Depression in late life is a risk factor for cognitive decline. Depression is also associated with increased disability and social support deficits; these may precede conversion to dementia and inform risk. In this study, we examined if baseline or one-year change in disability and social support predicted later cognitive deterioration.

299 cognitively intact depressed older adults were followed for an average of approximately seven years. Participants received antidepressant treatment according to a standardized algorithm. Neuropsychological testing and assessment of disability and social support were assessed annually. Cognitive diagnosis was reviewed annually at a consensus conference to determine if participants remained cognitively normal, or if they progressed to either dementia or cognitively impaired, no dementia (CIND).

During study participation, 167 individuals remained cognitively normal (56%), 83 progressed to CIND (28%), and 49 progressed to dementia (16%). Greater baseline instrumental activities of daily living (IADL) deficits predicted subsequent conversion to a cognitive diagnosis (CIND or dementia). However, neither baseline measures nor one-year change in basic ADLs (BADLs) and social support predicted cognitive conversion. In post hoc analyses, two IADL measures (managing finances, preparing meals) significantly increased the odds of cognitive conversion.

Greater IADL deficits predicted increased risk of cognitive conversion. Assessment of IADL deficits may provide clues about risk of later cognitive decline.

Religious and spiritual issues are clearly important to the older adult population and may play a positive role in maintaining health and recovering from illness. This study systematically reviewed the literature examining the effects of religion and spirituality on health outcomes such as cognitive functioning, coping strategies, and quality of life in people with dementia.

First, 51 articles with defined keywords were collected from online databases. Then, using inclusion and exclusion criteria, 11 articles were selected. These were classified according to methodological quality before being analyzed one by one.

The findings highlight the benefits of spirituality and religion on health outcomes. Three articles showed that in participants who used their spirituality or religion more, through their faith, their practices and in maintaining social interactions, their cognitive disorders tended to reduce or stabilize. In the other eight articles, use of spirituality or faith in daily life enabled people to develop coping strategies to help accept their disease, maintain their relationships, maintain hope, and find meaning in their lives, thereby improving their quality of life.

Spirituality and religion appear to slow cognitive decline, and help people use coping strategies to deal their disease and have a better quality of life. This literature review allows us to take stock of research over the last decade on spirituality/religion and health outcomes. The benefits observed should be considered with caution and included in rigorous experimental research in the future.

Folate and vitamin B12 insufficiencies have been associated with increased risk of depression. This systematic review aimed to clarify if, compared with placebo, treatment with folate and/or vitamin B12 reduces depression scale scores, increases remission, and prevents the onset of clinically significant symptoms of depression in people at risk.

This systematic review searched the PubMed, PsychInfo, Embase, and Cochrane databases from inception to 6 June 2014, using the following terms and strategy: (vitamin B12 or vitamin B9 or folate or folic acid or cobalamin or cyanocobalamin) and (depression or depressive disorder or depressive symptoms) and (randomized controlled trial or RCT). The electronic search was supplemented by manual search. Two independent reviewers assessed all papers retrieved for eligibility and bias, and extracted crude data. Review Manager 5 was used to manage and analyze the data.

Two hundred and sixty-nine manuscripts were identified, of which 52 were RCTs and 11 fulfilled criteria for review. We found that the short-term use of vitamins (days to a few weeks) does not contribute to improve depressive symptoms in adults with major depression treated with antidepressants (5 studies, standardized mean difference = −0.12, 95% confidence interval – 95% CI = −0.45, 0.22), but more prolonged consumption (several weeks to years) may decrease the risk of relapse (1 study, odds ratio (OR) = 0.33, 95% CI = 0.12, 0.94) and the onset of clinically significant symptoms in people at risk (2 studies, risk ratio = 0.65, 95% CI = 0.43, 0.98).

The number of available trials remains small and heterogeneity between studies high. The results of these meta-analyses suggest that treatment with folate and vitamin B12 does not decrease the severity of depressive symptoms over a short period of time, but may be helpful in the long-term management of special populations.

Physical health has been demonstrated to mediate the mental health and mortality risk association. The current study examines an alternative hypothesis that mental health mediates the effect of physical health on mortality risk.

Participants (N = 14,019; women = 91%), including eventual decedents (n = 3,752), were aged 70 years and older, and drawn from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project. Participants were observed on two to four occasions, over a 10-year period. Mediation analysis compared the converse mediation of physical and mental health on mortality risk.

