Attitudes towards frailty assessment in clinical practice among psychiatrists in the UK

Purpose: Although there is substantial evidence about the association between frailty and mental illnesses in older people, there is currently little evidence about how this is integrated into psychiatric clinical practice. The purpose of this paper is to explore the attitudes of a sample of psychiatrists in the UK about the concept and assessment of frailty in their clinical practice. Design/methodology/approach: This research used a qualitative approach with semi-structured interviews. Interview schedules and transcripts were analysed using thematic analysis. NVivo software and an audit trail were used for the data analysis. Findings: There were ten respondents (all psychiatrists) in this study. From the interviews, it appeared that some respondents were not be fully familiar with existing concepts of frailty. However, from their perspectives, frailty appeared to be multidimensional, reversible and for some could be enhanced by older people’s ability. Negative stereotypes of being frail could undermine the accessibility to appropriate assessment and care. Existing multidisciplinary assessments, with some adjustments to the particular needs of psychiatric patients, can be used to establish a frailty index. Originality/value: The concept of frailty, especially those concerning its multidimensional and homeostatic nature, should be further examined to make it more applicable to psychiatric practice. Without much more effort, frailty could be assessed within current psychiatric practices. This could constitute a care plan tailored for frail people with a psychiatric illness, so as to improve the outcomes of their treatment and quality of life

Association between Social Support and Frailty among Older People with Depressive Disorders

Objectives: This study aimed at examining the association between social support and frailty status, specifically amongst older people with depressive disorders. / Methods: It was conducted in older people, aged 65 and over, with depressive disorders at the Psychiatry Outpatient Unit of Songklanagarind Hospital, Thailand. The main independent variable, level of social support, was assessed using the Inventory of Social Support Behaviors (ISSB) – Thai. The main dependent variable, frailty status, was assessed via the adapted Fried Frailty Phenotype. Bivariate and ordinal regression analyses were conducted to examine the relationships between variables. / Results: In our study sample, 32% of the 147 participants were considered frail, 51% pre-frail, and 17% robust. From the ordinal regression analysis, four variables – social support score, current depressive symptoms, level of education, and key family caregivers – were statistically significantly associated with frailty status. The odds of having pre-frailty and frailty were statistically significantly reduced by a factor of 0.99, or around 1.0 percent, for each 1-point increment of the social support scale (Ordinal OR 0.99, 95% CI = 0.97–0.99, p-value = 0.015). / Conclusions: Social support interventions should be designed to influence multiple items of the social support scale at the same time, which might, therefore, have a substantial effect on frailty status among the older population. / Clinical implications: We recommend a regular practice that focuses not only on biological (i.e., prescribing medications) and psychological aspects (i.e., providing psychotherapy) but also on the social dimension of older people living with frailty and depressive disorders

Prevalence of depression, and its associated factors among the elderly in Songkhla Province, Thailand: Two-stage cluster sampling study

BACKGROUND: Depression in elderly usually goes unnoticed in the general population. The aim of this research is to study on the prevalence, and associated factors of elderly depression within Songkhla province. This being a major city with a population of one and a half million, situated in the south of Thailand. METHODS: This is a two-stage cluster sampling study. We collected data from members of the elderly population (65-99 years of age) in Songkhla Province from 1st of September – 30th of November 2015. The sample size was calculated by R-program. We used the 15-item Thai Geriatric Depression Scale (TGDS-15) questionnaire to find the prevalence and its association of factors. The associated factors were analyzed by multiple logistic regression using a backward-stepwise method. RESULTS: By using TGDS-15, the prevalence of depression in the elderly population in Songkhla province was 12.0 percent. The association of depression as well as potential, associated factors in this study; sex, age, and residential area, were not found to be significant. We found more prevalence among Muslims, those being alone, and having a lower educational level within this area (p-value < 0.05). CONCLUSIONS: The prevalence of depression was quite high among the elderly population of Songkhla province. Many statically, both significant and insignificant, correlations were found. We need an in-depth research, concerning both biological and spiritual aspects to explain the etiology of depression. Then, some policies need to be implemented to intervene those factors, so as to promote better health and quality of life in elderly people

Prevalence of mental disorders in older outpatients in Songklanagarind hospital

OBJECTIVE: Investigate the prevalence and the characteristics of mental illness in elderly outpatients at Songklanagarind Hospital, a university hospital in southern Thailand. MATERIAL AND METHOD: This was a cross-sectional study. We extracted the medical records of the outpatients aged over 65 years old diagnosed with a category (F) mental disorder in the International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10) over the periods between July 1 and December 31, 2014, from all outpatient medical records. We used R program for analyzing descriptive data. RESULTS: There were 31,329 patients, aged over 65 years, who visited the outpatient clinic. We found that 752 patients in this group had been diagnosed with mental disorders; the prevalence was 2.4%. The most common diagnoses were: mood disorders (0.89%), organic mental disorders (0.85%), and neurotic-somatoform disorders (0.51%). Most patients (85.5%) received some form of medication. For each visit, the average medical fee for these patients was 3,431.30 Baht (96.80 US dollar). CONCLUSION: The prevalence of geriatric mental disorders, among the outpatients of Songklanagarind Hospital was much lower than the inpatient and community setting. This could be a reflection that some were under-diagnosed for these disorders in the outpatient clinics. One of these factors was the limited time available for each patient. We need some interventions and policies to detect these abnormalities early and thoroughly, so the patients would be receiving appropriate treatments, which in turn would provide them with a better quality of life

Depression and Associated Factors among Elderly Outpatients in Songklanagarind Hospital, Thailand: A Cross-Sectional Study

