Systematic evaluations of knowledge translation interventions in nursing homes to improve practice are scarce. There is also a lack of studies focusing on creating sustainable evidence-based practice in the setting of residential dementia care.

The aim of this paper is to describe a model for implementing national evidence-based guidelines for care of persons with dementia in nursing homes. The secondary aim is to outline the nursing home staff experiences during the first year of the implementation process. The intervention had a participatory action research approach. This included educational activities such as: (i) thematic seminars introducing national guidelines for dementia care, (ii) regular unit-based seminars; and (iii) later dissemination of information in reflective seminars and several days of poster-exhibitions. Areas of practice development were selected on each of the 24 units, based on unit-specific needs, and a quality improvement strategy was applied and evaluated. Each unit met ten times during a period of eight months. Data for this study were extracted from the reflective seminars and poster presentations, analyzed using a qualitative content analysis.

Findings showed that implementation of guidelines were perceived by staff as beneficial for both staff and the residents. However, barriers to identification of relevant sources of evidence and barriers to sustainable implementation were experienced.

One of our assumptions was that dementia nursing homes can benefit from becoming knowledge driven, with care practices founded in evidence-based sources. Our findings show that to be partly true, even though most staff units found their efforts to pursue and utilize knowledge adversely impacted by time-logistics and practical workload challenges.

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.

Behavioral and psychological symptoms of dementia (BPSD) are virtually ubiquitous in dementia. Excessive recourse to use of psychotropics which have high risk to benefit ratio remains a global problem. We aimed to identify components of quality prescribing in BPSD to develop a tool for quality prescribing and to test this tool.

We used Delphi methodology to identify elements of quality prescribing in BPSD. The tool was tested by a range of medical and nursing professionals on 48 patients, in inpatient and ambulatory settings in Northern Sydney Local Health District, Australia.

Consensual opinion using Delphi method was that quality prescribing in dementia comprised ten factors including failure to use first line non-pharmacological strategies, indication, choice of drug, consent, dosage, mode of administration, titration, polypharmacy, toxicity, and review. These elements formed the quality use of medications in dementia (QUM-D) tool, lower scores of which reflected quality prescribing, with a possible range of scores from 0 to 30. When inter-rater reliability was tested on a subgroup of raters, QUM-D showed high inter-rater reliability. A significant reduction in QUM-D scores was demonstrated from baseline to follow-up, mean difference being 5.3 (SD = 3.8; 95% confidence interval 4.1–6.4; t = 9.5; df = 47; p < 0.001). There was also a significant reduction in score from baseline to follow-up when rated by clinical nurse consultants from a specialized behavior assessment management service (BAMS) (N = 12).

The QUM-D is a tool which may help to improve quality prescribing practices in the context of BPSD. In this setting, we consider quality prescribing, and accordingly the obligations of prescribers, to be an inclusive concept rather than just adding to the mantra of “not prescribing.”

Early individualized interventions for informal dementia caregivers can prevent overburdening in the later stages. However, the needs of early-stage dementia caregivers (EDC) remain largely unknown. This study aimed to explore the needs and wishes and need for care of EDC to maximize the benefit of potential programs for EDC and tailor interventions accordingly.

Four focus group interviews with 28 informal caregivers of people with dementia (PwD) were analyzed using inductive content analysis. Both EDC and caregivers in the later stages were included to compare perceived EDC needs from different points in the caregiver career.

Four themes were identified: the early-stage needs paradox, barriers in acceptance, facilitators in acceptance, and a transition from loss to adaptation. The retrospective view provided by later-stage caregivers differed from the view of EDC; EDC struggled with acknowledging needs due to fear of stigma and low acceptance. EDC stressed the importance of acceptance as a prerequisite for adequate adaptation, but were hindered by lack of knowledge, difficulty acknowledging changes, and focus on loss. In contrast, better understanding of the disease, increasing personal time, structuring ones day, and using appropriate humor can reduce negative communication, increase positive encounters and caregiver-confidence, contributing to positive interaction with the care recipient and an increase in well-being.

Early therapeutic interventions could help caregivers identify their needs, increase knowledge about changes in roles and relationship reciprocity, and focus on enhancement of the positive, intact experiences to prevent caregiver burden.

