Background: This study aims to evaluate the prevalence of depressive symptoms and associated factors among elderly hospital inpatients.

Methods: A cross-sectional study evaluated 189 participants using the Geriatric Depression Scale, the Mini-mental State Examination and the Katz and Lawton Index, to assess dependence regarding activities of daily living (ADL).

Results: Most of the participants were women, aged between 60 and 92 years, with low levels of educational attainment and personal income, and non-qualified occupations. The prevalence of depressive symptoms was 56%, but only 3% had a psychiatric diagnosis registered in their medical records. Univariate analysis showed significant associations between depressive symptoms and low educational level and income, marital status, number of hospitalizations in the previous year, cognitive decline, dependence regarding basic and instrumental ADL, and death. After logistic regression, the only variables that remained significantly associated with depression were low educational level, dependence regarding basic ADL, and death.

Conclusions: Depressive symptoms were independently associated with low educational level and dependence regarding basic ADL. Hospitalized elderly people with depressive symptoms were more likely to die. It is essential to diagnose and treat depression properly in this population to minimize its negative impacts.

Introduction: In this report, the results of a household survey were used to examine the prevalence of very mild and mild dementia in Chinese older persons in Hong Kong.

Methods: The study adopted a two-phase design. At Phase 1, 6100 subjects were screened using the Cantonese version of the Mini-mental State Examination (MMSE) and a short memory inventory. At Phase 2, 2073 subjects were screened positive and 737 were evaluated by psychiatrists. Clinical Dementia Rating (CDR) and cognitive assessment were used for diagnosis of dementia. Very mild dementia (VMD) was defined as a global CDR of 0.5, with memory and non-memory subscale scores of 0.5 or more. Mild dementia was classified for subjects with a CDR of 1.

Results: The overall prevalence of VMD and mild dementia for persons aged 70 years or above was 8.5% (95%CI: 7.4–9.6) and 8.9% (95%CI: 7.8–10.0) respectively. Among subjects with clinical dementia, 84.6% had mild (CDR1) dementia. Logistic regression analyses revealed that older age, lower educational level and significant cerebrovascular risk factors were risk factors for dementia, while regular physical exercise was a protective factor for dementia.

Conclusions: A sizable proportion of community-living subjects suffered from milder forms of dementia. They represent a high risk for early intervention to reduce potential physical and psychiatric morbidity.

Background: Despite the increase in the proportion of older people in the population, little is known about factors that facilitate the development of specialist mental health services for older people.

Methods: The relationship between the presence of specialist mental health programs for older people and elderly population size, proportion of older people in the population, gross national domestic product (GDP), and various parameters of health funding, mental health funding and mental health service provision was examined in an ecological study using data from the World Health Organization.

Results: The presence of specialist mental health programs for older people was significantly associated with higher GDP, higher expenditure on healthcare and mental healthcare, the presence of a national mental health policy and a national mental health program, the availability of mental health care in primary care and the community, and higher density of psychiatric beds, psychiatrists, psychiatric nurses, psychologists and social workers.

Conclusion: The challenge will be to persuade policy-makers in low and medium income countries, where the increase in the elderly population is most rapid, to develop specialist mental health services for older people.

Introduction: Studies in the West have concluded that the severity of depression is the strongest predictor of the course of suicidal ideations among the elderly. However, Asian culture tends to be more reserved and this may impact on the reporting of suicidal ideations. This study aims to determine the prevalence of suicidal ideation among depressed elderly people in Singapore and attempts to investigate the relationship between severity of depression and suicidality.

Method: Eighty consecutive depressed patients were recruited and severity of depressive symptoms rated with Beck's Depression Inventory (BDI). Suicidality was assessed using the Beck's Hopelessness Scale (BHS) and Beck's Suicide Intent Scale (BSS). Suicidal ideation was defined as any thought of wanting to kill oneself over the past seven days and not just a passive wish to die.

