Background: The aim of this study was to determine levels, rates and progression of apathy in healthy older persons and to investigate factors associated with its progression.

Methods: Seventy-six healthy elderly subjects, aged 58–85 years (mean 69.9), who were recruited by general advertisement and through local community groups, participated as a control group for a longitudinal study of stroke patients. Data were collected on demographic, psychological, neuropsychological and neuroimaging (MRI) variables and apathy was rated by informants on the Apathy Evaluation Scale (AES).

Results: Apathy scores and rates increased over 5 years, especially in men. Change of apathy was associated with informant ratings of cognitive decline in the years prior to baseline assessment but not to subsequent neuropsychological, neuroimaging or functional changes.

Conclusions: Apathy increases with age in otherwise healthy community-dwelling individuals, particularly in men.

Background: Older adults with mental health disorders underutilize mental health services more than other adults. While there are well known general barriers to help seeking across the population, specific barriers for older adults include difficulties with transportation, beliefs that it is normal to be anxious and depressed in old age, and beliefs by referrers that psychological therapy is less likely to be effective. This study examined barriers related to identifying the need for help, seeking help and participating in therapy in a clinical population of older adults.

Method: Sixty older adults (aged 60–79 years) with comorbid anxiety and unipolar mood disorders completed barriers to treatment questionnaires before and after psychological group treatment, as well as measures of cognitive ability, anxiety, depression, and quality of life at baseline.

Results: The greatest barriers to help seeking related to difficulties identifying the need for help, with 50% of the sample reporting their belief that their symptoms were normal as a major barrier. Other major barriers identified were related to: self-reliance, cost of treatment, and fear of medication replicating previous findings. The main barriers reported for difficulties in continuing therapy included not finding therapy helpful, cost of treatment, and thinking that the therapist did not understand their issues.

Conclusions: The main barriers identified related to issues with identifying the need to seek help. More attention is needed to educate older adults and professionals about the need for, and effectiveness of, psychological therapies for older adults with anxiety and depression to reduce this barrier to help seeking.

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: This paper provides a systematic review of selected experimental studies of the effectiveness of psychosocial treatments in reducing psychological symptoms in dementia (e.g. anxiety, depression, irritability and social withdrawal).

Method: English language reports published or in press by February 2008 were identified by means of database searches and checks of previous reviews. Reports were appraised with respect to study design, participants' characteristics and reporting details. Because people with dementia often respond positively to personal contact, studies were included only if control conditions entailed similar levels of social attention or if one treatment was compared with another.

Results: Only 12 of 48 relevant papers met every specification. Treatments proved more effective in reducing psychological symptoms than an attention control condition or another treatment in only six of the 12 selected studies. Interventions with moderate effect sizes included music and recreation therapy.

Conclusions: Some psychosocial interventions appear to have specific therapeutic properties, over and above those due to the benefits of participating in a clinical trial. Their effects were generally modest with an unknown duration of action. This limited efficacy suggests that treatments will work best in specific, time-limited situations, tailored to individuals' requirements. There is no preferred method to rate psychological symptoms.

While all delirious patients have clouding of consciousness (alteration of attention) and cognitive dysfunction, the level of alertness of different patients may range from stuporous to hyperalert. We, therefore, developed an analog scale to rate the alertness of delirious patients, and a separate scale to rate the severity of their clouding of consciousness. Based on these scales, patients were categorized overall as relatively “activated” (relatively alert despite clouding of consciousness), or “somnolent” (relatively stuporous along with clouding of consciousness). Cognitive function was estimated using the Mini-Mental Status Exam. Separate ratings were made of hallucinations, delusions, illusions, and agitated behavior. Activated and somnolent patients had similar ages, overall severity of delirium, and Mini-Mental Status Exam scores. Activated patients, however, were more likely to have hallucinations, delusions, and illusions than somnolent patients, and were more likely to have agitated behavior. Patients with hepatic encephalopathy were more likely to have somnolent delirium, while patients with alcohol withdrawal appeared more likely to have activated delirium. These data indicate that phenomenologic subtypes of delirium can be defined on the basis of level of alertness. These subtypes are validated in part by their differing associations with symptoms unrelated to alertness. These subtypes may have different pathophysiology, and thus, potentially different treatments.