Older patients may be more vulnerable to the deleterious effect of depressive episodes on delayed narrative memory, a cognitive task which reflects hippocampal activity. We aimed to disentangle which factors could explain such increased vulnerability in the elderly, including the poorer response to treatment, a longer lifetime exposure to past depressive episodes, and lower baseline memory skills.

From an initial sample of 8,229 depressed outpatients, we focused on the 2,424 treatment responders, and compared older (65 years old and over, N = 233) to younger (N = 2,191) ones. These patients were included through general practitioners’ assessment and tested for the Wechsler delayed paragraph recall index, a valid and sensitive test assessing verbal declarative memory (and a marker of the hippocampal function), at baseline and after six weeks of treatment.

As expected, older patients after response to antidepressants showed decreased narrative memory abilities compared to younger ones. As baseline memory performance and residual depressive symptoms were also found in excess in this sample, they could act as confounders. Indeed, after controlling for these two factors, the role of age in memory performance after treatment response was ruled out.

The potential “toxicity” of a depressive episode to cognitive functions related to the hippocampus may not be more critical in older patients compared to younger ones. Limiting remaining depressive symptoms in older depressed patients might be a way to counteract the observed worsening of memory functions in depressed patients.

Many definitions of successful aging (SA) exist in the absence of an established consensus definition. There are few examples of a priori application of SA models in real world contexts using external validation procedures. The current study aims to establish the predictive validity of an a priori, continuous model of SA with respect to service utilization.

Individuals (n = 740; 64.2% female) aged 65 years and over (mean 75.9; SD 6.2), randomly selected from general practitioner registries in five sites across the United Kingdom included in the second and third combined screen and assessment waves of the Medical Research Council Cognitive Function and Aging Study (MRC CFAS; a longitudinal population-based cohort study) comprised the baseline and two-year follow-up in the current study. A Successful Aging Index (SAI) was created using items identified by systematic reviews of operational definitions and lay perspectives of SA, capturing physiological and psychosocial components. Demographic data and SAI components were collected at baseline. Outcome measures, i.e. health service use, informal care use, and functional service, were captured at two years follow-up.

Logistic regression revealed significant relationships between the SAI and six of eight service use outcomes in models adjusted for age, sex, education, and socio-economic status. Analysis of the area under the receiver operating characteristic (ROC) curve demonstrated sufficient predictive capabilities for all models, (range 0.65–0.86).

The SAI demonstrated a strong association, and predictive accuracy, with respect to service use, providing preliminary support for the practical utility and usefulness of this measure.

The use of antidepressants is associated with decreased suicide risk in late life, and these drugs are often prescribed after a suicide attempt. Yet little is known about attitudes to antidepressants in older persons with suicidal behavior. The aim of this study was to assess beliefs about antidepressant medicines in older persons in treatment one year after a suicide attempt.

Forty-four individuals aged 70 years and older, who were treated in emergency wards at five hospitals in western Sweden in connection with a suicide attempt, were interviewed at index attempt and one year later. Beliefs about medicines questionnaire (BMQ) specific for antidepressants were analyzed one year after index attempt, in relation to sociodemographic variables, medication use, psychiatric evaluation, and personality traits.

The majority of participants perceived the necessity of their antidepressant medicine to outweigh their concerns. Lower perceived necessity of antidepressants was observed in those who were not on antidepressants at the time of the attempt as well as those with no prior history of suicide attempt before the index attempt. Individuals reporting hopelessness at follow-up had a higher perceived concern about using medication.

Beliefs about antidepressants tended to be more positive than negative in older persons taking these drugs in the aftermath of a suicide attempt. Further studies are called for, and should include objective measures of medication adherence.

The Geriatric Anxiety Inventory (GAI) is a recently developed scale aiming to evaluate symptoms of anxiety in later life. This 20-item scale uses dichotomous answers highlighting non-somatic anxiety complaints of elderly people. The present study aimed to evaluate the psychometric properties of the Brazilian Portuguese version GAI (GAI-BR) in a sample from community and outpatient psychogeriatric clinic.