Results: 53.8% verbalized thoughts of wanting to kill themselves. Males were three times more likely to report suicidal thoughts. Severity of depression did not significantly influence the presence of suicidal thinking. The association of depression severity and suicidal ideations is not strongly supported.

Conclusions: Elderly males were more likely to report suicidal ideations when depressed. Elderly patients who reported suicidal ideations were likely to be more severely depressed. However, in a depressed elderly person, the absence of suicidal ideations would not infer that the episode of depression was less severe.

Background: The population size of the elderly from ethnic minority groups in many developing countries is rapidly increasing. The authors perceived a paucity of publications in the geriatric psychiatry literature pertaining to ethnic minority elders.

Methods: A study examining the proportion of research publications pertaining to ethnic minority elders in two leading geriatric psychiatry journals, International Psychogeriatrics and International Journal of Geriatric Psychiatry, was undertaken.

Results: The main findings were: (1) overall only 7.6% of the publications examined ethnic minority elders; (2) only 5.1% of publications were exclusively of ethnic minority elderly groups; and, (3) only 2.5% of publications included ethnic minority elderly groups in their overall sample.

Conclusions: Findings from studies, such as epidemiological studies of risk factors for mental disorders in old age and randomized controlled studies of treatment interventions, which exclude ethnic minority elders, cannot be assumed to apply to these groups. Researchers, research institutions, funding organizations and policy-makers should acknowledge the rising numbers of ethnic minority elders and recognize the importance of using ethnic minority-specific research data in the planning of culturally sensitive services and mental health promotion programs.

Background: Many older patients have difficulty in swallowing their tablets and capsules. Dose form modification, by crushing tablets or opening capsules, is often used by nurses to administer such medication.

Methods: Electronic searches of five literature databases on tablet crushing and capsule opening were carried out. A review of medication incident reports involving tablet crushing from the U.K. National Reporting and Learning System (NRLS) was also undertaken. An observational study of medication administration on two long-stay wards for older mentally ill inpatients was carried out in a large psychiatric hospital.

Results: Only 17 incidents involving tablet crushing were reported to NRLS in 13 months. In the observational study, the administration of 1257 oral doses of medication at 36 medication rounds was observed. Tablets were crushed or capsules opened for 25.5% (266/1045) of solid oral doses. For 44.0% (117/266) of these doses the tablet crushing had not been authorized by the prescriber. For 4.5% (12/266) of doses crushing was specifically contra-indicated by the manufacturer. In 57.5% (153/266) of doses, tablet crushing was avoidable by the correct use of more suitable preparations. Crushing caused contamination, spillage and hygiene problems.

Conclusions: Although tablet crushing and capsule opening are common practices, they are rarely reported as causing patient harm. Tablet crushing can often be avoided by the use of more suitable preparations. Crushing tablets and opening capsules are contra-indicated for some preparations. Older patients' medication may benefit from review by a pharmacist in order to optimize safe medication administration. Where tablet crushing is unavoidable, attention to cleanliness, contamination and spillage are necessary.

Background: Although sleep problems are commonly reported among dementia caregivers, the nature and frequency of caregiver sleep disruptions, and their relationship to health status, has received little empirical attention to date.

Methods: The current study investigated the sleep situations of a sample of 60 spousal caregivers currently residing with a Alzheimer disease care recipient, including the frequency of nocturnal disruptions by the care recipient, and the reasons for these disruptions. In addition, exploratory correlations were computed between caregiver sleep variables and health outcomes.

Results: Some 63% of spousal caregivers reported sleep disruptions due to the nocturnal behavior of the recipients of their care. Poorer caregiver sleep quality was associated with higher frequency of nocturnal disruptions by the care recipient, the care recipient needing to use the bathroom, and wandering, higher caregiver depressive symptoms, and higher levels of caregiver role burden. The frequency of nocturnal disruptions was associated with poorer mental health status and a greater number of depressive symptoms.

