Comparison of anxiety symptoms in spouses of persons suffering from dementia, geriatric in-patients and healthy older persons

Fagfellevurdert, vitenskapelig tidsskriftartikkelObjective:To describe and compare anxiety symptoms in spouses of persons suffering from dementia, geriatric in-patients and healthy controls, and to study possible risk factors associated with anxiety in these groups of older people. Method: The participants were 70 years and above: 1) 76 spouses of persons with dementia recruited from a memory clinic, 2) 98 in-patients without dementia but suffering from one or more chronic diseases, who were admitted to a geriatric department of an acute hospital, and 3) 68 healthy elderly people recruited from day-centres. The State-Trait Anxiety Inventory (STAI-X-1, 12-item) was used to tap anxiety symptoms. Results: Spouses of persons suffering from dementia expressed the same degree of anxiety symptoms as geriatric patients, and anxiety in these two groups differed significantly from the healthy elderly persons. In an adjusted linear regression analysis, anxiety, expressed as a high score on STAI-X-1, was associated with female gender (ß 0.16, p=0.01); being a spousal carer (ß 0.49, p <0.001) and being a geriatric patient (ß 0.57, p<0.001). Conclusion: Spouses of persons suffering from dementia reported as much anxiety symptoms as geriatric in-patients and both groups reported significantly more symptoms of anxiety than healthy older persons without caring obligations. The mental health nurses should include assessment of carers’ anxiety as routine

Plasma free choline, betaine and cognitive performance: the Hordaland Health Study

Choline and betaine are nutrients involved in one-carbon metabolism. Choline is essential for neurodevelopment and brain function. We studied the associations between cognitive function and plasma concentrations of free choline and betaine. In a cross-sectional study, 2195 subjects (55 % women), aged 70–74 years, underwent extensive cognitive testing including the Kendrick Object Learning Test (KOLT), Trail Making Test (part A, TMT-A), modified versions of the Digit Symbol Test (m-DST), Block Design (m-BD), Mini-Mental State Examination (m-MMSE) and Controlled Oral Word Association Test (COWAT). Compared with low concentrations, high choline (>8·4 μmol/l) was associated with better test scores in the TMT-A (56·0 v. 61·5, P= 0·004), m-DST (10·5 v. 9·8, P= 0·005) and m-MMSE (11·5 v. 11·4, P= 0·01). A generalised additive regression model showed a positive dose–response relationship between the m-MMSE and choline (P= 0·012 from a corresponding linear regression model). Betaine was associated with the KOLT, TMT-A and COWAT, but after adjustments for potential confounders, the associations lost significance. Risk ratios (RR) for poor test performance roughly tripled when low choline was combined with either low plasma vitamin B12 ( ≤ 257 pmol/l) concentrations (RRKOLT= 2·6, 95 % CI 1·1, 6·1; RRm-MMSE= 2·7, 95 % CI 1·1, 6·6; RRCOWAT= 3·1, 95 % CI 1·4, 7·2) or high methylmalonic acid (MMA) ( ≥ 3·95 μmol/l) concentrations (RRm-BD= 2·8, 95 % CI 1·3, 6·1). Low betaine ( ≤ 31·1 μmol/l) combined with high MMA was associated with elevated RR on KOLT (RRKOLT= 2·5, 95 % CI 1·0, 6·2). Low plasma free choline concentrations are associated with poor cognitive performance. There were significant interactions between low choline or betaine and low vitamin B12 or high MMA on cognitive performance.publishedVersio

Three-year mortality in previously hospitalized older patients from rural areas - the importance of co-morbidity and self-reported poor health

Background The risk factors for mortality after hospitalization in older persons are not fully understood. The aim of the present study was to examine the three-year (1,096 days) mortality in previously hospitalized older patients from rural areas, and to explore how objectively and self-reported health indicators at baseline were associated with mortality. Methods The study included 484 (241 men) medical inpatients with age range 65–101 (mean 80.7, SD 7.4) years. Baseline information included the following health measures: the Charlson Index, the Mini-Mental-State Examination, Lawton and Brody’s scales for physical self-maintenance and the instrumental activities of daily living, the Hospital Anxiety and Depression scale, self-reported health (one item), and perceived social functioning (one item) and assistance in living at discharge. Results In all, 172 (35.5%) of those patients included had died within the three years of the follow-up period. Three-year mortality was associated with a high score at baseline on the Charlson Index (HR 1.73, 95%CI 1.09-2.74) and poor self-reported health (HR 1.52, 95%CI 1.03-2.25) in a Cox regression analysis adjusted for age, gender, other objectively measured health indicators, and perceived impaired social functioning. Conclusion In a study of older adults admitted to a general hospital for a wide variety of disorders, we found co-morbidity (as measured with the Charlson Index) and poor self-reported health associated with three-year mortality in analysis adjusting for age, gender, and other health-related indicators. The results suggest that self-reported health is a measure that should be included in future studies