Background: There is a paucity of past research concerning longitudinal changes in loneliness in old age and in the factors that correlate with loneliness in older persons. This study examines (a) whether loneliness increases with age, (b) characteristics of the lonely older population, and (c) predictors of becoming lonely in old age.

Methods: Data are from the Cross-Sectional and Longitudinal Aging Study, a national longitudinal study on the health, mental, and social status of people aged 75 and older living in Israel. Loneliness was measured as the frequency at which participants had felt lonely during the last month (range: 0–3). The analysis included two waves of data, with an average gap of 3.5 years between them, with 1147 participants at wave 1 and 588 participants at wave 2.

Results: Data showed an increase in the mean level of loneliness over time, rising from 0.62 to 0.80, p<0.001. The strongest correlate of being lonely at wave 1 was unmarried status. Different variables predicted loneliness in the married and the unmarried. Among the married, lonelier persons tended to have experienced more traumatic events, had more doctor's visits, and manifested less cognitive vitality. In contrast, among the unmarried, loneliness was higher in those with financial difficulties, poor health, and less social network support. The longitudinal transition to becoming lonely was more likely in women, those with insufficient financial resources, and people with poorer health.

Conclusions: Results highlight the following implications for the development of preventive programs: (a) helping older persons maintain and develop social networks for preventing increased loneliness, (b) taking demographic factors, health factors, and previous trauma into account when designing interventions, and (c) targeting unmarried women for interventions.

Depression is the most prevalent mental health problem among the elderly, including Chinese-American elderly. A Chinese-language version of the popular Geriatric Depression Scale Long Form (GDS-LF) and Short Form (GDS-SF) was developed. Based on the responses of 50 elderly Chinese immigrants to the U.S. (25 women and 25 men), the GDS-LF evidenced high internal consistency but the GDS-SF did not. Factor analysis was then used to develop a new version of the GDS-SF, which was internally consistent. The revised GDS-SF is an important and easy-to-administer tool for community screening of depression among elderly Chinese immigrants.

Depression in the geriatric population is a frequents, serious, and potentially reversible disorder, yet relatively few blinded, controlled, antidepressant trial have been reported. A number of age-related issues complicate safe and effective pharmacotherapy. In a 6-week, double-blind trial in moderately to severely depressed (nonpsychotic) outpatients over age 60, fluoxetine (N = 335) was statistically significantly more efficacious than placebo (N = 336) in overall response (43.9% vs. 31.6%, p = .002) and remission (31.6% vs. 18.6%, p < .001) rates. Analyses of early discontinuations because of an adverse drug event revealed no statistically significantly greater rate with fluoxetine (n = 39; 11.6%) than was seen with placebo (n = 29; 8.6%). These results corroborate that major depression in an older population is responsive to antidepressant pharmacotherapy. Specifically, fluoxetine, at a conventional 20-mg dose, was both safe and effective relative to placebo in this special population.

Objective: Falls are an everyday risk for the elderly and their etiology is multifactorial. Because there are little data focusing on falls among elderly psychiatric inpatients, we aimed to retrospectively assess the characteristics of inpatients that had sustained a fall during hospitalization. Methods: Over 4 years, all adverse-event reports of falls were reviewed. Inclusion criteria were age > 65 years and intact cognition. The control group consisted of the previous and next admission of an elderly patient to the same ward. Anti-cholinergic score was calculated for each patient. Results: Of 414 admissions of elderly patients, 34 (8.2%) patients had had a fall. The control group (n = 68) did not differ in mean age, distribution of diagnoses, or use of benzodiazepines, antidepressants, or antipsychotics. Two variables were significantly associated with falls: female gender (68% vs. 39%, p < .05) and anticholinergic burden score (ABS) (mean: 3.7 vs. 2.1, p < .05). Conclusions: Our results support reported findings of higher rates of falls among elderly women and suggest that ABS may be a risk factor for falls.