Conclusions: Results suggest that nocturnal disruptions by the care recipient may have adverse health consequences for spousal caregivers, and that further study of the determinants of caregiver sleep quality and health outcomes are warranted.

Background: Socioeconomic status may influence cross-national variations in elderly suicide rates.

Methods: The relationship between suicide rates in both sexes in the age-bands 65–74 years and 75+ years and (i) life expectancy, (ii) measures of socioeconomic status (per capita gross national domestic product (GDP) and the Gini coeffcient), and (iii) measures of the quality and quantity of available healthcare services (the proportion of GDP spent on health, per capita expenditure on health and child mortality rates) was examined using data from the World Health Organization and the United Nations.

Results: The main findings were: (i) a significant negative correlation between the Gini coefficient and suicide rates for both sexes in both age-bands; (ii) a significant positive correlation between per capita expenditure on health and suicide rates for both sexes in both age-bands; (iii) the significant positive correlation between the proportion of GDP spent on health and suicide rates was only evident in males in both age-bands; (iv) a significant negative correlation between child mortality rates and suicide rates for both sexes in both age-bands; and, (v) the significant positive correlation between life expectancy and suicide rates was evident in females in both age-bands.

Conclusions: A potentially testable model with five sequential stages was proposed to explain these findings.

Background: In elderly schizophrenia patients remission is difficult to determine due to long disease duration, exposure to differing treatments, long-standing side-effects, non-adherence, cognitive decline and physical comorbidity.

Method: Retrospective chart reviews were undertaken of 48 elderly (60+ years) schizophrenia patients admitted to a university-affiliated tertiary psychiatric center in 2006. These patients were experiencing an exacerbation of symptoms at admission. Remission criteria used were those of the American Psychiatric Association's “Remission in Schizophrenia Working Group”, and clinical status and improvement were quantified using the Clinical Global Impression scale (CGI).

Results: Of 25 patients treated with long-acting risperidone (LAR), 19 (76%) continued uninterrupted treatment for 6 months or longer. In six patients treatment was discontinued due to insufficient response. The clinical severity ratings with the CGI of all patients were in the range 5–7 prior to treatment. Following six months of LAR treatment, mean dose 36.0 mg/2 weeks (range: 25–50), 18 patients were rated as “improved” or “very much improved” on the CGI-global improvement item scale. In 15/25 patients (60%) symptomatic remission was achieved.

Conclusion: LAR may be effective in achieving remission among elderly schizophrenia patients. Tolerability was high and adherence rates improved. However, the results must be treated with caution owing to the inherent bias in this retrospective analysis.

Background: Gamma glutamyltransferase (GGT) plays a role in cellular glutathione uptake, which is an important element of antioxidant mechanisms. An increase in serum GGT is thought to be an early and sensitive marker of oxidative stress. Oxidative stress has a role in the pathogenesis of Alzheimer's disease (AD). The aim of this study was to investigate the GGT levels in AD.

Method: In this cross-sectional study, 132 patients with AD (mean age: 74.1 ± 7.4, female 62.9%) and 158 age- and gender-matched normal controls (mean age: 74.5 ± 6.3, female 67.1%) were evaluated. For cognitive assessment, MMSE and clock drawing tests were performed; DSM-IV and NINCDS-ADRDA criteria were used. Serum GGT, aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase concentrations were determined.

Results: Median (min-max) GGT levels were 18 (9–70) in AD group and 17 (5–32) in normal controls. Mann-Whitney U test showed that GGT levels were significantly higher in AD patients (p = 0.012). Linear regression analysis revealed AD was an independent correlate of elevated GGT levels. Hypertension, diabetes mellitus, total cholesterol, and low density lipoprotein cholesterol were not associated with GGT levels.

Conclusion: GGT levels were increased significantly in AD patients. To evaluate the role of GGT as a marker of oxidative stress in AD, further studies are needed.