Three-year mortality in previously hospitalized older patients from rural areas - the importance of co-morbidity and self-reported poor health

Abstract BACKGROUND: The risk factors for mortality after hospitalization in older persons are not fully understood. The aim of the present study was to examine the three-year (1,096 days) mortality in previously hospitalized older patients from rural areas, and to explore how objectively and self-reported health indicators at baseline were associated with mortality. METHODS: The study included 484 (241 men) medical inpatients with age range 65-101 (mean 80.7, SD 7.4) years. Baseline information included the following health measures: the Charlson Index, the Mini-Mental-State Examination, Lawton and Brody's scales for physical self-maintenance and the instrumental activities of daily living, the Hospital Anxiety and Depression scale, self-reported health (one item), and perceived social functioning (one item) and assistance in living at discharge. RESULTS: In all, 172 (35.5%) of those patients included had died within the three years of the follow-up period. Three-year mortality was associated with a high score at baseline on the Charlson Index (HR 1.73, 95%CI 1.09-2.74) and poor self-reported health (HR 1.52, 95%CI 1.03-2.25) in a Cox regression analysis adjusted for age, gender, other objectively measured health indicators, and perceived impaired social functioning. CONCLUSION: In a study of older adults admitted to a general hospital for a wide variety of disorders, we found co-morbidity (as measured with the Charlson Index) and poor self-reported health associated with three-year mortality in analysis adjusting for age, gender, and other health-related indicators. The results suggest that self-reported health is a measure that should be included in future studies

Livskvalitet, depressive symptomer og funksjonssvikt hos personer med demens

Bakgrunn: Det er usikkert om sammenhengen mellom livskvalitet, depressive symptomer og funksjonssvikt er like sterk hos personer med demens som hos dem uten demens. Hensikt: Å undersøke sammenhengen mellom livskvalitet, depressive symptomer, funksjonssvikt og grad av demens. Metode: Opplysninger om 223 pasienter med demens i sykehjem ble innhentet gjennom intervju av pasientenes primærpleiere. Livskvalitet ble kartlagt med Quality of life in late stage dementia scale (QUALID), symptomer på depresjon med Cornell skala, funksjonsevne med Lawtons ADL skala og grad av demens med Klinisk demensvurdering. Resultater: Korrelasjonsanalyser viste at livskvalitet var signifikant assosiert til depressive symptomer, grad av demens og tap av funksjonsevne. Spearman’s korrelasjon varierte mellom 0,37 og 0,53. En trinnvis lineær regresjonsanalyse viste at fire av f em subskalaer i Cornell skalaen, affekt-, adferds-, retardasjon– og syklisk subskala var signifikant assosiert med QUALID-skåren. Den fysiske sub skalaen var det ikke fordi sub skalaene retardasjon og fysisk korrelerte sterkt. Tap av funksjonsevne og grad av demens var også signifikant relatert til redusert livskvalitet. Konklusjon: Livskvalitet hos personer med demens påvirkes av depresjonssymptomer, spesielt kjernesymptomer for depressiv lidelse, og funksjonsnivå

Trajectories of Depression in Late Life: A 1-Year Follow-Up Study

Aims: To investigate the prognosis of depression in late life (DLL) in terms of the course of depression over 1 year and assess clinical factors related to the prognosis. Methods: We performed an observational, multicenter, longitudinal study of 160 patients aged ≥60 years who were admitted to inward treatment of DLL. The patients were followed with 3 assessments: at inclusion (T0), at discharge from the hospital (T1), and after 1 year (T2). Growth mixture modeling was applied to identify patient classes following distinct trajectories of the Montgomery-Åsberg Depression Rating Scale (MADRS) score. Two regression models were estimated to assess clinical factors for the trajectories and for a clinical assessment of the depression course between T1 and T2. Results: Two trajectory classes were identified: one with higher and one with lower MADRS scores. Not being in remission at T1 and a longer hospital stay were associated with higher odds of being in the trajectory class with more severe depression. Early-onset depression (EOD) was associated with higher odds of being in a group with a poorer clinical course between T1 and T2. Conclusion: EOD and not being in remission at discharge were important negative prognostic factors for DLL

