diagnosed using the Confusion Assessment Method. Other measures included the Mini-Mental State Examination, Informant Questionnaire on Cognitive Decline in the Elderly, Barthel Index (BI), premorbid instrumental activities of daily living, Charlson Comorbidity Index, Clinical Severity of Illness scale (CSI), and the Acute Physiology Score (APS). RESULTS: The intraclass correlation coefficient of interrater reliability was 0.98. Two measures of fluctuation were significantly higher in patients with delirium than in those without delirium. At baseline, the DI was correlated with the BI, APS, and CSI in delirious patients with (correlation coefficient (r)=-0.43, 0.17, and 0.36, respectively) or without (r=-0.44, 0.39, 0.22, respectively) dementia. At 8 weeks, in delirious patients with and without dementia, internal responsiveness as measured by effect sizes was -0.60 and -0.74, respectively, and the standardized response mean for both groups was -0.64. Low to good levels of external responsiveness were found. CONCLUSION: The DI appears to be a reliable, valid, and responsive measure of the severity of delirium, in patients with delirium, with or without dementia.

Activities of Daily Living↗
PubMed2003

Does delirium increase hospital stay?

OBJECTIVES: To determine the effects of prevalent and incident delirium on length of hospital stay. DESIGN: Prospective cohort study, comparing (1). length of stay after admission in cases of prevalent delirium versus controls without prevalent delirium with (2). length of stay after diagnosis in cases of incident delirium versus controls matched by day of diagnosis. SETTING: The medical services of a primary, acute care hospital. PARTICIPANTS: Medical admissions of patients aged 65 and older from the emergency department with delirium diagnosed during the first week in hospital. Patients admitted to intensive care or oncology and those with a primary diagnosis of stroke were excluded. A sample of those without delirium was also enrolled. MEASUREMENTS: Delirium was diagnosed using the Confusion Assessment Method. Data on length of stay and diagnosis-related groups (DRGs) were abstracted from administrative data. Measures of covariates included the Informant Questionnaire on Cognitive Decline in the Elderly, the Delirium Index, the instrumental activities of daily living questionnaire from the Older American Resources and Services project, the Charlson Comorbidity Index, the Clinical Severity Scale, and the Acute Physiology Score. RESULTS: The study sample comprised 359 patients: 204 with prevalent delirium, 37 with incident delirium, and 118 without delirium. After controlling for covariates, prevalent delirium was not associated with a significantly longer hospital stay, but incident delirium was associated with an excess stay after diagnosis of 7.78 days (95% confidence interval=3.07, 12.48). Similar results were obtained using log-transformed or DRG-adjusted estimates of length of stay. CONCLUSION: In older medical inpatients, incident but not prevalent delirium is an important predictor of longer hospital stay. Interventions to prevent incident delirium may reduce length of stay.

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PubMed2003

Risk factors for depression among elderly community subjects: a systematic review and meta-analysis.

OBJECTIVE: The goal of this study was to determine risk factors for depression among elderly community subjects. METHOD: MEDLINE and PsycINFO were searched for potentially relevant articles published from January 1966 to June 2001 and from January 1967 to June 2001, respectively. The bibliographies of relevant articles were searched for additional references. Twenty studies met the following six inclusion criteria: original research reported in an English or French publication, study group of community residents, age of subjects 50 years or more, prospective study design, examination of at least one risk factor, and use of an acceptable definition of depression. The validity of studies was assessed according to the four primary criteria for risk factor studies described by the Evidence-Based Medicine Working Group. Information about group size at baseline and follow-up, age, proportion of men, depression criteria, exclusion criteria at baseline, length of follow-up, number of incident cases of depression, and risk factors was abstracted from each report. RESULTS: Follow-up of the inception cohort was incomplete in most studies. In the qualitative meta-analysis, risk factors identified by both univariate and multivariate techniques in at least two studies each were disability, new medical illness, poor health status, prior depression, poor self-perceived health, and bereavement. In the quantitative meta-analysis, bereavement, sleep disturbance, disability, prior depression, and female gender were significant risk factors. CONCLUSIONS: Despite the methodologic limitations of the studies and this meta-analysis, bereavement, sleep disturbance, disability, prior depression, and female gender appear to be important risk factors for depression among elderly community subjects.

