Biomedical subjects

Perla Werner

Publications and source records attributed to Perla Werner.

32 records · Page 2Linked to original sources

PubMed2003

Anxiety disorder and accompanying subjective memory loss in the elderly as a predictor of future cognitive decline.

OBJECTIVE: The aim of the study was to empirically investigate the hypothesis that anxiety in the elderly, secondary to loss of memory, predicts future cognitive decline. METHOD: The participants were 137 elderly subjects with no depression or cognitive impairment from a community geriatric assessment unit, 45% with anxiety. In addition to demographic characteristics, cognitive status was assessed using the Mini Mental State Examination; depression was assessed by Tucker's short Interviewer-Assisted Depression Rating Scale; anxiety by Sinoff's Short Anxiety Screening Test and Activities of Daily Living function by Shah's modified Barthel's Index. RESULTS: At follow-up 37 persons had dropped out, leaving 100 participants for final analysis. Mean re-examination time was 3.2 years with no group differences. The mean MMSE and modified Barthel scores decreased significantly more in those with anxiety. A relative risk of 3.96 for developing future cognitive impairment was found. Regression analysis showed that only anxiety was a significant predictor of cognitive decline. By path analysis, a more parsimonious model showed anxiety to have both a direct and an indirect effect on predicting future cognitive decline, and that the effect of loss of memory on cognitive decline was via anxiety. CONCLUSIONS: Anxiety is inter-related and inseparable with loss of memory and its presence is a strong predictor for future cognitive decline, directly or indirectly via depression. It appears that loss of memory is the initial problem with consequent development of anxiety. Therefore, anxiety, like depression, is probably an early predictor of future cognitive decline and even possible future cognitive impairment.

Activities of Daily Living↗

PubMed2003

Knowledge about symptoms of Alzheimer's disease: correlates and relationship to help-seeking behavior.

OBJECTIVE: The aim of this study was to assess relationships between knowledge about symptoms of Alzheimer's disease (AD) and help seeking intention among the lay public. DESIGN, SETTING AND PARTICIPANTS: A convenience sample of 150 community-dwelling persons aged over 45, who did not have a close relative diagnosed with AD, participated in the study. MEASURES: Knowledge about 11 warning signs of AD as described in the information provided by the Alzheimer's Association, and four non-AD symptoms was assessed, together with intentions to seek help from professional and non-professional sources. Background characteristics included socio-demographic characteristics, personal experience with AD, and perceived threat. RESULTS: Although participants' knowledge about AD symptoms overall was fair, only a slight percentage reported memory problems to be symptoms of the disease. Participants differentiated between AD warning and non-warning signs. Older participants reported consistently more AD and non-AD symptoms, while higher concerns about developing the disease was associated with reporting more non-AD symptoms. Higher knowledge about AD symptoms was associated with increased intentions to seek help from professional sources. CONCLUSIONS: Efforts to increase knowledge about AD symptoms should be expanded, with special attention to risk groups. Improved recognition of AD symptoms will promote adequate help-seeking behaviors and will increase early identification and treatment of AD.

Aged↗

PubMed2003

Validation of the modified telephone interview for cognitive status (TICS-m) in Hebrew.

INTRODUCTION: The validity of the Hebrew version of the Telephone Interview for Cognitive Status-Modified (TICS-m) for Mild Cognitive Impairment (MCI), for dementia, and for cognitive impairment (either MCI or dementia) was investigated. METHODS: Of the 10 059 who took part of the Israel Ischemic Heart Disease Cohort, 1902 of the 2901 survivors in 1999 had TICS-m interviews. Those with a score of 27 or below and a random sample with a score of 28 or 29 were invited to have a physician's examination for the diagnosis of dementia. The analysis was performed on the 576 who agreed. RESULTS: Based on physician's diagnosis, 269 were diagnosed as suffering from dementia, 128 as suffering from MCI, and 179 were diagnosed with no cognitive impairment. The TICS-m Hebrew version's internal consistency was very high (Cronbach's alpha = 0.98) and showed a strong convergent validity with the MMSE (r = 0.82; p < 0.0005). The sensitivity was 100% for each of the conditions. Finally, after controlling for age, education and hearing impairment, TICS-m was a strong predictor of dementia, MCI and cognitive impairment. CONCLUSION: At a cut-off of 27/50 the Hebrew version of the TICS-m is a useful screening instrument to identify subjects suffering from mild cognitive impairment, dementia and cognitive impairment (MCI or dementia).

Aged↗

PubMed2003

Factors influencing intentions to seek a cognitive status examination: a study based on the Health Belief Model.

AIMS: The aim of the present study was to examine the factors influencing intention to seek a cognitive status evaluation in the presence of memory problems. METHODS: A convenience sample of 186 community-dwelling adults (mean age=64) were interviewed face-to-face using measures derived from the Health Belief Model. RESULTS: Participants' intentions to be examined were higher when presented with scenarios describing family history of Alzheimer's disease (AD). Perceived barriers and cues to action were significant predictors of intention, accounting for 24% of the variance. CONCLUSIONS: These findings suggest the need to develop effective educational strategies to improve knowledge about AD and decision-making concerning cognitive status examinations.