Background: Nursing care for people with dementia diseases affecting the frontal lobes places special demands on staff, but there is little information available about how best to tailor nursing care. The aim of this study was to describe nurses' experience of difficulties and possibilities in caring for people with dementia diseases with frontal-lobe dysfunction.

Method: The study was carried out as a descriptive qualitative study. Data collected during interviews with nursing staff (n = 10) were analyzed using qualitative content analysis.

Results: The difficulties experienced were related to the patients' lack of inhibition and judgment, anxiety, agitation, reduced ability to deal with physical needs, egocentricity, imbalance between rest and activity and depressed mood. The possibilities were seen in relation to the nursing staff's professional encounters, characterized as being clear and consistent, a step ahead, flexible, calm and creating a positive atmosphere, close and trusting and being and doing things together. Continuous feedback and support were prerequisites for the engagement of the staff.

Conclusion: Nursing care in this context involves ethical issues whereby the residents' integrity must be balanced against a safe and secure environment. Nursing care is a sensitive but also demanding task, where nurses' actions can reduce the negative effects of the disease. It is therefore important to support staff in nursing care so they are able to manage their work and reduce the risk of emotional exhaustion.

Background: It has been anecdotally suggested that health care professionals have stigmatic beliefs about persons with Alzheimer's disease (AD). However, the nature and prevalence of those beliefs have yet to be elucidated. The aim of the present study is to examine stigma towards a person with AD among primary care physicians.

Methods: A nationally representative sample of 501 family physicians (54.1% female, mean age = 49, mean years in the profession = 21) were interviewed using a computer-assisted telephone interview and a structured questionnaire based on an expanded version of attribution theory.

Results: The findings showed that physicians' discriminatory behavior was especially high in the dimension of avoidance and coercion, but low in the dimension of segregation. Two central emotions (anger-fear and pity) were found to affect participants' tendency to discriminate, as were attributions of dangerousness.

Conclusions: Addressing these factors may require targeted education of health professionals as well as the enforcement of anti-discrimination policies.

Background: The treatment of depression in Australian aged psychiatry units has been found to be effective in terms of symptom improvement and readmission rates. There is little information, however, about how such hospitalization is viewed by the patients themselves. While users' views are increasingly seen as important for the evaluation of mental health services and for improving outcomes, the views of older patients are less likely to be sought. In this study, former patients were asked about their experience of admission, which aspects were helpful and which were not. Negative experiences have been described in an earlier paper. This paper focuses on what study participants considered to be the positive aspects of their time in hospital.

Methods: Fifty former patients from three Melbourne hospitals were interviewed in their own homes using a semi-structured, open-ended questionnaire.

Results: Forty-six percent expressed an overall favorable view of their hospital stay; 34% had some reservations; and 20% had a poor overall view. Favorable views did not necessarily preclude distressing incidents or complaints but were associated with the ward environment, experienced as a safe haven; the re-evaluation of negative experiences; and, in most but not all cases, recovery.

Conclusions: Retrospective accounts are useful for understanding the ways in which hospital experience is processed. Remembering the experience as positive is, in itself, a good therapeutic outcome. In addition, it may influence readiness to seek future treatment, help prevent relapse, and, indirectly, be helpful to others with similar problems.

Background: With the number of older drivers increasing, self-regulation of driving has been proposed as a viable means of balancing the autonomy of older adults against the sometimes competing demand of public safety. In this study, we investigate self-regulation of driving among a group of older adults with varying functional abilities.

Method: Participants in the study comprised 1,543 drivers aged 75 years or older. They completed an objective measure of visual attention from which crash risk was estimated, and self-report measures of driving avoidance, driving exposure, physical functioning, general health status, and vision. Crash records were obtained from the State Department of Public Safety.

