Six-year effect of depressive symptoms on the course of physical disability in community-living older adults.

BACKGROUND: Late-life depression affects physical health and impedes recovery from physical disability. But whether milder symptoms that occur frequently in the general population increase the risk of developing a disability or decrease the likelihood of recovery remains unclear. OBJECTIVE: To examine the effect of mild symptoms of depression, assessed by a reduced version (10 items, ranging from 0-10) of the Center for Epidemiological Studies-Depression Scale, on the course of physical disability, assessed by items from the Katz Activities of Daily Living Scale, the Rosow-Breslau Functional Health Scale, and the Nagi Index. METHODS: A population-based longitudinal study was conducted, with 6 follow-up interviews of 3434 community-dwelling persons aged 65 years and older in East Boston, Mass. RESULTS: The likelihood of becoming disabled increased with each additional symptom of depression (for the Katz measure: odds ratio, 1.16 per symptom; 95% confidence interval, 1.13-1.19; for the Rosow-Breslau measure: odds ratio, 1.14; 95% confidence interval, 1.11-1.16; and for the Nagi measure: odds ratio, 1.17; 95% confidence interval, 1.14-1.19). As the number of depressive symptoms increased, the likelihood of recovering from a physical disability decreased (for the Katz measure: odds ratio, 0.96; 95% confidence interval, 0.93-0.99; for the Rosow-Breslau measure: odds ratio, 0.86; 95% confidence interval, 0.84-0.89; and for the Nagi measure: odds ratio, 0.89; 95% confidence interval, 0.87-0.91). This effect was not accounted for by age, sex, level of educational attainment, body mass index, or chronic health conditions. CONCLUSION: Mild depressive symptoms in older persons (those aged > or =65 years) are associated with an increased likelihood of becoming disabled and a decreased chance of recovery, regardless of age, sex, and other factors that contribute to physical disability.

Complementary and alternative therapies to manage HIV-related symptoms.

Persons with HIV infection report substantial use of complementary and alternative medical (CAM) therapies for symptom management. Anecdotal reports from patients indicate that CAM approaches are helpful; however, there is limited scientific information on the safety and efficacy of these therapies in the HIV population. The purpose of this review is to critically appraise the scientific evidence for selected CAM therapies that are used by HIV-infected persons to manage three common symptoms: nutritional alterations, pain, and depression.

Promoting interactions with basic scientists and clinicians: the NIA Alzheimer's Disease Data Coordinating Center.

To benefit Alzheimer's disease research, a central data co-ordinating centre (CDCC) is planned that will systematically collect data from 27 Alzheimer's disease centres (ADCs) located nationwide. This CDCC will combine, analyse and disseminate epidemiologic, demographic, clinical and neuropathological data to researchers from the ADCs and the broader scientific community. New and larger scale collaborative studies on Alzheimer's disease will be possible through this centre. Since 1 July 1997, an interim data co-ordinating centre (IDCC) has been serving as the agent of the ADCs to begin the data sharing process until a permanent CDCC is established. The data collected by the IDCC are limited to administrative information and to indexing of specimens and clinical material, with future plans for the transfer of the data collected to the CDCC once it is established.

Interventions for cognitive impairment and neurobehavioral disturbances of older adults.

This synthesis of the research literature includes a discussion of selected neurobehavioral disturbances that accompany impairments in cognitive functioning in older adults. A combination of computerized and manual searches was used to access interdisciplinary and nursing research reports on the care and treatment of older adults who are cognitively impaired. The results demonstrated that protocols are needed that systematically integrate and evaluate extant working knowledge and evolving research bases for proactive preventive approaches to the care of cognitively impaired older adults with neurobehavioral disturbances.

Behavioral symptoms in dementia: an update.

A descriptive literature review was done to identify research conducted in both community and institutional settings and published from 1986 to 1993 on the correlates of behavioral symptoms associated with dementia. Critical appraisal and synthesis of the 40 studies revealed theoretical and methodological problems that tempered conclusions about the relationships between behavioral symptoms and the correlates under study. While direct relationships were found in studies in which relationships between behavioral symptoms and cognitive impairment and contextual factors were examined, contradictory results were found in studies of demographic and functional variables. Recommendations for research-based practice are advanced, including the development and testing of alternatives to physical and chemical restraints in the care of persons with dementia.

Acute confusion: nursing intervention in older patients.