A mixed convenience sample of 72 subjects was recruited for answering the research protocol. The interview procedures were structured with questionnaires about sociodemographic data, clinical health status, anxiety, and depression previously validated instruments, Mini-Mental State Examination, Mini International Neuropsychiatric Interview, and GAI-BR. Twenty-two percent of the sample were interviewed twice for test–retest reliability. For internal consistency analyses, the Cronbach's α test was applied. The Spearman correlation test was applied to evaluate the test–retest GAI-BR reliability. A ROC (receiver operating characteristic) curve study was made to estimate the GAI-BR area under curve, cut-off points, sensitivity, and specificity for the Generalized Anxiety Disorder diagnosis.

The GAI-BR version showed high internal consistency (Cronbach's α = 0.91) and strong and significant test–retest reliability (ρ = 0.85, p < 0.001). It also showed moderate and significant correlation with the Beck Anxiety Inventory (ρ = 0.68, p < 0.001) and the State-Trait Anxiety Inventory (ρ = 0.61, p < 0.001) showing evidence of concurrent validation. The cut-off point of 13 estimated by ROC curve analyses showed sensitivity of 83.3% and specificity of 84.6% to detect Generalized Anxiety Disorder (DSM-IV).

GAI-BR has demonstrated very good psychometric properties and can be a reliable instrument to measure anxiety in Brazilian elderly people.

Becoming widowed is a significant event. There is considerable evidence that surviving partners report substantial changes in their wellbeing and mental health. Changes can occur prior to partner's death as an anticipatory effect and consequently during the period after partner's death. For most, declines in wellbeing and mental health dissipate over time. However, there is a limited long-term evidence to compare age-normative trajectories in mental health and wellbeing with the trajectories of those who transition into widowhood.

Participants (n = 652) were older adults (aged 65–94 years at baseline) from the 16-year Melbourne Longitudinal Studies on Healthy Ageing project who were either married or de facto (n = 577), or recently widowed (n = 75). Generalized Estimating Equations (GEE) examined the immediate and long-term impact of widowhood. GEE piecewise regression analyses examined the trajectories of wellbeing and mental health in those who transitioned into widowed with time centered at time of partner's death. Analyses were stratified by gender.

For both men and women, becoming widowed was strongly related to a strong decline in positive affect post partner's death. Otherwise, no long-term impact of widowhood on negative affect or depressive symptomology was reported.

The impact of widowhood reports differential impacts on different indicators of wellbeing and mental health, which were inconsistent between men and women.

In older persons, a relationship between both higher and lower blood pressure and depression has inconsistently been reported. Blood pressure may be differentially associated with distinct symptom domains of depression. We examined the cross-sectional relation of current systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) with different depressive symptom domains among depressed older persons.

In the Netherlands Study of Depression in Older Persons (NESDO), 270 participants aged 60 years and above were diagnosed with depression in the past month. Using the three corresponding subscales of the Inventory of Depressive Symptoms-Self Report (IDS-SR), motivational, mood and somatic symptom domains were assessed. Additionally, symptoms of apathy were determined with the Apathy Scale. Multiple linear regression was used to examine the cross-sectional relationship between current SBP, DBP and MAP with both IDS-SR subscale and Apathy Scale scores. Unstandardized betas were calculated per 10 mmHg increase in blood pressure measures.

Mean age of participants was 70.4 years (standard deviation 7.3). Higher SBP (Beta 0.33, t (254) = 2.01, p = 0.045), higher DBP (Beta 0.68, t (254) = 2.15, p = 0.03) and higher MAP (Beta 0.63, t (254) = 2.33, p = 0.02) were associated with higher Apathy Scale scores in the fully adjusted model. Furthermore, a higher SBP was associated with higher IDS-SR mood subscale scores (Beta 0.25, t (254) = 2.13, p = 0.03).

Depressed older people with higher blood pressure measures had particularly more symptoms of apathy. To disentangle the relationship of blood pressure with late-life depression, it is important to pay attention to the role of apathy symptoms.

Studies have shown the clock-drawing test (CDT) to be a useful screening test that differentiates between normal, elderly populations, and those diagnosed with dementia. However, the results of studies which have looked at the utility of the CDT to help differentiate Alzheimer's disease (AD) from other dementias have been conflicting. The purpose of this study was to explore the utility of the CDT in discriminating between patients with AD and other types of dementia.

A review was conducted using MEDLINE, PsycINFO, and Embase. Search terms included clock drawing or CLOX and dementia or Parkinson's Disease or AD or dementia with Lewy bodies (DLB) or vascular dementia (VaD).