Aged↗

PubMed2003

A model of the willingness to use telemedicine for routine and specialized care.

We examined factors associated with the willingness to use telemedicine for routine and specialized care within a theoretical framework. The conceptual model proposed that willingness to use telemedicine is associated directly with attitudes to telemedicine, attitudes to the patient-physician relationship, and to satisfaction with current health-care. In addition, technology anxiety and past behaviour were both assumed to affect willingness to use telemedicine indirectly. Telephone interviews were conducted with a national sample of 1204 Jewish, non-institutionalized adults in Israel. Structural equation modelling was used to examine the hypothesized relationships. Participants were more willing to use telemedicine for routine than for specialized care. Overall, willingness to use telemedicine was affected by attitudes to telemedicine, attitudes to the patient-physician relationship and by level of technology anxiety. Educational interventions aimed at encouraging the use of telemedicine should target potential users' attitudes, as well as feelings of uneasiness and anxiety regarding technology.

Adult↗

PubMed2003

Knowledge and correlates of osteoporosis: a comparison of Israeli-Jewish and Israeli-Arab women.

The present study examined levels and correlates of knowledge about osteoporosis among 176 Israeli-Jewish (mean age = 55) and 80 Israeli-Arab (mean age = 51) women. Levels of knowledge about the disease were low among all women, especially regarding some of the risk factors. Knowledge and awareness about the disease were especially deficient among Arab women. Younger age and lower education were the main vulnerability factors among Jewish women, and lower desire to seek information from the medical establishment, higher religiosity, and the lack of extended medical insurance among Arab women. Educational programs, geared to the needs and capabilities of the different ethnic populations, should be encouraged.

Arabs↗

PubMed2002

The cost of behavioral and psychological symptoms of dementia (BPSD) in community dwelling Alzheimer's disease patients.

INTRODUCTION: Behavioral and psychological symptoms of dementia (BPSD) are highly prevalent in Alzheimer's disease (AD) patients. They are a source of distress for the caregivers and one of the main reasons for nursing home placement, which is the major component of the cost of Alzheimer's disease. The aim of the present study was to assess the direct and indirect cost related to the care of BPSD within a prospective study examining the overall cost of AD in Israel. METHODS: Seventy-one community dwelling AD patients were interviewed. Interviews covered information about the number of caregivers' hours invested in caring for the patient and amount of expenditure such as in-house paid help and payments for day care. Effort devoted to BPSD was defined as the number of hours spent by primary and secondary caregivers in a typical week dealing with BPSD (managing aggression, pacing, attempts to leave the house under inappropriate circumstances, or comforting a hallucinating, depressed or anxious patient). RESULTS: The annual indirect cost for management of BPSD in an AD patient was approximately 2665 dollars -over 25% of the total annual indirect cost of care ($10 520). The annual direct cost of BPSD of an AD patient was approximately 1450 dollars -over 35% of the total annual direct cost of care (3900 dollars). CONCLUSIONS: Approximately 30% (4115 dollars) of the total annual cost of AD (14420 dollars) is invested in the direct management of BPSD. Given the importance of BPSD as one of the main components of the cost of AD, future cost studies should be designed to measure the cost of specific components of BPSD and verify which are the most costly aspects of the disease. Despite the considerable methodological difficulties in disentangling the costs of the specific symptoms of AD, cost effectiveness studies of different interventions should be conducted in order to determine the optimal intervention with relation to cost.

Activities of Daily Living↗

PubMed2002

Interventions used by nursing staff members with psychogeriatric patients resisting care.

Although resistance to care can have a major impact on the provision of care, relatively limited research has been reported on the topic. This research examined differences in the use of interventions by nurses in different care settings to manage resistance to care with eating and dressing. A convenience sample of 50 nurses (34 working in psychiatric hospitals and 16 in nursing homes) participated in the study. Nurses in both settings reported using similar interventions for both problems. Non-nursing interventions were consistently mentioned to be more common when resistance was accompanied by physical aggression than by verbal aggression.

Alzheimer Disease↗

PubMed2002

Women's knowledge of new regulations about publicly funded medications for osteoporosis.

To provide adequate and updated information regarding changes in health care regulations or policies can be a challenging task for policy makers. The aim of the present study was to examine knowledge about new regulations regarding publicly funded drugs for the treatment of osteoporosis in a group of 109 Israeli women. Participants were interviewed between 3 and 6 months after the new regulations were enacted. Although participants were aware of their eligibility, moderate levels of knowledge were found regarding the content of the regulations. Especially low levels of knowledge were found regarding the scope of services and the definition of osteoporosis according to the regulations. High-risk participants (i.e. older participants and those with lower T score or who had suffered a fracture) had no better knowledge of the regulations. The development of multifaceted information programs aimed at disseminating the content of policy changes is encouraged.