Age Factors↗
PubMed2003

An empirical study of different diagnostic criteria for delirium among elderly medical inpatients.

This study compared the sensitivity and specificity of DSM-IV criteria for delirium with the sensitivity and specificity of DSM-III and ICD-10 criteria among elderly medical inpatients with or without dementia. Secondary objectives were to examine the effect of changing the definition of criterion A on sensitivity and specificity and to compare the sensitivity and specificity of different numbers of symptoms of delirium. A total of 322 elderly patients who had been admitted from the emergency department to the medical services were classified into one of four groups using DSM-III-R criteria: delirium and dementia (n = 128), delirium only (n = 40), dementia only (n = 94), and neither (n = 60). The sensitivity and specificity of DSM-IV, DSM-III, and ICD-10 criteria were determined against DSM-III-R criteria using three definitions of criterion A (clouding of consciousness only, clouding of consciousness and inattention, clouding of consciousness or inattention). When criterion A was defined as clouding of consciousness or inattention, the sensitivity and specificity of DSM-IV, DSM-III, and ICD-10 criteria were 100% and 71%, 96% and 91%, and 61% and 91%, respectively. The results were similar among patients with or without dementia. The lower specificity of DSM-IV was accounted for by its inclusion of patients who did not show disorganized thinking. DSM-IV criteria for delirium are the most inclusive criteria to date for elderly medical patients with or without dementia.

Aged↗
PubMed2002

Systematic detection and multidisciplinary care of delirium in older medical inpatients: a randomized trial.

BACKGROUND: Delirium is common and often goes undetected in older patients admitted to medical services. It is associated with poor outcomes. We conducted a randomized clinical trial to determine whether systematic detection and multidisciplinary care of delirium in older patients admitted to a general medical service could reduce time to improvement in cognitive status. METHODS: Consecutive patients aged 65 or more who were newly admitted to 5 general medical units between Mar. 15, 1996, and Jan. 31, 1999, were screened with the Confusion Assessment Method within 24 hours after admission to detect prevalent delirium and rescreened within a week to detect incident cases. Patients with delirium were randomly allocated to receive the intervention or usual care. Subjects in the intervention group were seen by a geriatric specialist consultant and followed in hospital for up to 8 weeks by an intervention nurse who liaised with the consultant, attending physicians, family and the primary care nurses. Subjects in the usual care group received standard hospital services but could consult geriatric specialists as needed. A research assistant, blinded as to treatment allocation, administered within 24 hours after enrolment the MiniMental Status Exam (MMSE), Delirium Index (measuring the severity of the delirium) and Barthel Index (measuring independence of personal care). Improvement was defined as an increase in the MMSE score of 2 or more points, with no decrease below baseline plus 2 points, or no decrease below a baseline MMSE score of 27. A short form of the Informant Questionnaire on Cognitive Decline in the Elderly was completed to identify patients with possible dementia. Subjects were assessed 3 times during the first week and weekly thereafter for up to 8 weeks in hospital or until discharge. Data on clinical severity of illness, length of stay and living arrangements after discharge were also collected. The primary outcome measure was time to improvement in MMSE score. RESULTS: Of the 1925 patients who met the inclusion criteria and were screened, 227 had prevalent or incident delirium and consented to participate (113 in intervention group and 114 in usual care group). There were no clinically significant differences between the intervention and usual care groups except for sex (female 58.4% v. 50.0%) and marital status (married 34.8% v. 41.2%). Overall, 48% of the patients in the intervention group and 45% of those in the usual care group met the predetermined criteria for improvement. The Cox proportional hazards ratio (HR) for a shorter time to improvement with the intervention versus usual care, adjusted for age, sex and marital status, was 1.10 (95% confidence interval [CI] 0.74-1.63). There were no significant differences within 8 weeks after enrolment between the 2 groups in time to and rate of improvement of the Delirium Index, the Barthel Index, length of stay, rate of discharge to the community, living arrangements after discharge or survival. Outcomes between the 2 groups did not differ statistically significantly for patients without dementia (HR 1.54, 95% CI 0.80-2.97), for those who had less co-morbidity (HR 1.36, 95% CI 0.75-2.46) or for those with prevalent delirium (HR 1.15, 95% CI 0.48-2.79). INTERPRETATION: Systematic detection and multidisciplinary care of delirium does not appear to be more beneficial than usual care for older patients admitted to medical services.