For men, neither physical nor mental health was associated with mortality risk. For women, poor mental health reported only a small effect on mortality risk (Hazard Risk (HR) = 1.01; p < 0.001); more substantive was the risk of low physical health (HR = 1.04; p < 0.001). No mediation effects were observed.

Mental health effects on mortality were fully attenuated by physical health in men, and partially so in women. Neither mental nor physical health mediated the effect of each other on mortality risk for either gender. We conclude that physical health is a stronger predictor of mortality risk than mental health.

Older prisoners are the fastest growing group of prisoners in most countries. They have high rates of physical and psychiatric co-morbidity, compared to community dwelling older persons and also compared with other prisoner groups. Very high rates of mental illness have been found in remand (pre-trial) prisoners when compared with other prisoner groups; however to date there have been no studies examining older male and female remand prisoners.

A retrospective chart review was conducted of all remands, to a male and a female prison, over a six and half-year period. Demographic data were collected pertaining to psychiatric and medical diagnoses and seriousness of offending.

We found rising numbers of older prisoners amongst male remand prisoners. Older remand prisoners had very high rates of affective disorder and alcohol misuse. They had rates of psychotic illnesses and deliberate self-harm comparable to younger remand prisoners. High rates of vulnerability were found among older prisoners and older prisoners had a greater need for general medical and psychiatric services than younger prisoners. We also found comparable offending patterns with younger prisoners and high rates of sexual offending among the older male prisoner group.

Given the ageing population of many countries it is likely the numbers of older prisoners will continue to grow and given their high levels of both physical and psychiatric illness this will have implications for future service delivery.

Mental disorders in the elderly are common, with a 12-month prevalence in the community ranging from 8.54% to 26.4%. Unfortunately, many mental disorders are unrecognized, untreated, and associated with poor health outcomes. The aim of this paper is to describe the prevalence of mental disorders in the elderly primary care (PC) population and its associated factors by age groups.

Cross-sectional survey, conducted in 77 PC centers in Catalonia (Spain), 1,192 patients over 65 years old. The prevalence of mental disorders was assessed through face-to-face evaluations using the Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version (SCID-I-RV) and the Mini International Neuropsychiatric Interview (MINI); chronic physical conditions were noted using a checklist; and disability through the Sheehan Disability Scales (SDS).

Nearly 20% of participants had a mental disorder in the previous 12 months. Anxiety disorders were the most frequent, (10.9%) (95% CI = 8.2–14.4), followed by mood disorders (7.4%) (95% CI = 5.7–9.5). Being female, greater perceived stress and having mental health/emotional problems as the main reason for consultation were associated with the presence of any mental disorder. There were no differences in prevalence across age groups. Somatic comorbidity was not associated with the presence of mental disorders.

Mental disorders are highly prevalent among the elderly in PC in Spain. Efforts are needed to develop strategies to reduce this prevalence and improve the well-being of the elderly. Based on our results, we thought it might be useful to assess perceived stress regularly in PC, focusing on people who consult for emotional distress, or that have greater perceived stress.

The Clutter Image Rating (CIR) was created to meet a gap in the research on compulsive hoarding: how to ascertain clutter level in an individual's home without a home visit, as not all clinicians have the ability to conduct a home visit. The CIR has proven itself to be both reliable and valid for use in adults with compulsive hoarding symptoms. However, there is currently a dearth of information on performance of the CIR in older adults diagnosed with hoarding disorder (HD). Because older adults have increased medical issues, including fall risks, evaluating the level of clutter in the house is especially critical in geriatric populations.

The current study was an investigation of the reliability and validity of the CIR in assessing late life HD. The internal consistency, convergent and divergent validity, and norms of the CIR were investigated in a large geriatric HD sample and compared with a midlife sample of individuals with HD. Criterion validity of the CIR was investigated through the comparison of participant ratings conducted in the clinic and clinician ratings conducted in the home.

The current study found similar levels of reliability and validity in a late life sample as in previous studies conducted in mid-life adults.

Unlike previous studies, the current study did not find a significant relationship between the CIR and the non-clutter related subscales of the Savings Inventory-Revised. The CIR appears to be both reliable and valid for assessing clutter levels in older adults diagnosed with HD.

The Confusion Assessment Method (CAM) is the most widely used delirium screening instrument. The aim of this study was to evaluate the reliability and validity of the European Portuguese version of CAM.