This article presents the epidemiology of suicide with a special focus on suicides among the elderly, and discusses the known risk factors for suicide within a framework designed to encourage a systematic approach to theory testing and prevention. Throughout the world, suicide rates are highest among the elderly. The risk factors for suicide can be classified as distal or proximal, and, within these broad categories, as sociodemographic, psychiatric, biological, familial, and situational. Mental and addictive disorders are the major risk factors for suicide in all age groups. Other risk factors include male gender, disrupted marital status, prior suicide attempt, reduced brain stem serotonergic activity, family history of psychiatric disorder or suicide, a firearm in the home, and a recent, severely stressful life event. Since risk factors for suicide rarely occur in isolation, prevention efforts are more likely to succeed if multiple risk factors are targeted.

Background: This study aims to develop and validate a Chinese translation of the 6-item De Jong Gierveld Loneliness Scale – a widely used instrument to measure loneliness – specifically determining its psychometric properties in community-dwelling Chinese elders in Hong Kong. The relationships between loneliness and several clinical variables are also assessed.

Method: The English version was translated into Chinese. Content validity was established by group discussion and Delphi panel. The questionnaire was administered to 103 Hong Kong Chinese community-dwelling elders. Statistical analysis was performed to test the reliability and validity of the scale.

Results: The content validity was high as shown by the results of the Delphi panel. Cronbach's α of the 6-item scale was 0.76. For the inter-rater reliability of the six items, the intra-class correlation coefficients ranged from 0.98 to 1.00. The emotional loneliness subscale significantly correlated with the social loneliness subscale (ρ = 0.37; p < 0.001). In using a direct question to measure loneliness, 21 participants (20%) reported that they were lonely. The overall loneliness scale score significantly correlated with the answers on the direct question of loneliness (rpb = 0.71; p < 0.001). The overall loneliness score showed significant correlation with Cornell Scale for Depression in Dementia (ρ = 0.29; p = 0.003), current smoking status (rpb = 0.24; p = 0.014), and some objective social characteristics.

Conclusion: The Chinese version of the 6-item De Jong Gierveld Loneliness Scale is a reliable and valid measure of loneliness in Chinese elders.

Considerable burden is reported by informal caregivers of older individuals with cognitive impairment. Significant progress in the understanding of determinants of this burden has been achieved. However, further progress could be attained if we considered important methodological issues that may have limited our understanding of caregiver burden. These issues include subgroups of care recipients and caregivers, measurement issues, research design, and statistical techniques. Fifty-three studies published between 1980 and 1997 (inclusive) that focused on caregiver burden were abstracted to determine the extent to which the methodological issues discussed above were considered. Overall, we found considerable variability among the studies surveyed. Further understanding of the caregiving process and reductions in caregiver burden will depend on the attention to methodological issues and understanding of burden across the whole caregiving career.

The purpose of this study was to investigate the prevalence and comorbidity of current mental disorders defined by DSM-III-R among elderly suicide victims and to compare them with the mental disorders among younger victims. Using a psychological autopsy method, we collected comprehensive data on all suicides in Finland during 1 year. Retrospective Axis I-III consensus diagnoses were assigned to a random sample consisting of 43 victims aged 60 years or over and 186 victims aged under 60 from the nationwide suicide population. At least one Axis I diagnosis was made for 91% of the elderly victims. Major depression as the principal diagnosis was more common among the elderly victims. Almost all elderly female victims were major depressives. Psychiatric comorbidity was more common among elderly male than among elderly female victims. More of the elderly victims (88%) than the younger (36%) received Axis III diagnoses. Suicide among the elderly without a diagnosable mental disorder and somatopsychiatric comorbidity seems to be rare.