Older patients are at high risk for developing acute confusion while hospitalized with an associated increased risk of morbidity and mortality. Causes for acute confusion include physiologic, psychosocial, and environmental alterations. Often not recognized by nurses, acute confusion needs to be differentiated from depression and dementia. Nursing assessment of acute confusion should include baseline data on cognition, behavior, and functional status. Standard, routine, and systematic assessments of cognition, behavior, and functional status need to be ongoing during hospitalization if nurses are to identify and manage acute confusion in hospitalized older patients.

Characterizing the neuropsychological functioning of persons with human immunodeficiency virus (HIV) infection, Part II. Neuropsychological functioning of persons at different stages of HIV infection.

Neuropsychological impairment has been reported to occur in persons at all stages of infection with the human immunodeficiency virus (HIV). However, the findings of studies to characterize the incidence and pattern of impairment have been limited by inconsistent definitions of impairment and the failure to control for confounding variables, such as hematological abnormalities, history of head injury, or substance abuse. In the present study, neuropsychological tests were administered to 141 persons at four stages of HIV infection. Significant differences were found in the percentage of persons who showed impairment at each stage of infection. Further, participants' performance on the tests tended to decline across progressive stages of infection. These findings may help psychiatric nurses identify and manage the changes associated with HIV infection.

Characterizing the neuropsychological functioning of persons with human immunodeficiency virus infection, Part I. Acquired immunodeficiency syndrome dementia complex: a review.

The findings of studies that use psychoneuroimmunological frameworks can help nurses evaluate and treat patients' psychological and physical responses to infection with the human immunodeficiency virus (HIV). One response to HIV infection, acquired immunodeficiency syndrome (AIDS) dementia complex (ADC), may occur at any stage of the infection and is particularly distressing to both patients and nurses. In Part I of this series, current research pertinent to ADC is reviewed. In Part II, we describe an approach used to characterize the neuropsychological functioning of persons at different stages of HIV infection.

Operationalizing dyspnea: focus on measurement.

Dyspnea is a multidimensional disorder that nurses and physicians deal with in a variety of settings. Because dyspnea can have major effects on the lives of patients, health care providers need to accurately assess the antecedents and reactions to dyspnea and to evaluate the efficacy of their individualized interventions. To help practitioners assess patients who experience dyspnea related to physiologic and psychogenic alterations, we critically appraised the current tools used to evaluate dyspnea and present an organizing framework to categorize these tools.

Dementia & depression in persons with AIDS: causes and care.

1. Nurses who care for AIDS patients are challenged to effectively manage two common problems: AIDS dementia complex (ADC) and depression. 2. Nurses can briefly assess certain neuropsychological functions related to ADC and differentiate dementia from depression. 3. Nursing interventions to manage the behaviors associated with ADC and depression can ensure patients' safety and promote the quality of their lives.

Increasing psychiatric inpatients' community adjustment through therapeutic passes.

Using several self-generated instruments, the authors monitored patient care records and interviewed psychiatric patients, psychiatrists, and psychiatric nurses to identify the role of passes in discharge planning and community adjustment and to assess passes' utility in the inpatient treatment program. Findings indicate that while therapeutic passes are considered an integral component of discharge planning and community adjustment, the purposes and use of passes are ambiguous. The authors offer suggestions to maximize the benefits of passes in promoting patients' transition from the hospital to home settings.

Return to work after rehabilitation following traumatic brain injury.

The relationship of medical variables and discharge functional status to vocational and educational outcomes was examined in 79 closed head-injured patients who were consecutively admitted to an inpatient rehabilitation hospital during a two-year period. A follow-up study, conducted after hospital discharge (median, 16.5 months), found that 66% (n = 52) of the patients had returned to work or school, while 34% (n = 27) did not. Patients were divided into return and non-return to work groups. Traditional variables included age, severity of brain-damage as characterized by CT head scan, duration of post-traumatic amnesia, duration of coma, length of stay and acute inpatient rehabilitation program. Discharge functional scores were analysed by t-tests and chi-square analysis. Results suggest that traditional factors of younger age, shorter length of coma, minimal CT head scan findings and shorter length of stay were significant contributors to educational/vocational outcome. Their significance was enhanced by discharge functional profile measurement of medical, physical and psychological/neuropsychological integrity. Those functional measures not significant were in social, vocational, recreational and communication areas. These factors may continue to improve over a longer period of time and should be tracked in the post-acute rehabilitation phase for their significance in return to work/school.