The sample included elderly patients (≥65 years), admitted for at least 48 h, into two intermediate care units (ICMU) of Intensive Medicine and Surgical Services in a university hospital. Exclusion criteria were: score ≤11 on the Glasgow Coma Scale (GCS), blindness/deafness, inability to communicate and to speak Portuguese. For concurrent validity, a blinded assessment was conducted by a psychiatrist (DSM-IV-TR, as a reference standard) and by a trained researcher (CAM). This instrument was also compared with other cognitive measures to evaluate convergent validity. Inter-rater reliability was also assessed.

In this sample (n = 208), 25% (n = 53) of the patients had delirium, according to DSM-IV-TR. Using this reference standard, the CAM had a moderate sensitivity of 79% and an excellent specificity of 99%. The positive predictive value was 95%, indicating a strong ability to confirm delirium with a positive test result, and the negative predictive value was lower (93%). Good convergent validity was also found, in particular with Mini-Mental State Examination (MMSE) (rs = −0.676; p ≤0.01) and Digit Span Test (DST) forward (rs = −0.605; p ≤0.01), as well as a high inter-rater reliability (diagnostic k = 1.00; single items’ k between 0.65 and 1.00).

Robust results on concurrent and convergent validity and good reliability were achieved. This version was shown to be a valid and reliable instrument for delirium detection in elderly patients hospitalized in intermediate care units.

The aim of this study was to examine the efficiency of the mini-Kingston standardized cognitive assessment-revised (mini-KSCAr) in classifying patients according to DSM-5 major and mild neurocognitive disorders (NCD) due to possible Alzheimer's disease (AD).

Files of 85 individuals who were tested on the Kingston standardized cognitive assessment-revised were reviewed and scores were calculated for the mini-KSCAr. Medical history, psychiatric and physical status, basic and instrumental activities of daily living, as well as scores on the Cambridge cognitive examination-revised (CAMCOG-R), and the clinical dementia rating (CDR) scale were used to establish DSM-5 diagnoses of major or mild neurocognitive disorders (NCD) due to possible AD or no cognitive decline. All participants were tested on the Mini-Mental State Examination (MMSE) and the clock drawing test (CDT), and a subset (N = 28) were also tested on three well-known memory tasks.

Scores on the MMSE, CDT, and mini-KSCAr differed across groups, but only the mini-KSCAr significantly distinguished each group from the other two. The mini-KSCAr showed better sensitivity, specificity, and likelihood ratios (LRs) than did the MMSE and the CDT. A regression analysis revealed that the mini-KSCAr accounted for almost half of the variance in memory performance, whereas the MMSE and the CDT contributed nothing to this prediction once the mini-KSCAr was used.

The mini-KSCAr is an efficient instrument for the diagnosis of DSM-5 major and mild NCD due to possible AD in a specialized psychogeriatric setting, and its utility is greater than that of the MMSE and the CDT.

Delirious individuals are at increased risk for functional decline, institutionalization and death. Delirium is also associated with other geriatric syndromes, behavioral care issues, and new illnesses. The objectives of this study were to determine how often certain geriatric syndromes, care issues, and additional diagnoses occur in delirious individuals, and to see whether they correlate with worse functional recovery.

Consecutive delirious older medical in-patients (n = 343) were followed for the occurrence of geriatric syndromes (falls, pressure ulcers, poor oral intake, and aspiration), care issues (refusing treatments or care, need for sitters, security services, physical restraints, and new neuroleptic medications) and additional diagnoses occurring after the third day of admission. Poor functional recovery was defined by any one of death, permanent institutionalization or increased dependence for activities of daily living (ADLs) at discharge or three months after discharge from hospital, elicited through chart review or a follow-up telephone interview.

Poor functional recovery was seen in 237 (69%) delirious patients. Geriatric syndromes and additional illnesses were common and associated with poor functional recovery (falls in 21%, adjusted OR 2.27; possible aspiration in 26%, adjusted OR 3.06; poor oral intake in 49%, adjusted OR = 2.31; additional illnesses in 38%, adjusted OR 3.54). Care issues were also common (range 9%–54%) but not associated with poor recovery.

Geriatric syndromes, behavioral care issues and additional illnesses are common in delirium. Future studies should assess whether monitoring for and intervening against geriatric syndromes and additional illnesses may improve functional outcomes after delirium.

Falls in long-term care residents with dementia represent a costly but unresolved safety issue. The aim of the present study was to (1) determine the incidence of falls, fall-related injuries and fall circumstances, and (2) identify the relationship between patient characteristics and fall rate in long-term care residents with dementia.