Results: Overall, participants were most likely to avoid driving in bad weather followed by driving at night, driving on high traffic roads, driving in unfamiliar areas, and making left-hand turns across oncoming traffic. With the exception of driving at night, drivers at higher risk of crashes generally reported greater avoidance of these driving situations than lower risk drivers. However, across all driving situations a significant proportion of higher risk drivers did not restrict their driving. In general, self-regulation of driving did not result in reduced social engagement.

Conclusion: Some older drivers with visual attention impairments do not restrict their driving in difficult situations. There is a need for physicians and family members to discuss driving behaviors with older adults routinely to ensure their safety. The association between visual attention and driving restriction also has implications for interventions aimed at preserving mobility in the elderly.

Background: Research concerning negative attitudes toward the elderly among samples of North American respondents has uncovered two distinct yet comparable three-factor structures: (1) avoidance, antilocution and separation; and (2) discrimination, stereotypes and affective attitudes. In addition, previous research has demonstrated that men and younger people have more negative attitudes toward the elderly than do women and older people. The aim of this study is to examine the extent to which these findings can be generalized to individuals from a different culture.

Method: The Fraboni Scale of Ageism (FSA) was administered to 491 Israeli participants aged 20–50 years.

Results: Exploratory factor analysis with varimax rotation uncovered a three-factor structure, similar to previous investigations. In contrast to the literature, however, no simple group (gender, age) differences were found for ageism. However, discriminant function analysis revealed a more complex relationship between age, gender and ageism. Older males, in contrast to older females, demonstrated a tendency to perceptions of the elderly that associated avoidance of the elderly with negative stereotypes whereas older females, in contrast to younger females, held perceptions that associated avoidance of the elderly with a negative perception of the elderly person's contribution to society.

Conclusions: Despite cultural differences between Israel and North America, the similarity of findings provides support for the generalizabilty of the structure of attitudes toward the elderly as measured by the FSA to various cultures. In addition, the combined effect of age and gender on differential forms of ageism is complex and should be examined in future research.

Background: This study examines the psychometric properties of the Chinese version of the Activities of Daily Living Questionnaire (ADLQ-CV) in a sample of older Hong Kong Chinese adults with dementia.

Method: The ADLQ-CV was administered to primary family caregivers of 125 community-dwelling individuals with dementia. Assessments were then made of the scale's reliability, validity and factor structure.

Results: Factor analysis yielded six factors that closely resembled the six subscales proposed in the original scale. The ADLQ-CV demonstrated excellent convergent validity with the Chinese version of the Disability Assessment for Dementia (rp = −0.92, p < 0.001). The internal consistency of the ADLQ-CV was good (Cronbach's α = 0.81). Excellent test-retest reliability (ICC = 0.998) and inter-rater reliability (ICC = 0.997) of the ADLQ-CV were obtained. The ADLQ-CV showed a significant negative association with global mental states (rp = −0.80, p < 0.001), but it did not correlate with the age or educational level of individuals with dementia.

Conclusion: The findings suggest that the ADLQ-CV is a valid and reliable instrument for evaluating the functional abilities of Hong Kong Chinese people with dementia. The brevity and simplicity of administration make ita potentially useful tool for routine assessment of functional status of people with dementia in community or hospital outpatient settings.

Background: Increasing evidence suggests that functional impairment can be detected in older persons with mild cognitive impairment (MCI). This study explores the functional profiles and the clinical correlates of a population-based sample of Chinese older persons with MCI in Hong Kong.

Methods: A random sample of 765 Chinese elderly subjects without dementia was recruited, of which 389 were elderly normal controls (Clinical Dementia Rating = 0), and 376 had questionable dementia (CDR = 0.5). The latter were categorized into an MCI group (n = 291) and a very mild dementia (VMD) group (n = 85). Their functional performances were measured and compared with the normal controls (NC). Multiple regression analyses investigated the associations between functional scores (Disability Assessment in Dementia) and clinical correlates (cognitive test scores, neuropsychiatric symptoms and motor signs) in the NC subjects and cognitively impaired subjects.

