It gives us great pleasure to announce that in 2007 and beyond International Psychogeriatrics will appear six times each year in February, April, June, August, October and December. In 2007 each issue will comprise 176 pages, and at least one supplement (to contain the abstracts for the Thirteenth Congress of the International Psychogeriatric Association (IPA)) will be published as well. This increase in publication frequency and annual number of published pages will cut the time between the online publication of accepted manuscripts as “forthcoming articles” at our website www.journals.cambridge.org/jid_IPG and their appearance in a specific issue of the journal, and also will permit the further development of innovations such as the popular “for debate” series (e.g. Ames et al., 2005) which was initiated last year. This development represents a vote of confidence in the future of the journal by both its parent association, IPA, and its publisher, Cambridge University Press, and, in consequence, IPA members and other journal subscribers will now derive markedly increased value from their subscriptions, as the number of journal pages published annually will have risen from 446 in 2002 and 2003 to 1056 in 2007, coincident with a marked improvement in the timeliness of the journal's publication dates (Ames, 2006). The number of pages to be published each year will be reviewed every 12 months, and we hope that a continuation of the recent steady rise in both number and quality of manuscript submissions (Ames, 2006) will permit further growth of the journal in future. Meanwhile, we encourage the 30% or more of subscribers who have not yet activated their online subscriptions to do so by registering at the Cambridge University Press website as advised in letters sent out by the Press at the start of August. Those subscribers who are entitled to receive hard copies of the journal will not lose this entitlement by activating their online subscriptions, and online registration brings with it the considerable advantages of early access to accepted articles and the ability to obtain pdf copies of journal content.

Background: In recent years, many different forms of interventions for caregivers of people with dementia have been developed. However, their results have been, in part, inconclusive.

Methods: Meta-analysis was used to integrate the results of 127 intervention studies with dementia caregivers published or presented between 1982 and 2005.

Results: Interventions had, on average, significant but small effects on burden, depression, subjective well-being, ability/knowledge and symptoms of care recipient. Only multicomponent interventions reduced the risk for institu-tionalization. Psychoeducational interventions that require active participation of caregivers had the broadest effects. Effects of cognitive-behavioral therapy, support, counseling, daycare, training of care recipient, and multicomponent interventions were domain specific. The effect sizes varied by study chara-cteristics, such as caregiver gender and year of publication.

Conclusions: Because most interventions have domain-specific outcomes, clinicians must tailor interventions according to the specific needs of the individual caregivers. Although more recent interventions showed stronger effects, there is room for further improvements in interventions.

Background: Animal-assisted therapy (AAT) is gaining popularity as part of therapy programs in residential aged care facilities. Humans and pet dogs respond to quiet interaction with a lowering of blood pressure and an increase in neuroche-micals associated with relaxation and bonding. These effects may be of benefit in ameliorating behavioral and psychological symptoms of dementia (BPSD).

Methods: Medline, PsychInfo and CINAHL databases (1960–2005) were searched for papers on AAT or pets and dementia. Publications of controlled trials that measured the effect of AAT for dementia were reviewed.

Results: Several small studies suggest that the presence of a dog reduces aggression and agitation, as well as promoting social behavior in people with dementia. One study has shown that aquaria in dining rooms of dementia care units stimulate residents to eat more of their meals and to gain weight but is limited by the small number of facilities studied. There is preliminary evidence that robotic pets may provide pleasure and interest to people with dementia.

Conclusions: Current literature suggests that AAT may ameliorate BPSD, but the duration of the beneficial effect has not been explored. The relative benefits of “resident” versus “visiting” pet dogs are unclear and are confounded by the positive effect of pet interaction on staff or caregivers. Further research on the potential benefits of AAT is recommended.

Background: Music therapy is a potential non-pharmacological treatment for the behavioral and psychological symptoms of dementia, but although some studies have found it to be helpful, most are small and uncontrolled.

Methods: This case–control study was carried out by qualified music therapists in two nursing homes and two psychogeriatric wards. The participants were 38 patients with moderate or severe Alzheimer's disease (AD) assigned randomly to a music therapy group and a control group.

Results: The study showed a significant reduction in activity disturbances in the music therapy group during a 6-week period measured with the Behavior Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD). There was also a significant reduction in the sum of scores of activity disturbances, aggressiveness and anxiety. Other symptoms rated by subscales of the BEHAVE-AD did not decrease significantly. Four weeks later the effects had mostly disappeared.