Twenty long-term care residents with dementia (80 ± 11 years; 60% male) participated. Falls were recorded on a standardized form, concerning fall injuries, time and place of fall and if the fall was witnessed. Patient characteristics (66 variables) were extracted from medical records and classified into the domains: demographics, activities of daily living, mobility, cognition and behavior, vision and hearing, medical conditions and medication use. We used partial least squares (PLS) regression to determine the relationship between patient characteristics and fall rate.

A total of 115 falls (5.1 ± 6.7 falls/person/year) occurred over 19 months, with 85% of the residents experiencing a fall, 29% of falls had serious consequences and 28% was witnessed. A combination of impaired mobility, indicators of disinhibited behavior, diabetes, and use of analgesics, beta blockers and psycholeptics were associated with higher fall rates. In contrast, immobility, heart failure, and the inability to communicate were associated with lower fall rates.

Falls are frequent and mostly unwitnessed events in long-term care residents with dementia, highlighting the need for more effective and individualized fall prevention. Our analytical approach determined the relationship between a high fall rate and cognitive impairment, related to disinhibited behavior, in combination with mobility disability and fall-risk-increasing-drugs (FRIDs).

The evaluation of quality of life (QoL) among older adults has become increasingly important, and living arrangements play a pivotal role in determining the QoL of people with cognitive impairment (PWCI). Although informal care (home-based) is favored, transition to formal care (residential care) often becomes necessary, especially in the later stages of cognitive impairment. The primary objective was to compare the QoL of PWCI in the community and nursing homes. Additionally, factors differentiate the QoL of PWCI in these two settings were identified.

This is a quasi-experimental study design involving 219 older adults with cognitive impairment, aged 60–89 years old from both nursing home and home care. Participants completed the EUROPE Health Interview Survey-QoL (WHO-8), the Short Mini-Mental State Examination (SMMSE), the Barthel Index (BI), the Geriatric Depression Scale (GDS-15), and the Friendship Scale (FS).

There were significant differences in QoL, depression, social connectedness (p < 0.01) and cognitive functions (p = 0.01) between home care recipients and nursing home participants. No significant differences were observed with regards to health condition, co morbidities and physical functions between study cohorts.

Older adults with cognitive impairment living at home experienced higher QoL, had better cognitive function, were less depressed and reported higher social connectedness compared to those living in institutional care. Therefore, support should be provided in enabling home care and empowering caregivers to provide better care for PWCI.

Factors affecting quality of life (QOL) ratings for people with dementia (PWD) have been well studied, but few studies have examined the effect of residence on PWD- and caregiver-rated QOL for PWDs. We designed this study to determine the factors related to PWD- and caregiver-rated QOL in dementia as well as factors related to the discrepancy in these ratings.

For this cross-sectional study, we analyzed data from a convenience sample of 106 PWD-family caregiver dyads (58 community-dwelling dyads and 48 nursing-home dyads). PWDs’ data included socio-demographic variables, QOL (assessed by the Quality of Life-Alzheimer's Disease [QOL-AD] scale), cognition, dementia severity, depression, comorbidities, and quality of the dyadic relationship. Caregivers’ data included socio-demographic variables, depressive symptoms, and mutuality of the dyadic relationship.

QOL-AD scores were lower when rated by caregivers than by PWDs. The key factors positively related to both PWD- and caregiver-rated QOL for PWDs were fewer PWD depressive symptoms and higher quality of the PWD-caregiver relationship. The key factors related to the discrepancy in PWD- and caregiver-rated QOL in dementia were PWD residence in a nursing home and lower dementia severity, as well as higher caregiver depression, being an adult child caregiver, and lower caregiver-PWD mutuality.

Caregiver-rated QOL for PWDs and the discrepancy in rated QOL were significantly associated with PWD residence. If caregiver-rated QOL is needed, the effect of residence of PWD should be taken into consideration. Caregivers’ depressive status and mutuality with PWD must be also carefully assessed.

The relationship between sexuality and quality of life (QoL) of spouse-caregivers remains unclear. We designed this study to evaluate the relationship between sexual satisfaction and spouse-caregivers’ QoL, and to determine the influence of the clinical characteristics of people with dementia (PWD) on spouse-caregivers’ self-reported QoL.

Using a cross-sectional design, 54 PWD and their spouse-caregivers completed the QoL in Alzheimer's Disease scale (QoL-AD), questionnaire on sexual experience and satisfaction (QSES), Mini-Mental State Examination (MMSE), Clinical Dementia Rating scale (CDR), Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), Pfeffer functional activities questionnaire (FAQ), the Cornell scale for depression in dementia (CSDD) and Zarit burden interview (ZBI). Univariate and multivariate regression analyses were conducted to identify the factors that influenced the spouse-caregivers’ QoL ratings.