Aged↗

PubMed2002

Perceptions regarding the use of physical restraints with elderly persons: comparison of Israeli health care nurses and social workers.

In view of the difficulty involved in decision-making regarding the use or removal of physical restraints and the recent pattern encouraging the use of interdisciplinary teams for elder care issues, the present study compared the perceptions of Israeli nurses and social workers in health care settings regarding the use of physical restraints. Data were collected from a convenience sample of 50 nurses and 69 social workers working in long-term and acute care settings. The findings indicated that participants in all professions attributed moderate to low importance towards the use of physical restraints. Social workers' perceptions were similar to those of nurses in psychiatric hospitals and slightly more favourable to the use of physical restraints than those of nurses in nursing homes. Patients' safety (as reflected in the scores of the items related to protecting an older person from falling and protecting an older person from pulling out a catheter) was the most important reason for using physical restraints for both groups. Increased attention should be given to the role of social workers as team members in the process of decision-making regarding the use or removal of physical restraints, especially as mediators between the elderly person, family members and staff members.

Aged↗

PubMedDate not supplied

Self-reported prevalence and correlates of osteoporosis: results from a representative study in Israel.

The aim of the present study was to determine self-reported prevalence of osteoporosis and its correlates in a representative sample of Jewish elderly persons aged 60 and older in Israel. Participants included 3022 Jewish community-dwelling men and women who provided information about themselves. Information was collected during home interviews regarding self-reported osteoporosis, health-related information, health behaviors and psychological measures. Osteoporosis self-reported prevalence rate was 7% for men and 25% for women. A history of fracture, joint pain and back pain, and psychological distress were the most important independent predictors in both men and women. Findings of the present study showed that also when based on self-reported measures, osteoporosis is a significant public health problem. Special attention should be paid to those who report themselves as suffering from the disease, but are not involved in health-related behaviors.

Aged↗

PubMedDate not supplied

Economic cost of Alzheimer disease in Israel.

The objective of this prospective study was to evaluate the cost of Alzheimer disease (AD) in Israel. Seventy-one AD patients who lived in the community, 50 institutionalized AD patients, both AD groups' respective primary caregivers, and 50 healthy elderly subjects were interviewed. The interviews covered information about the number of caregivers' hours invested in caring for the patient and amount of expenditures such as in house paid help and payments for day care. The annual social cost of caring for a person with AD in Israel was approximately $17,000, whether the patient lived at home or in a nursing home, but the cost components differed in the two groups. For community-dwelling patients, 60% of the cost represented an imputed value of unpaid indirect care compared with 12% for institutionalized patients. Also, in both residences, the private cost was significantly higher than the public cost, i.e., more 75% of the services provided to patients were paid out of pocket. Cost of institutionalization was the major component of the social cost. The cost of the disease increased with functional and cognitive deterioration for the community-dwelling group only. With projected increases in the number of persons at risk for developing AD, the economic impact of the disease on future costs will be significant. Efforts to delay deterioration and, as a result, delay institutionalization seem crucial for cost containment.

Aged↗

PubMedDate not supplied

Acoustic properties of vocally disruptive behaviors in the nursing home.

BACKGROUND: Disruptive vocalizations are among the most common behavior problems in the nursing home. However, their acoustic properties have not been previously investigated. OBJECTIVE: This paper examines the acoustic properties of disruptive vocalizations and attempts to link them to resident and verbalization characteristics. METHODS: This study characterizes the sounds emitted by 26 nursing home residents who manifested disruptive vocalizations. Verbalizations were audiotaped and then used in a sonographic evaluation and an acoustic analysis. RESULTS: Vocalizations of verbally agitated nursing home residents were characterized by their relatively short duration. Consistent positive correlations were found between seemingly disturbing types of vocalizations, such as yelling and howling, and higher levels of several parameters of the fundamental frequency. A similar positive correlation was also found between acoustic parameters and medical disease indicators. With the exception of the length of stream of utterances, the indicators did not differentiate between types of dementia. CONCLUSIONS: Because of the large number of comparisons undertaken, it is difficult to conclude which associations between acoustic properties and resident or vocalization characteristics are attributable to real underlying trends and which are due to chance and error. Consistencies that deserve further research pertain to the perceptions of the types of vocalizations the person tends to emit and to the physical health of the person.

Aged↗

PubMedDate not supplied

Assessing correlates of concern about developing Alzheimer's dementia among adults with no family history of the disease.

In an attempt to add to the knowledge about concerns regarding the development of Alzheimer's disease (AD), a sample of 186 Jewish and Arab adults with no family history of the disease were examined on the basis of sociodemographic and health characteristics, social-cognitive determinants, and knowledge about AD. Nearly 50 percent of the participants reported being very concerned about developing AD. Memory problems and the likelihood of developing the disease emerged as significant predictors of concern about AD. The need to expand the use of theoretically-based models, including social-cognitive determinants, for the study of specific concerns about AD as a basis for the development of educational programs is discussed.

Alzheimer Disease↗