Cultural modification of neuropsychiatric assessment: complexities to consider.

Cognitive screening tests are culture bound and have been shown to perform differently depending on the culture, even with adequate translation. Khan et al examine in detail ways in which the Montreal Cognitive Assessment (MoCA) has been modified for different languages and cultures and produce a systematic guide for future modifications. However, questions arise regarding the availability of the MoCA. Other important issues in the transcultural use and modification of neuropsychiatric tests include providing a culturally safe context for testing, understanding the cultural context in which screening takes place and assessing other neuropsychiatric conditions, which may manifest differently in different cultural contexts and which affect cognition.

Performance of the Cognitive Performance Scale of the Resident Assessment Instrument (interRAI) for Detecting Dementia amongst Older Adults in the Community.

The Cognitive Performance Scale (CPS) in the widely used interRAI suite of instruments is of interest to clinicians and policy makers as a potential screening mechanism for detecting dementia. However, there has been little evaluation of the CPS in home care settings. This retrospective diagnostic study included 134 older adults (age ≥ 65) who were discharged from two acute psychogeriatric inpatient units or assessed in two memory clinics. The reference test was a diagnosis of clinical dementia, and the index test was interRAI CPS measured within 90 days of discharge. The overall accuracy of the CPS was good, with an area under the Receiver Operating Characteristic curve of 0.82 (95% CI = 0.75-0.89). The optimal cut point was 1/2, coinciding with the recommended cut point, with good sensitivity (0.90, 95% CI = 0.81-0.96) but poor specificity (0.60, 95% CI = 0.46-0.72). Positive predictive value improved from 0.72 (95% CI = 0.66-0.78) to 0.89 (95% CI = 0.75-0.96) when using a cut point of 2/3 instead of 1/2. If the results of the present study are replicated with more generalisable interRAI samples, older adults with a CPS of 3 or above, but without a formal diagnosis of dementia, should be referred for further cognitive assessment.

Developing a dementia-friendly Christchurch: Perspectives of people with dementia.

AIM: Christchurch, New Zealand has a unique opportunity to potentially rebuild as a dementia-friendly city in the wake of the 2010 and 2011 earthquakes. The present study gathered insights from people with dementia about what would make it possible for them to live better in Christchurch. METHODS: Twenty-six older people living with dementia were interviewed using a semi-structured questionnaire. Interviews were transcribed for thematic analysis. RESULTS: Participants talked about the importance of being connected and engaged; of accommodation from service providers and others in the community and raising awareness of dementia, and attributes of the physical environment requiring consideration in the rebuild. CONCLUSION: The themes that emerged about what people with dementia seek from dementia-friendly communities reinforce previous research, but with an overlay of the difficulties of living in an earthquake-damaged city.

Geographic variation in psychotropic drug utilisation among older people in New Zealand.

AIM: To examine psychotropic drug utilisation in older people in New Zealand by age, sex, health board domicile and deprivation status. METHODS: A repeated cross-sectional analysis of population-based drug utilisation data stratified by age, sex, ethnicity, health board and deprivation status was conducted from 2005 to 2013. RESULTS: Psychotropic utilisation increased between 2005 and 2013 (ranging from 7.0 to 74.0%) across all the health boards. In people aged 85 years and above, the hypnotic and sedative prevalence ratio compared to the 65- to 69-year age group was 1.45 (95% CI 1.44, 1.46). Between 2005 and 2013, the antidepressants prevalence ratio increased (1.27 (95% CI 1.22, 1.33)) relative to anxiolytics. CONCLUSIONS: Overall psychotropic drug utilisation increased over time. Despite safety concerns, hypnotic and sedative utilisation increased in the oldest vulnerable group. Shifts from anxiolytics to antidepressants in some health boards were consistent with guidelines for extended indications of antidepressant drug use.

Assessment of older drivers in New Zealand: the current system, research and recommendations.

The purpose of this article is to clarify the current New Zealand driving licensing requirements for older adults and to provide practical recommendations for those health professionals who make decisions regarding driving ability in older adults. Health professionals involved in the assessment of older drivers were asked to clarify areas where more efficient use could be made of assessment resources. A review of driving literature was performed to find specific factors associated with increased risk of negative driving outcomes in older adults. Particular attention was paid to the suitability of different types of on-road assessment for certain patient groups, the effect of specific diseases and medications on driving safety, and the effect of cognitive impairment. A list of seven recommendations were compiled which include a focus on appropriate on-road driving assessment referral, driver refresher courses, cognitive screening for those presenting for licence renewal and sensitive broaching of the topic of driving cessation.