Conclusions: Music therapy is a safe and effective method for treating agitation and anxiety in moderately severe and severe AD. This is in line with the results of some non-controlled studies on music therapy in dementia.

Background: A recent Cochrane report concluded that more and better quality research is required to investigate the effectiveness of music therapy in reducing problems in behavioral, social, emotional and cognitive domains in patients with dementia. This randomized placebo-controlled trial with blinded observer rater aimed to explore whether music, live or pre-recorded, is effective in the treatment of apathy in subjects with moderate to severe dementia.

Methods: Thirty-two subjects meeting ICD-10 diagnostic criteria for moderate to severe dementia and fulfilling diagnostic criteria for apathy were exposed to live interactive music, passive pre-recorded music or silence for 30 minutes. Each subject was randomized to 30-minute music or silent periods and was video recorded and the muted recording analyzed every 3 minutes using dementia care mapping to assess the quality of engagement to the blinded music intervention.

Results: Compared to low baseline levels of positive engagement (12.5%) in the silent placebo period, the majority of subjects (69%), regardless of dementia severity, showed a significant and positive engagement to live music. Engagement to pre-recorded music was non-significant, with just 25% of all subjects showing positive engagement. No subjects showed any evidence of experiencing a state of ill-being during either the live or pre-recorded music sessions.

Conclusions: During the intervention, live interactive music has immediate and positive engagement effects in dementia subjects with apathy, regardless of the severity of their dementia. Pre-recorded music is non-harmful but less clearly beneficial.

Background: Very little is known about the utility of psychiatric day hospitals for elderly adults with mood disorders. The objectives of this study were to evaluate a long-standing day-hospital program and to explore whether demographic and non-demographic patient characteristics were associated with treatment outcomes.

Method: We used t-tests to compare retrospective admission and discharge data for 708 patients over a 16-year period, and multiple regression to examine predictors of improvement.

Results: Depressed patients showed statistically and clinically significant improvements on the Geriatric Depression Scale and the Hamilton Depression Rating Scale. The number and severity of depressive symptoms at admission were strongly related to treatment outcomes. After controlling for initial levels of depression, demographic characteristics did not predict improvement, and axis I and II diagnoses modestly and inconsistently predicted improvement.

Conclusions: A biopsychosocially-focused day-hospital treatment program was associated with improvements in depression in a large sample of elderly adults with mood disorders. Except for depression severity at admission, patient characteristics had very little impact on treatment outcomes, suggesting that day hospital programs are beneficial for a wide range of depressed elderly adults.

Background: To determine the prevalence of dementia among the residents of geriatric institutions in the greater Jerusalem area.

Methods: A population-based, cross-sectional survey of a representative sample, weighted according to the level of care, of 11 of the 88 long-term care (LTC) wards in 34 LTC institutions providing care for the elderly residents in the greater Jerusalem area in 1999. A single physician interviewed 311 residents. The presence of dementia was determined from medical records and by performance on the Modified Mini-mental State Examination (3MS) instrument (with a score less than 78/100 indicating significant cognitive impairment or suspected dementia), and professional care providers were interviewed for their opinion regarding the presence of dementia in each subject.

Results: The mean age of the patients was 83.9 years and 75% were women. Overall, 180 residents, representing 49.9% of the weighted sample in Jerusalem LTC facilities, were determined to have dementia according to medical records, ranging from 22.9% in independent and frail care units to 97.7% in skilled nursing care wards. However, based on their performance on the 3MS, the prevalence of cognitive impairment with suspected dementia among the subjects was substantially greater, with the staff being unaware of this diagnosis in about one-quarter of the subjects.

Conclusions: There is a high prevalence of dementia in geriatric institutions in the Jerusalem area, particularly in those providing greater care. Moreover, significant cognitive impairment is probably under-reported in the medical records.

Background: Assessing function is a crucial element in the diagnosis of dementia. This information is usually obtained from key informants. However, reliable informants are not always available.

Methods: A 10-item semi-structured home interview (the CHIF, or Clinician Home-based Interview to assess Function) to assess function primarily by measuring instrumental activities of daily living directly was developed and tested for inter-rater reliability and validity as part of the Indianapolis–Ibadan dementia project. The primary validity measurements were correlations between scores on the CHIF and independently gathered scores on the Blessed Dementia Scale (from informants) and the Mini-mental State Examination (MMSE). Sensitivities and specificities of scores on the CHIF and receiver operator characteristic (ROC) curves were constructed with dementia as the dependent variable.

