Predictors of improvement in health-related quality of life among elderly patients with depression.

BACKGROUND: Depression is the most prevalent disabling psychiatric syndrome of aging and may lead to important decrements in the elderly depressed patient's health-related quality of life (HRQL). The goal of this study was to determine whether severity of chronic illness at admission, severity of depressive symptoms at admission, or living alone before admission was associated with lack of improvement in HRQL at 3 months postdischarge among elderly depressed inpatients. METHODS: Subjects were 100 consecutive patients admitted to a 26-bed inpatient geriatric psychiatry unit from 1994 through 1997, who were residing in the community and were not demented. At admission, severity of depressive symptoms was assessed using the Geriatric Depression Scale and severity of chronic physical illness was measured using the Cumulative Illness Rating Scale (Geriatrics). HRQL was assessed at admission and again at 3 months postdischarge using the Medical Outcomes Study (MOS) 6-Item General Health Survey. RESULTS: This study found large improvements in all MOS items between admission and 3 months postdischarge. Severity of chronic physical disease was negatively associated with the probability of improvement in three MOS items (role functioning, psychological functioning, and general health perceptions) whereas the severity of depressive symptoms on admission was negatively associated with the probability of improvement in role functioning, social functioning, and bodily pain. Living alone was negatively associated with social functioning but not with any of the other MOS items. CONCLUSION: The results of this study suggest that the inpatient treatment of depression in the elderly brings about improvements in quality of life that persist for at least 3 months following discharge. The patient's initial level of depression and initial level of physical health may be important factors to be considered when evaluating a patient's prognosis.

Dental hygienists' knowledge, opinions, and practices related to oral and pharyngeal cancer risk assessment.

METHODS: A pre-tested, validated 62-item survey was mailed to a 1% national random sample of licensed dental hygienists, (n = 960). Four complete mailings of the instrument resulted in a 74.4% percent return rate of which 65% percent were usable (n = 464). Respondents provided information on their knowledge of oral cancer risk assessment factors, their use of health history questions to assess patients' oral cancer risks, how they conduct oral cancer examinations, and their beliefs about their oral cancer training. Data were analyzed using descriptive and inferential statistics and evaluated at a significance level of p < or = 0.05. RESULTS: Based on responses to 14 questions, the average score on knowledge of oral cancer risk factors was 7.92, with a significant difference found among age groups and year of graduation, (p = 0.006). On average, dental hygienists assessed five of eight risk assessment items with "use of alcohol" receiving the least attention. Although nearly 100% percent agreed that oral cancer examinations for adults 40 years of age or older should be provided annually, only 66% percent reported doing so for patients on their initial appointment. Seventy-four percent believed they were adequately trained to provide oral cancer examinations, while only 27 percent agreed that they were prepared to provide tobacco cessation counseling. There was no significant correlation between knowledge of oral cancer risk factors and probing these risk factors when conducting a health history. CONCLUSIONS: Results from this study indicate that interventions are needed to increase dental hygienists' knowledge of oral cancer risk factors, correct misinformation, and close the gap between their knowledge and its application in providing prevention and early detection services. The majority believed that they are not as knowledgeable as they could be and are interested in attending an oral cancer continuing education (CE) course.

Caries preventive knowledge and practices among dental hygienists.

PURPOSE: The aim of this study was to determine the knowledge, opinions, and practices of dental hygienists in the areas of dental caries etiology and prevention. METHODS: A pretested, validated 35-question survey instrument was mailed to a one percent national, stratified random sample of dental hygienists in the United States (n = 960) in October 1996. Four complete mailings of the instrument resulted in a 67% response rate, of which 77% were useable (n = 498). Respondents were asked if they agreed or disagreed with statements on caries etiology and preventive procedures, and also asked to rate the effectiveness of procedures for preventing dental caries in children and adults. Data were analyzed using descriptive statistics, t-tests, and ANOVA. RESULTS: Overall level of knowledge of caries etiology and preventive procedures was low. More than 40% of subjects did not recognize that remineralization is the most important mechanism of action of fluoride, and fewer than 50% recognized that dental caries is a chronic infectious disease. Analysis of four factors thought to be related to knowledge and practice showed that younger graduates, more recent graduates, and ADHA members were more knowledgeable about the effectiveness of caries preventive procedures for children (p < .01). Although an overwhelming majority correctly agreed that adults benefit from fluoride and that root caries is an emerging problem, this knowledge was inconsistent with practice (p = .02). Fewer than 35% reported that they provide fluoride to adults of any age, or they wait until the disease is present. For children and adults who did receive fluoride treatments, a one-minute application of an APF gel or foam was most often provided. CONCLUSIONS: Correct information about the etiology and prevention of dental caries is a predisposing factor to making informed decisions. Overall, respondents overrated the effectiveness of flossing and toothbrushing while underrating the effectiveness of fluorides. In the majority of cases, efficiency rather than efficacy was given priority when providing a topical fluoride treatment. An improved understanding of dental caries etiology and the scientific evidence for appropriate caries preventive procedures will allow dental hygienists to prevent and manage this disease better.

Religious training and religiosity in psychiatry residency programs.