Background: Consensus recommends early recognition of memory problems through multi-disciplinary assessment in memory clinics; however, little is known about the experiences of people accessing such services. The aim of this review was to synthesis empirical evidence on patient and carer experiences in the transition to dementia.

Methods: This review updates an earlier review (Bamford et al., 2004) on the topic of disclosure of the diagnosis of dementia. Key electronic databases were searched including OVID Medline, CINAHL, Web of Science, EMBASE, and Sociological Abstracts; this was supplemented by hand searching of reference lists and contact with experts in the field. Only papers published after 2003 were included.

Results: Of the 35 papers included in the review, only one study observed the process of disclosure and only two papers explored the effects on the person with dementia's health. The vast majority of people with dementia wished to know their diagnosis. The key challenges for the person with dementia were coming to terms with losses on multiple levels. Although there may be short-term distress, the majority of people with dementia do not appear to experience long-term negative effects on their psychological health. For family carers, becoming the main decision-maker and adjusting to increased responsibility were common concerns.

Conclusions: There is still little empirical research observing the process of diagnostic disclosure in dementia. Studies exploring the views of patients and their families suggest this should be an ongoing process with the provision of support and information tailored to individual needs. The term “Alzheimer's disease” appears to have more negative connotations than the word “dementia”.

Recent research on the prevalence of age-associated memory impairment (AAMI) has reflected considerable variability, with estimates ranging from 35% to 98%. This variability is attributed to (a) failure to employ the complete diagnostic criteria for AAMI and (b) failure to consider age as a variable in estimating prevalence. Analysis of published normative data on both standard clinical memory tests and computer-simulated everyday memory tests shows a clear increase in the percentage of persons meeting the AAMI memory performance criterion as a function of age. These data are offered as an upper-bound estimate of the prevalence of AAMI, by age decade.

Patients with dementia with lewy bodies (DLB) have progressive deficits in cognition, parkinsonism, and neuropsychiatric symptoms. Cholinesterase inhibitors have been used to ameliorate cognitive decline and neuropsychiatric symptoms in short-term trials. In this study, patients with DLB were treated with rivastigmine up to 96 weeks. Improvement from baseline was seen in cognitive function as measured by the Mini-Mental State Examination (MMSE), and neuropsychiatric symptoms as measured by the Neuropsychiatric Inventory (NPI) over the first 24 weeks of treatment. By 96 weeks, neither the MMSE scores nor the NPI scores were significantly worse than at baseline.

Background: The needs of younger people with dementia have become increasingly recognized in service development. However, little is known about the impact of a diagnosis of young onset dementia on people aged under 65 years and their families. This paper reviews the literature on the experiences of younger people with dementia and their families in the U.K., and outcomes for carers.

Methods: Twenty-six studies, encompassing a variety of themes concerning this population, were reviewed following a systematic literature search.

Results: Results are divided into the impact on the individual and the impact on the family, specifically carer outcomes and the impact on children.

Conclusions: The studies reviewed reveal a number of negative outcomes for the individual and carers, and highlight the need for further research.

Background: The aim of this study was to determine the prevalence of dementia in a socioeconomically disadvantaged population of older adults living in the city of São Paulo, Brazil.

Methods: A cross-sectional one-phase population-based study was carried out among all residents aged ≥ 65 in defined census sectors of an economically disadvantaged area of São Paulo. Identification of cases of dementia followed the protocol developed by the 10/66 Dementia Research Group.

Results: Of 2072 individuals in the study, 105 met the criteria for a diagnosis of dementia, yielding a prevalence of 5.1%. Prevalence increased with age for both men and women after age 75 years, but was stable from 65 to 74 years. Low education and income were associated with increased risk of dementia.

Conclusions: The prevalence of dementia among older adults from low socioeconomic backgrounds is high. This may be partly due to adverse socioeconomic conditions and consequent failure to compress morbidity into the latter stages of life. The increasing survival of poorer older adults with dementia living in developing countries may lead to a rapid increase in the prevalence of dementia worldwide.