Results: Inter-rater reliability for the CHIF was high (Pearson's correlation coefficient 0.99 in Indianapolis and 0.87 in Ibadan). Internal consistency, in both samples, was good (Cronbach's α 0.95 in Indianapolis and 0.83 in Ibadan). Scores on the CHIF correlated well with the Blessed Dementia scores at both sites (−0.71, p < 0.0001 for Indianapolis and −0.56, p < 0.0001 for Ibadan) and with the MMSE (0.75, p < 0.0001 for Indianapolis and 0.44, p < 0.0001 for Ibadan). For all items at both sites, the subjects without dementia performed significantly better than those with dementia. The area under the ROC curve for dementia diagnosis was 0.965 for Indianapolis and 0.925 for Ibadan.

Conclusion: The CHIF is a useful instrument to assess function directly in elderly participants in international studies, particularly in the absence of reliable informants.

Objectives: To describe and classify individual trajectories of 15-day changes in delirium severity.

Methods: A longitudinal hospital-based study was carried out with 230 medical inpatients aged 65 and over admitted to St Mary's Hospital in Montreal, Canada, between 1996 and 1999, diagnosed with delirium at enrollment, and who had at least four measurements of delirium severity during the next 15 days. Delirium severity was assessed using the Delirium Index (DI). To classify patients' individual trajectories, we applied a new method that relies on principal factor analysis and cluster analysis. We used multiple linear regression to investigate if clusters were associated with DI scores measured at an 8-week follow-up. Multivariable Cox's proportional hazards regression was used to assess whether the clusters were associated with survival over the next 12 months.

Results: Individual patterns were classified into five clusters: Steady (n = 89, 38.9%), Fluctuating (n = 36, 15.7%), Worsening (n = 15, 6.6%), Fast Improve-ment (n = 26, 11.3%), and Slow Improvement (n = 63, 27.5%). The Fast Improvement cluster had much lower prevalence of dementia (38.5% vs. 55.6% to 77.8% in other clusters, p = 0.003). Subjects whose 2-week patterns were classified as Fast or Slow Improvement had a significantly lower DI at 8 weeks than those in the Steady or Fluctuating clusters. The Worsening cluster had the largest percentage of deaths. The Fast Improvement and Worsening clusters initially had a high risk of death in the first 2 weeks (adjusted relative risks of approximately 3 and 6, respectively) but that risk decreased rapidly thereafter.

Conclusion: Two-week trajectories of delirium severity were associated with short-term mortality and delirium severity at 8-week follow-up.

Objectives: To examine delirium, chronic medical problems and sociodemographic factors as predictors of activities of daily living (ADL), basic ADL (BADL) and instrumental ADL (IADL).

Methods: A prospective cohort study of four groups of elderly patients examined in the emergency department (ED): those with delirium, dementia, neither, and both. All were aged 66 years or older and living at home. Delirium was assessed with the Confusion Assessment Method and dementia with the Informant Questionnaire on Cognitive Decline in the Elderly. Demographic variables and chronic medical problems were ascertained with questionnaires. Outcome was ADL at 6, 12 and 18 months, measured with the ADL subscale of the Older Americans Resources and Services instrument.

Results: Univariate analyses suggested significantly poorer ADL, particularly IADL, at 18 months in the delirium versus the non-delirium group, in the absence of dementia only. Statistically significant independent predictors of poorer ADL at 18 months in the non-dementia groups were poorer initial ADL, stroke, Parkinson's disease, hypertension and female sex. Independent predictors of poorer BADL at 18 months in the non-dementia groups were poorer initial BADL, Parkinson's disease, stroke, cancer, colds/sinusitis/laryngitis, female sex and hypertension. Independent predictors of poorer IADL at 18 months in the non-dementia groups were poorer initial IADL, stroke, never-married status, colds/sinusitis/laryngitis, arthritis and hypertension, with Parkinson's disease showing a non-significant but numerically large regression coefficient.

Conclusion: Rather than finding delirium to be a predictor of poorer functional outcome among survivors, we found an interaction between delirium and dementia and several plausible confounders, primarily chronic medical problems, although we cannot rule out the effect of misclassification or survivor bias.

Background: Few studies have investigated the association of psychiatric morbidity with acute hospitalization risk in elderly people.

Method: We examined this association using population-based data for 1092 older adults aged ≥60 years in Singapore, including subjects who reported at least one acute hospitalization from any medical condition(s) in the 12 months prior to interview (N = 136). Psychiatric morbid/comorbid disorders were diagnosed using the Geriatric Mental State examination.