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PubMed2002

The prevalence and phenomenology of auditory hallucinations among elderly subjects attending an audiology clinic.

BACKGROUND: Studies of auditory hallucinations are scant. METHOD: To determine the prevalence and phenomenology of auditory hallucinations among elderly subjects with hearing impairment. OBJECTIVE: We surveyed 125 men and women aged 65 years and over referred to the Audiology department of a university-affiliated primary acute-care hospital. RESULTS: The prevalence of auditory hallucinations was 32.8% (95% confidence interval (CI) 24.7-41.8). These hallucinations represented a spectrum of phenomenology from elementary personal impressions to complex percepts. The types of auditory hallucinations included humming or buzzing (35.9%), shushing (12.8%), beating or tapping (10.6%), ringing (7.7%), other individual sounds (15.4%), multiple sounds (12.6%), voices (2.5%) or music (2.5%). Subjects with any type of hallucination were younger and had poorer discrimination scores in the left ear and impaired binaural discrimination with lip-reading. Subjects with hallucinations that had more qualities of a true percept heard different types of sounds and had lower reflex thresholds and better air conduction in the right ear. CONCLUSION: Auditory hallucinations are frequent in elderly subjects with hearing impairment and seem to be associated with younger age and asymmetrical hearing impairment.

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PubMed2002

Symptoms of delirium among elderly medical inpatients with or without dementia.

This study examined the frequencies of the 10 symptoms of delirium identified in DSM-III-R among patients with delirium (DSM-III-R criteria) who did or did not have dementia. The prevalence of each symptom, the numbers of symptoms, and the combinations of symptoms were determined among 322 elderly medical inpatients classified into one of four groups: delirium and dementia (n=128), delirium only (n=40), dementia only (n=94), or neither (n=60). Symptoms were assessed at the time of diagnosis and independently (by use of a different scale) within 24 hours of diagnosis. Delirium appeared to be phenomenologically similar among patients with and those without dementia, although patients with dementia had more psychomotor agitation at the time of diagnosis and more disorganized thinking and disorientation at the second assessment.

Adult↗
PubMedDate not supplied

Short-term stability of diagnoses of major and minor depression in older medical inpatients.

The authors sought to determine the short-term stability of diagnoses of major and minor depression in older medical inpatients. The investigation was a test-retest design involving comparisons between different pairs of interviewers who assessed patients independently on medical wards of two acute-care, university-affiliated hospitals by use of the Diagnostic Interview Schedule (DIS) at intervals between 1 and 51 days. Patients were 380 cognitively-intact patients age > or =65, assessed twice with the DIS. Core depressive symptoms (depressed mood, loss of interest or pleasure) were more stable than the other depressive symptoms. The presence of moderate-to-severe depressive symptoms, moderate-to-severe disability, and depression symptoms of > or =6 months' duration were associated with a higher short-term stability of diagnosis. Age, gender, language, education, rater, interval between assessments, baseline number of medications, medical comorbidity, severity of medical illness, acute physiology score, and cognitive functioning were not associated with short-term depression stability. Stability of diagnosis may be improved by emphasis on core depressive symptoms or the presence of more severe depressive symptoms, moderate-to-severe disability, and duration of symptoms > or =6 months.

APACHE↗