We did not find a significant difference in QoL between male and female spouse-caregivers (p = 0.71). We also found that 13% of males and 48.1% of females demonstrated moderate to severe sexual dissatisfaction. However, we did not find a significant correlation between spouse-caregivers’ QoL and sexual satisfaction (p = 0.41). The linear regression indicated that impaired awareness and lower QoL of PWD were significantly related to spouse-caregivers’ QoL (p = 0.000).

The spouse-caregivers’ QoL is influenced by awareness of disease and PWD QoL. Our study would be helpful for the development of adequate psycho-educational approaches to increase spouse-caregivers’ QoL, considering the specificities of the couples’ relationship.

There has been an increasing interest in the relationship between severity of disease and costs in the care of people with dementia. Much of the current evidence is based on cross-sectional data, suggesting the need to examine trends over time for this important and growing cohort of the population.

This paper estimates resource use and costs of care based on longitudinal data for 72 people with dementia in Ireland. Data were collected from the Enhancing Care in Alzheimer's Disease (ECAD) study at two time points: baseline and follow-up, two years later. Patients’ dependence on others was measured using the Dependence Scale (DS), while patient function was measured using the Disability Assessment for Dementia (DAD) scale. Univariate and multivariate analysis were used to explore the effects of a range of variables on formal and informal care costs.

Total costs of formal and informal care over six months rose from €9,266 (Standard Deviation (SD): 12,947) per patient at baseline to €21,266 (SD: 26,883) at follow-up, two years later. This constituted a statistically significant (p = 0.0014) increase in costs over time, driven primarily by an increase in estimated informal care costs. In the multivariate analysis, a one-point increase in the DS score, that is a one-unit increase in patient's dependence on others, was associated with a 19% increase in total costs (p = 0.0610).

Higher levels of dependence in people with Alzheimer's disease are significantly associated with increased costs of informal care as the disease progresses. Formal care services did not respond to increased dependence in people with dementia, leaving it to families to fill the caring gap, mainly through increased supervision with the progress of disease.

Sexual violence and wartime rapes are prevalent crimes in violent conflicts all over the world. Processes of reconciliation are growing challenges in post-conflict settings. Despite this, so far few studies have examined the psychological consequences and their mediating factors. Our study aimed at investigating the degree of longtime readiness to reconcile and its associations with post-traumatic distress within a sample of German women who experienced wartime rapes in 1945.

A total of 23 wartime rape survivors were compared to age- and gender-matched controls with WWII-related non-sexual traumatic experiences. Readiness to reconcile was assessed with the Readiness to Reconcile Inventory (RRI-13). The German version of the Post-traumatic Diagnostic Scale (PDS) was used to assess post-traumatic stress disorder (PTSD) symptomatology.

Readiness to reconcile in wartime rape survivors was higher in those women who reported less post-traumatic distress, whereas the subscale “openness to interaction” showed the strongest association with post-traumatic symptomatology. Moreover, wartime rape survivors reported fewer feelings of revenge than women who experienced other traumatization in WWII.

Our results are in line with previous research, indicating that readiness to reconcile impacts healing processes in the context of conflict-related traumatic experiences. Based on the long-lasting post-traumatic symptomatology we observed that our findings highlight the need for psychological treatment of wartime rape survivors worldwide, whereas future research should continue focusing on reconciliation within the therapeutic process.

Stroke is the most common neurological disease and the primary cause of lifelong disability in industrialized countries. Because of this it is important to investigate any kind of successful therapy.

From the 24 recruited stroke patients who were between 23 and 72 years old, 14 patients were separated either in a golf training group (EG), or a social communication meeting (CG). Both groups met for one hour sessions, twice a week, for ten weeks. All participants completed assessment tests before and after the experimental period: cognitive tests measuring attention (Go/No-Go task), visual-spatial memory (Block-Tapping test) and mental rotation performance (MRT); a balance test (Berg Balance Scale), and an emotional well-being test (CES-D-Scale).

The results show that both groups improved in the CES Scale, the block-tapping test and the balance test. In addition, stroke patients who received a golf training showed a significant improvement in the MRT comparing to the control group (CG).

It is indicated that golf training can improve visual imagery ability in stroke patients, even late after stroke.