Results: In a multivariate analysis, comorbid psychiatric disorders were inde-pendently associated with hospitalization [adjusted odds ratio 2.76, 95% confidence interval 1.20–6.33], after controlling for age, ethnicity, employment status, number of medical comorbidities, number of activities of daily living limitations, hearing and visual impairment, SF-12 Physical and Mental Component Summary scores, social, productive, fitness and health activities, and regular visits to health-care providers. Neither dementia diagnosis nor cognitive impairment measured by the Mini-mental State Examination was associated with increased hospitalization risk.

Conclusion: Psychiatric morbidity in old age was significantly associated with increased hospitalization risk. This finding underlines the importance of treating psychiatric illness to reduce the risk of acute hospitalization in elderly patients.

Background: Behavioral and psychological symptoms of dementia (BPSD) commonly occur among cognitively impaired people in geriatric care. BPSD are often managed with antipsychotic drugs, despite the associated serious health risks. The aim of the present study was to discover factors associated with the use of antipsychotics.

Methods: A cross-sectional study in all geriatric care units in the county of Västerbotten, Sweden, which included 2017 residents aged 65 years and over with cognitive impairment (mean age was 83.5 years). Data were collected from prescription records and observations made by care staff of BPSD among residents during the preceding week. A multivariate regression model was con-structed to find factors independently associated with antipsychotic drug use.

Results: Eleven factors were independently associated with the use of antipsychotics. Aggressive, verbally disruptive and wandering behavior, hallucinatory and depressive symptoms, male sex, living in a group dwelling for people with dementia, imposed mental workload, the ability to rise from a chair, activities of daily living (ADL) dependency and lower age all correlated significantly.

Conclusions: Antipsychotic drug treatment of old people with cognitive impairment in geriatric care is common, and determined not only by the patient's symptoms but also by factors related more closely to the caregiver and the caring situation. These findings raise important questions about the indications for drug treatment in relation to the patient's quality of life.

Background: It is currently not known whether elderly men and women present with different subtypes of depression and mania/bipolar disorder. The aim of this study was to compare the prevalence of subtypes of a single depressive episode and mania/bipolar disorder according to the ICD-10 for elderly men and women in a nationwide sample of all out- and inpatients in psychiatric settings.

Methods: All patients older than 65 years who received a diagnosis of a single depressive episode and mania/bipolar disorder in the period from 1994 to 2002 at the end of their first outpatient treatment or at their first discharge from psychiatric hospitalization in Denmark were identified in a nationwide register.

Results: A total of 9837 patients aged more than 65 years received a diagnosis of a single depressive episode (69.9% were women) and 443 a diagnosis of mania/bipolar disorder (61.6% were women) at the end of their first contact with psychiatric health care. Slightly more women than men received a diagnosis of mild (70.8%) or moderate depression (67.4%) compared to severe depression (65.9%). Men more often presented with a single depressive episode with comorbid substance abuse or comorbid somatic illness. No gender differences were found in the prevalence of depression with or without melancholic or psychotic symptoms. Men more often presented with mania/bipolar disorder with comorbid substance abuse.

Conclusions: The distributions of the subtypes of a single depressive episode or mania/bipolar disorder are remarkably similar for male and female patients aged over 65 years with first contact with the psychiatric health-care system.

Background: Post-stroke depression (PSD) frequently complicates stroke and is associated with an impaired functional outcome, more severe cognitive deficits, a reduced quality of life, and a higher mortality. The aim of this study was to assess whether general risk factors for major depressive disorder (MDD) in the community are also risk factors for PSD, and to identify additional, stroke-related risk factors.

Methods: In a hospital setting, 190 consecutively admitted patients were assessed for MDD 1 month after stroke, and at follow-up after 3, 6, 9 and 12 months. A Cox model was created with four established risk factors for MDD in the community (female sex, prior personal history of depression, positive family history of depression, and somatic comorbidity other than stroke). Five potential disease-related risk factors (disability, cognitive deterioration, inter- and intrahemispheric lesion location, and generalized vascular damage on computed tomography (CT) scan) were then added individually to this model, to see whether these would improve the significance of the overall model.

Results: The Cox model of four general risk factors for depression in the community was shown to be a valid model to predict depression in stroke patients. Of the disease-specific factors, only incorporation of “disability” in this model improved its significance.

Conclusion: Established risk factors for depression in the community are also predictors of depression in the first year after stroke. Disability is a non-specific disease-related variable that is associated with PSD. The contribution of stroke-specific factors may be less than is generally assumed.