Results: Subjects with MCI had intermediate functional performance between the NC and those with VMD. Regression analyses revealed that lower scores of cognitive tests (delayed recall and categorical verbal fluency tests), apathy, aberrant motor symptoms and parkinsonism features were associated with lower functional scores in clinically non-demented subjects. Functional scores had no correlation with age, education and medical illness burden.

Conclusion: Neuropsychiatric symptoms and parkinsonism features were associated with functional impairment in the clinically non-demented elderly in the community. Assessment of these should be incorporated in the evaluation of older persons for early cognitive impairment.

Background: The relationship between self-stigma and self-esteem in patients with schizophrenia is receiving increased attention. However, studies to date have been limited to samples of persons under the age of 65.

Aim: To examine the relationship between self-stigma and self-esteem in people with schizophrenia in both younger and older age groups.

Methods: Face-to-face interviews were completed with 86 inpatients with schizophrenia in a psychiatric hospital (mean age = 54, 55% female). Self-esteem was assessed using Rosenberg's Self Esteem Scale. Self-stigma was assessed using an adapted version of the Internalized Stigma of Mental Health (ISMI) scale. Information regarding socio-demographic characteristics and psychiatric history and symptomatology was collected.

Results: Self-stigma was moderate with only 20–33% of the participants reporting high levels of stigmatization. Older participants reported lower levels of self-stigma than younger participants. A relatively strong association between self-stigma and self-esteem was found.

Conclusions: The findings point to the complexity of the association between self-stigma, self-esteem and age in people with schizophrenia. This study stresses the importance of clinicians taking the issue of self-stigma into consideration when treating young and old patients with schizophrenia.

Background: Psychiatric symptoms and behavioral disturbances are highly prevalent in the residents of nursing homes. The Neuropsychiatric Inventory (NPI) is a commonly used scale for the assessment of such symptoms in diverse settings. We have conducted a study of the reliability and the validity of the Norwegian version of the NPI nursing home version (NPI-NH).

Methods: The reliability study comprised 41 patients. We established inter-rater reliability between raters with various levels of health education using κ statistics. Fifty patients were included in the validity study. The patients were examined by a physician, who also rated the patient's behavior using “behavioral pathology in Alzheimer's disease” (BEHAVE-AD). Subsequently, a research nurse performed a standardized interview using the NPI and the Cornell scale. Concurrent validity of the NPI and the BEHAVE-AD was analyzed.

Results: Internal consistency, as measured by Cronbach's α was above 0.8. Inter-rater reliability was, except for one item, between 0.85 and 1.0 across assessors with different levels of health education. All correlations between the NPI and the BEHAVE-AD were significant, ranging from 0.38 to 0.72. The weakest correlations were between items assessing affective and anxiety symptoms.

Conclusion: The Norwegian version of the NPI-NH is a reliable and valid instrument for assessing psychiatric symptoms and behavioral disturbances in the residents of nursing homes. The investigation of depressive symptoms merits particular attention.

Background: Paratonia is one of the associated movement disorders characteristic of dementia. The aim of this study was to develop an assessment tool (the Paratonia Assessment Instrument, PAI), based on the new consensus definition of paratonia. An additional aim was to investigate the reliability and validity of the PAI.

Methods: A three-phase cross-sectional survey was conducted. In the first two phases, the PAI was developed and validated. In the third phase, the inter-observer reliability and feasibility of the instrument was tested.

Results: The original PAI consisted of five criteria that all needed to be met in order to make the diagnosis. On the basis of a qualitative analysis, one criterion was reformulated and another was removed. Following this, inter-observer reliability between the two assessors resulted in an improvement of Cohen's κ from 0.532 in the initial phase to 0.677 in the second phase. This improvement was substantiated in the third phase by two independent assessors with Cohen's κ ranging from 0.625 to 1.

Conclusion: The PAI is a reliable and valid assessment tool for diagnosing paratonia in elderly people with dementia that can be applied easily in daily practice.