The psychological and health consequences of caring for a spouse with dementia: a critical comparison of husbands and wives.

Caring for someone with dementia can be demanding, particularly for spouses living with the care recipient. The main goal of this study was to clarify differences in the experience of caregivers who were husbands and wives with respect to burden, health, healthy behaviors, presence of difficult care recipient behaviors, social supports, and the quality of the premorbid relationship. The results of this study support research demonstrating a difference between the caregiving experiences of women and men. It is becoming increasingly apparent that female gender is a marker that places them at increased risk of high burden and less support.

The first 25 years of the Northwestern Ontario Medical Programme.

OBJECTIVE: A tracking study of the undergraduate medical students and postgraduate residents who participated in the Northwestern Ontario Medical Programme (NOMP) during its first 25 years (1972-1997) was conducted to search for factors related to physician recruitment to Northwestern Ontario. METHODS: Annual editions of the Canadian Medical Directory were used to determine how many participants returned to practise in Northwestern Ontario. RESULTS: A total of 1982 (84.9%) of the 2335 NOMP participants were located using the Canadian Medical Directory. Of those located, 217 (10.9%) had established practice in Northwestern Ontario. Significantly higher recruitment rates (p < 0.001) were found for postgraduate residents (88/410 [21.5%]) than for undergraduates (95/1445 [6.6%]). Undergraduates who returned for multiple placements were significantly (p < 0.001) more likely to practise in Northwestern Ontario. Furthermore, significant differences in recruitment rates (p < 0.001) were found among the 5 Ontario medical schools. A "snapshot" of 1999 identified that undergraduate medical students and postgraduate residents who undertook a NOMP placement were significantly (p < 0.001) more likely to practise in Northwestern Ontario (odds ratio 7.11, 95% confidence interval 5.11-9.90) than those graduating from Ontario universities who did not experience a NOMP placement. CONCLUSIONS: Analysis of 25 years of student tracking data confirms that NOMP placements were significantly associated with physician recruitment to Northwestern Ontario. Recruitment rates from participation in NOMP were higher for postgraduate residents, undergraduate medical students who returned for multiple placements, and for undergraduate medical students from certain Ontario universities.

Associations between psychotic symptoms and dependence in activities of daily living among older adults with Alzheimer's disease.

BACKGROUND: Alzheimer's disease (AD) is associated with dependence in activities of daily living (ADL). In addition to the cognitive impairment resulting from AD, the presence of psychotic symptoms may further increase this dependence. The objective of this study was to quantify the additional contribution of psychotic symptoms to dependence in ADL. METHOD: We analyzed data from 558 individuals with AD referred to a memory clinic. Information on ADL, psychotic symptoms, depression symptoms, and cognition was collected with standardized instruments. RESULTS: The frequency of psychotic symptoms was correlated with dependence in ADL (r = -.44, p < .001). The independent contribution of psychotic symptoms to ADL (basic and instrumental) after consideration for cognitive impairment and depression symptoms was assessed with hierarchical regression models. Twenty-five percent of basic ADL variance was explained by cognition; psychotic symptoms accounted for an additional 7% of the variance (b = -0.12, p < .001). Cognitive impairment explained 31% of instrumental ADL variance; psychotic symptoms accounted for an additional 6% (b = -0.21, p < .001). DISCUSSION: Psychotic symptoms are associated with dependence in ADL after controlling for cognitive impairment and depression symptoms. Future research should investigate possible causal linkages between psychotic symptoms and dependence in ADL. This may have implications regarding interventions to maintain independent living in people with AD.