The authors present the results of a survey that inquired into the religious life of 121 residents from 5 psychiatric residency programs. In addition, the study sought to explore the didactic and supervision experience of the residents regarding religious issues. The authors' results show that this group of residents appears to be more religious than what has been reported before in prior studies of psychiatrists' religious beliefs. While didactic exposure was limited, those who received didactic exposure were more likely than those who did not to believe that religion is important in the clinical setting, and the former also felt more competent to recognize and attend to a patient's religious and spiritual issues. Still, most residents felt competent to address religious issues in their clinical encounter. The implications of the results are discussed as they relate to training.

Formulating treatment partnerships with patients and their families. A case study.

1. A care environment, per se, can foster patient recovery and confidence that things will work out as well as can be expected when staff practices and explicit processes are patient-centered and adapted to developmental and individual needs. 2. Separating more cognitively impaired from higher functioning patients and developing more specialized nursing teams affords a healing and restorative care environment, individualized care routines and specialty groups along with finely-tuned patient/family education. 3. Organized staff education and mentoring programs combined with master scheduling enhances the continuity of patient-centered practices and risk management protocols.

Benzodiazepine use in the elderly prior to psychiatric hospitalization.

The objective of this study was to assess benzodiazepine use and the treatment of depression before admission to an inpatient geriatric psychiatry unit in a sample of elderly patients. The study design was a retrospective chart review, and the setting was a university hospital inpatient geriatric psychiatry unit. The subjects included 131 consecutively admitted patients. Preadmission benzodiazepine drug regimens were reviewed in relation to the Health Care Financing Administration (HCFA) guidelines for benzodiazepine use in nursing homes and in relation to psychiatric diagnoses. Psychiatric diagnoses were made based on DSM-III-R criteria. The preadmission benzodiazepine regimens of 38 of 59 patients receiving benzodiazepines (64.0%) were outside the HCFA guidelines. Also, 30 of 76 patients (39.5%) with depressive disorders received benzodiazepines as sole treatment of depression prior to their admission. This study suggests that benzodiazepines may be misused in the elderly and indicates the need for education and research on the appropriate use of benzodiazepines in the treatment of depression.

A randomized trial of dementia care in nursing homes.

OBJECTIVE: To evaluate the efficacy of a dementia care program to reduce behavior disorders in nursing home patients with dementia. DESIGN: Randomized controlled clinical trial with 6-month follow-up. SETTING: A 250-bed community nursing home. PATIENTS: The nursing home was screened to identify patients with dementia and behavior disorders. A total of 118 patients were eligible for randomization. Of these, 89 (75.4%) were randomized, and 81 of these (91.0%) completed the trial. INTERVENTION: The A.G.E. dementia care program consisted of Activities, Guidelines for psychotropic medications, and Educational rounds. The control treatment was usual nursing home care. MEASUREMENTS: Behavior disorders, antipsychotic drug and physical restraint use, patient activity levels, and cognitive and functional status. RESULTS: After 6 months, 12 of 42 (28.6%) intervention patients exhibited behavior disorders compared with 20 of 39 (51.3%) controls (OR = 0.38; 95% CI [0.15, 0.95]; P = .037). Controls were more than twice as likely to receive antipsychotics (OR = 2.55, 95% CI [0.96, 6.76]; P < .056), to be restrained during activity times (OR = 2.98, 95% CI [1.10, 8.04]; P < .028), and to be restrained on nursing units (OR = 2.14, 95% CI [0.9, 5.3]; P < .10). Intervention patients were much more likely to participate in activities (OR = 13.71; 95% CI [4.51, 41.73]; P = .001). CONCLUSIONS: The A.G.E. program reduces the prevalence of behavior disorders and the use of antipsychotic drugs and restraints. It is practical, feasible, and appears to improve the lives of patients with dementia in nursing homes.

A pet therapy intervention with geriatric psychiatry inpatients.

OBJECTIVE: The purpose of this study was to evaluate the effects of pet therapy on geriatric psychiatry inpatients. A demonstrable impact could lead to more widespread or targeted use of animal companionship programs for hospitalized older persons. METHOD: The study design was a randomized, parallel-group control treatment trial with pretreatment and posttreatment measures. Fifty-eight subjects with chronic age-related disabilities who were patients of the Wills Eye Hospital Geriatric Psychiatry Unit were assigned to a pet therapy intervention group or an exercise control group for 1 hr a day for 5 consecutive days. Every subject was blindly evaluated with the Multidimensional Observation Scale for Elderly Subjects (MOSES) before and after the intervention week. RESULTS: No significant differences in MOSES scores were found between or within groups before and after the interventions. There was a nonsignificant tendency for subjects who received the pet intervention to have less irritable behavior after treatment. However, women with dementia who received either pet therapy or exercise intervention had improved irritable behavior scores after treatment. CONCLUSION: This pilot study demonstrates the need for further research on animal-assisted interventions with hospitalized elderly persons. Differential improvement in women with dementia also requires further investigation.

The impact of antipsychotic drug regulations on psychotropic prescribing practices in nursing homes.

The authors prospectively studied psychotropic prescribing practices and quality assurance data in 17 nursing homes in the Baltimore area to assess the impact of federal antipsychotic drug regulations. There was a 36% reduction in prescriptions for neuroleptics over 6 months, no increase in prescriptions for sedative/hypnotics, and a small increase in prescriptions for antidepressants. The authors conclude that psychotropic drug prescribing practices and patient outcomes remain important areas of study in nursing homes.