Twenty studies were included. In most of the studies, no significant differences were found in quantitative CDT scores between AD and VaD, DLB, and Parkinson's disease dementia (PDD) patients. However, frontotemporal dementia (FTD) patients consistently scored higher on the CDT than AD patients. Qualitative analyses of errors differentiated AD from other types of dementia.

Overall, the CDT score may be useful in distinguishing between AD and FTD patients, but shows limited value in differentiating between AD and VaD, DLB, and PDD. Qualitative analysis of the type of CDT errors may be a useful adjunct in the differential diagnosis of the types of dementias.

The aim of this research was to compare associations of self-perceived successful aging (SPSA) among Young-Old (Y-O; age 50–74 years) versus Old-Old (O-O; 75–99 years) community-dwelling adults. To our knowledge, this is the first study to compare respondents’ self-perceptions of successful aging among O-O relative to Y-O adults.

Participants included 365 Y-O and 641 O-O adults. The two age groups were compared in terms of the association of SPSA with other preselected measures including sociodemographic information, physical and mental functioning, objective and subjective cognitive functioning, emotional health, and positive psychological constructs.

The O-O group reported higher levels of SPSA than the Y-O group. In multiple regression modeling examining predictors of SPSA in each group, there was a tendency toward lower associations in the O-O group overall. Most notably, the associations between physical and mental functioning with SPSA were significantly lower in the O-O versus Y-O group. There were no associations with SPSA that were significantly higher in the O-O versus Y-O group.

The lower predictive power of physical and mental functioning on SPSA among O-O relative to Y-O adults is particularly noteworthy. It is apparent that SPSA is a multidimensional construct that cannot be defined by physical functioning alone. Continuing to clarify the underlying factors impacting SPSA between groups may inform tailored interventions to promote successful aging in Y-O and O-O adults.

Cognitive impairment is underrecognized and misdiagnosed among community-dwelling older adults. At present, there is no consensus about which cognitive screening tool represents the “gold standard.” However, one tool that shows promise is the Brief Cognitive Assessment Tool (BCAT), which was originally validated in an assisted living sample and contains a multi-level memory component (e.g. word lists and story recall items) and complex executive functions features (e.g. judgment, set-shifting, and problem-solving).

The present study cross-validated the BCAT in a sample of 75 community-dwelling older adults. Participants completed a short battery of several individually administered cognitive tests, including the BCAT and the Montreal Cognitive Assessment (MoCA). Using a very conservative MoCA cut score of <26, the base rate of cognitive impairment in this sample was 35%.

Adequate internal consistency and strong evidence of construct validity were found. A receiver operating characteristic (ROC) curve was calculated from sensitivity and 1-specificity values for the classification of cognitively impaired versus cognitively unimpaired. The area under the ROC curve (AUC) for the BCAT was .90, p < 0.001, 95% CI [0.83, 0.97]. A BCAT cut-score of 45 (scores below 45 suggesting cognitive impairment) resulted in the best balance between sensitivity (0.81) and specificity (0.80).

A BCAT cut-score can be used for identifying persons to be referred to appropriate healthcare professionals for more comprehensive cognitive assessment. In addition, guidelines are provided for clinicians to interpret separate BCAT memory and executive dysfunction component scores.

There is a lack of information regarding geographical differences in the incidence and prevalence of dementia diagnosis according to the degree of aging of the population. The objectives of this study were to analyze the rate of dementia diagnoses, and to compare the dementia subtypes and the clinical characteristics of the patients depending on the degree of aging of their municipalities.

We used data from the Registry of Dementias of Girona (ReDeGi), containing the cases of dementia diagnosed in the memory clinics of the Health Region of Girona, in Catalonia (Spain), during 2007–2012. The municipalities were classified by a cluster analysis as aged or young municipalities according to their proportion of older people using population ageing indicators. The incidence rates of dementia diagnosis in each type of municipality were compared.

The ReDeGi registered 4,314 cases in the municipalities under surveillance. The clinical incidence of dementia was lower in aged municipalities (4.5 vs. 6.1 cases per 1,000 person-years aged 65 and over). Patients from young municipalities had an increased frequency of behavioral and psychological symptoms of dementia.

The environment may influence the clinical manifestations of dementia that predispose people to visit health specialists and obtain a diagnosis.