OBJECTIVE: Elderly patients with their deteriorating global health are becoming more vulnerable to mental disorders, especially depression. The aim of this study is to determine the prevalence and associated factors of depression amongst patients attending outpatient clinics in Songklanagarind Hospital, a tertiary care center in southern Thailand. MATERIAL AND METHOD: This is a cross-sectional descriptive study. Elderly people (65-99 years of age) attending the outpatient department of Songklanagarind Hospital during 1st of September-30th of November 2015 were included in the study. The sample size was calculated using Epicalc in R program. We used the 15-item Thai Geriatric Depression Scale (TGDS-15) questionnaire to find the prevalence of depression among this group. Associated factors of depression were identified by multiple logistic regression using a backward-stepwise method. RESULTS: The total number of participants in this study was 408. The prevalence of depression based on the TGDS-15, cut-off score of >5, among elderly outpatients in Songklanagarind Hospital was 9.6%. However, regarding multiple regression analysis, no statistically significant factors; sex, age, marital status, educational level, and religion, could be found to be associated with depression. CONCLUSION: Almost one-tenth of the elderly patients visiting the outpatient clinics within Songklanagarind Hospital had depression. This prevalence was quite high. The depression would worsen their health conditions. Good, rigorous screening coupled with a referral system should be encouraged and then implemented in this hospital

Sleep Quality Among Elderly People Within the Outpatient Department of Songklanagarind Hospital, Thailand: A Cross-Sectional Study

OBJECTIVE: To determine the prevalence of sleep quality in the elderly within our outpatient department. MATERIAL AND METHOD: A cross-sectional study was conducted by; calculating the sample size for a survey with ‘proportion to size’ at the outpatient department of Songklanagarind Hospital from; October to November, 2015. A total of 408 participants aged between 65 and 99 were interviewed. Demographic and sleep-related data were collected. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) – Thai version. The results were analyzed in terms of descriptive statistics and conducted using R-Epicalc and R-Survey software. RESULTS: Our subjects were predominantly married females. The proportion of those in the 65-74 age range was 63.0%. Most of the participants (70.8%) were poor sleepers, with mean and median PSQI scores of 7.7 and 7.0, respectively. Regarding poor sleepers, their problems were; short sleep duration (99.7%), poor sleep efficiency (61.6%) and day time dysfunction (51.6%). CONCLUSION: Similarly to previous studies, our findings showed a high prevalence of poor sleep quality in the elderly population. A sleep duration of less than 6 hours was the major problem in the poor sleeper group. Gaining a better insight into sleep quality correlating with comorbidities is recommended

Mapping and understanding the decision-making process for providing nutrition and hydration to people living with dementia: a systematic review

BACKGROUND: This systematic review aimed to explore the process of decision-making for nutrition and hydration for people living with dementia from the perspectives and experiences of all involved. METHODS: We searched CINAHL, the Cochrane Library, EMBASE, MEDLINE and PsycINFO databases. Search terms were related to dementia, decision-making, nutrition and hydration. Qualitative, quantitative and case studies that focused on decision-making about nutrition and hydration for people living with dementia were included. The CASP and Murad tools were used to appraise the quality of included studies. Data extraction was guided by the Interprofessional Shared Decision Making (IP-SDM) model. We conducted a narrative synthesis using thematic analysis. PROSPERO registration number CRD42019131497. RESULTS: Forty-five studies were included (20 qualitative, 15 quantitative and 10 case studies), comprising data from 17 countries and 6020 patients, family caregivers and practitioners. The studies covered a range of decisions from managing oral feeding to the use of tube feeding. We found that decisions about nutrition and hydration for people living with dementia were generally too complex to be mapped onto the precise linear steps of the existing decision-making model. Decision-making processes around feeding for people living with dementia were largely influenced by medical evidence, personal values, cultures and organizational routine. Although the process involved multiple people, family caregivers and non-physician practitioners were often excluded in making a final decision. Upon disagreement, nutrition interventions were sometimes delivered with conflicting feelings concealed by family caregivers or practitioners. Most conflicts and negative feelings were resolved by good relationship, honest communication, multidisciplinary team meetings and renegotiation. CONCLUSIONS: The decision-making process regarding nutrition and hydration for people living with dementia does not follow a linear process. It needs an informed, value-sensitive, and collaborative process. However, it often characterized by unclear procedures and with a lack of support. Decisional support is needed and should be approached in a shared and stepwise manner

How do people living with dementia perceive eating and drinking difficulties? A qualitative study

BACKGROUND: Eating and drinking problems are common among people living with later-stage dementia, yet few studies have explored their perspectives. OBJECTIVE: This study aimed to explore how people living with mild dementia understand possible future eating and drinking problems and their perspectives on assistance. DESIGN: Qualitative study using semi-structured interviews. SETTING: Community. METHODS: We conducted semi-structured interviews with 19 people living with mild dementia. Interviews were transcribed verbatim and analysed thematically. RESULTS: Five themes were identified: (i) awareness of eating and drinking problems; (ii) food and drink representing an individual’s identity and agency; (iii) delegating later decisions about eating and drinking to family carers; (iv) acceptability of eating and drinking options; and (v) eating and drinking towards the end of life. For people living with mild dementia, possible later eating and drinking problems could feel irrelevant and action may be postponed until they occur. Fears of being a burden to family and of being treated like a child may explain reluctance to discuss such future problems. People living with mild dementia might wish to preserve their agency and maintain good quality of life, rather than be kept alive at later stages by artificial nutrition and hydration. CONCLUSION: For people with mild dementia, eating and drinking problems may seem unrelated to them and so get left undiscussed. Negative connotations regarding eating and drinking problems may hinder the discussion. The optimal time to discuss possible future problems with eating and drinking with people with mild dementia may need an individual approach