The validity of the Hospital Anxiety and Depression scale and the Geriatric Depression scale-5 in home-dwelling old adults in Norway

Background Little is known about the validity of the Norwegian versions of the Geriatric Depression Scale-5 (GDS-5) and the Hospital Anxiety and Depression Scale-D (HADS-D). The aim of this study was therefor to validate the two assessment tools in a population of home-dwelling persons of 60 years of age and above. Methods A sample of 194 home-dwelling old adults with and without depressive symptoms were recruited. The participants were examined for depressive symptoms (GDS-5, HADS-D) and cognitive impairment. Sociodemographic information was collected. The participants underwent a blinded diagnostic evaluation for a depressive episode according to the diagnostic criteria of ICD-10. Results In all, 56 (28.9%) participants fulfilled criteria for a depressive episode according to ICD-10. The Receiver Operating Characteristics analyses of HAD-D and GDS-5 using the diagnostic criteria of ICD-10 for depression as gold standard was performed. For GDS-5 the Areal under the Curve was 0.81 and for HAD-D 0.75. The cut-off points of the measures that produced the highest accuracies were ≥2 for GDS-5 with a sensitivity of 73.2% and a specificity of 73.2% and ≥4 for HADS-D with a sensitivity of 70.3% and a specificity of 69.6%. Limitations A larger sample would have given the opportunity for analyzing home dwelling old adults with and without home health care separately. The participants were talked through the self-filling questionnaires. The procedure could have influenced the participants’ answers. Conclusion GDS-5 and HADS-D are useful screening tools for old adults, but only fairly good to identify depression according to criteria of ICD-10

Dementia in the National Cause of Death Registry in Norway 1969-2010

Background: The prevalence of dementia is expected to increase markedly during the coming decades. Epidemiological studies involving the National Cause of Death Registry (NCDR) may be useful for exploring the aetiology of dementia. We therefore wanted to study developments in the reporting of dementia in the NCDR over the last four decades. Methods: We calculated the age- and gender specific proportion of deaths with dementia reported in the NCDR (dementia deaths) in the period 1969-2010, and the proportion of vascular dementia and Alzheimer’s disease deaths in 1986-2010. Separate analyses were done for deaths occurring in nursing homes in 1996-2010. The proportion of dementia deaths where dementia was coded as underlying cause of death was also calculated. Results: The proportion of dementia deaths increased more than threefold in the period 1969-2010 among women (from 4% to 15%), and more than doubled among men (from 3% to 7%). In nursing homes the proportion increased from 17% to 26% for women and from 13% to 18% for men. The proportion of dementia deaths with Alzheimer’s disease reported in the NCDR increased from practically zero in 1986 to a maximum of 28% in 2005. The proportion of dementia deaths with dementia as underlying cause of death increased from a minimum of 6% in 1972 to a maximum of 51% in 2009. Conclusion: Although the reporting of dementia in the NCDR increased markedly from 1969 to 2010, dementia is still under-reported for old people and for deaths occurring in nursing homes when compared to prevalence estimates

Can depression in psychogeriatric inpatients at one year follow-up be explained by locus of control and coping strategies?

Objectives: Treatment of depression (in late life) is good. The short-term, but not long-term prognosis after treatment of depression in late life is good. To identify modifiable factors, we wanted to examine whether coping in terms of locus of control and coping strategies in depressed patients were associated with the prognosis of depression at follow-up, adjusted for sociodemographic information and health variables. Method: In total, 122 patients (mean age 75.4 years; SD = 6.6) were followed up (median 13.7 months, Q1-Q3 386-441) with a diagnostic evaluation(ICD-10) for depression and assessment of depressive symptoms (MADRS). Coping was assessed using Locus of Control of behavior (LoC-scale) and Ways of Coping questionnaire (WoC-scale). Results: At follow-up, 37.7% were diagnosed with a depressive episode. A stronger external LoC and lower MMSE-NR score at baseline were in adjusted linear regression analysis significantly more associated to higher depressive symptom scores (MADRS). More use of problem-focused coping, a lower I-ADL functioning, but not emotion-focused coping at baseline were significantly associated with being depressed (ICD-10), at follow-up in adjusted logistic regression analysis. Conclusion: LoC and coping strategies at baseline were associated with the prognosis of depression at follow-up, and may further be studied as indicators for choice of baseline intervention strategies