Epidemiological research on post-stroke affective disorders has been mainly focusing on post-stroke depression (PSD). In contrast, research on post-stroke anxiety (PSA) is in its early stages. The present study proposes a broad picture on post-stroke affective disorders, including PSD and PSA in German stroke in-patients during rehabilitation. In addition, we investigated whether lifetime affective disorders predict the emergence of PSD and PSA.

289 stroke patients were assessed in the early weeks following stroke for a range of mood and anxiety disorders by means of the Structured Clinical Interview relying on the Diagnostic and Statistical Manual of Mental Disorders IV. This assessment was conducted for two periods: for post-stroke and retroactively for the period preceding stroke (lifetime). The covariation between PSD and PSA was investigated using Spearman-ρ correlation. Predictors of PSD and PSA prevalence based on the respective lifetime prevalence were investigated using logistic regression analyses.

PSD prevalence was 31.1%, PSA prevalence was 20.4%. We also found significant correlations between depression and anxiety at post-stroke and for the lifetime period. Interestingly, lifetime depression could not predict the emergence of PSD. In contrast, lifetime anxiety was a good predictor of PSA.

We were able to highlight the complexity of post-stroke affective disorders by strengthening the comorbidity of depression and anxiety. In addition, we contrasted the predictability of PSA based on its lifetime history compared to PSD which was not predictable based on lifetime depression.

The value of care provided by informal carers in Canada is estimated at $26 billion annually (Hollander et al., 2009). However, carers’ needs are often overlooked, limiting their capacity to provide care. Problem-solving therapy (PST), a structured approach to problem solving (PS) and a core principle of the Reitman Centre CARERS Program, has been shown to alleviate emotional distress and improve carers’ competence (Chiu et al., 2013). This study evaluated the effectiveness of problem-solving techniques-based intervention based on adapted PST methods, in enhancing carers’ physical and emotional capacity to care for relatives with dementia living in the community.

56 carers were equally allocated to a problem-solving techniques-based intervention group or a control arm. Carers in the intervention group received three 1 hr visits by a care coordinator (CC) who had been given advanced training in PS techniques-based intervention. Coping, mastery, competence, burden, and perceived stress of the carers were evaluated at baseline and post-intervention using standardized assessment tools. An intention-to-treat analysis utilizing repeated measures ANOVA was performed on the data.

Post-intervention measures completion rate was 82% and 92% for the intervention and control groups, respectively. Carers in the intervention group showed significantly improved task-oriented coping, mastery, and competence and significantly reduced emotion-oriented coping, burden and stress (p < 0.01–0.001). Control carers showed no change.

PS techniques, when learned and delivered by CCs as a tool to coach carers in their day-to-day caregiving, improves carers’ caregiving competence, coping, burden, and perceived stress. This may reduce dependence on primary, psychiatric, and institutional care. Results provide evidence that establishing effective partnerships between inter-professional clinicians in academic clinical health science centers, and community agencies can extend the reach of the expertise of specialized health care institutions.

Although fear of falling is prevalent among older adults recovering from hip fracture, current instruments are inadequate due to focus on specific situations and measurement of self-efficacy rather than fear.

The authors revised and tested a form of the Fear of Falling Questionnaire with three groups of older adults: 405 recovering from hip fracture, 89 healthy community dwelling, and 42 with severe fear of falling. Test-retest reliability was evaluated in a subsample of 16 hip fracture patients. Internal consistency was compared across all groups. Construct validity was established through factor analysis, convergent validity with a measure of fall-related self-efficacy, and discriminant validity with measures of depression and affect.

A revised two-factor, six-item scale appears to have adequate psychometric properties. Scores were lower in the healthy comparison group relative to the hip fracture and fear of falling groups. Cronbach's α ranged from 0.72–0.83, with test-retest reliability of 0.82. Correlations with a measure of fall-related self-efficacy were moderate for the hip fracture group (0.42) and high with the healthy comparison (0.68) and fear of falling (0.70) groups. Correlations with depression and negative and positive affect were low to moderate.

The Fear of Falling Questionnaire – Revised shows promise as a self-report measure of fear of falling, and is one of the first to be tested in older adults recovering from hip fracture. Advantages are that it is global rather than situation-specific and measures fear rather than self-efficacy. Future research on this scale is recommended in other older adult samples for whom fear of falling is relevant.