Do community-dwelling Maori and Pacific peoples present with dementia at a younger age and at a later stage compared with NZ Europeans?

OBJECTIVE: Ethnicity may affect presentation to clinical services in people with dementia; however, no studies have examined this in Maori or Pacific peoples in New Zealand (NZ). Our objective was to examine the routinely collected clinical data from a memory assessment service in South Auckland to examine the presentation of dementia in the major NZ ethnic groups. METHODS: A total of 360 patients presenting to a memory service with a new diagnosis of dementia were included in this study. Demographic data (age, sex, and ethnicity) and dementia sub-type and severity were analyzed. RESULTS: There were 142 NZ European (mean age: 79.2, SD 7.4), 43 Maori (mean age: 70.2, SD 7.6), 126 Pacific (mean age: 74.3, SD 7.6), and 49 other ethnicities (mean age: 78.0, SD 8.5) presenting with a new diagnosis of dementia. After adjustment for gender and dementia subtype, Maori and Pacific patients were 8.5 and 5.3 years younger than NZ European patients (P < 0.0001). Pacific peoples tended to present with more advanced dementia (OR = 1.63, 95% CI: 0.98-2.70, P = 0.06) after adjustment for age and gender. There was little difference in the subtypes of dementia between ethnic groups. CONCLUSIONS: Maori and Pacific peoples with dementia presented to an NZ memory service at a younger age than NZ Europeans, and Pacific peoples presented with more advanced dementia. A population-based epidemiological study is critical to determine whether Maori and Pacific peoples have indeed a higher risk of developing dementia at a younger age.

Early onset dementia in New Zealand Pacific boxers: a case series.

AIM: To describe the biopsychosocial characteristics of a series of Pacific men living in South Auckland with a history of boxing presenting with early onset dementia. We discuss the history of boxing in Pacific people and the possibility of increased risk of early onset dementia in New Zealand Pacific men compared to their European counterparts. METHOD: We reviewed the files of Pacific men with a history of amateur or professional boxing who presented to our memory and older adult mental health services with early onset dementia over a 45-month period. We gathered relevant information to construct a biopsychosocial paradigm as possible explanation of this phenomenon. RESULTS: We identified a series of eight New Zealand Pacific men with early onset dementia and with a history of boxing. Alcohol was a contributing factor in seven of the eight cases, and vascular risk factors in five. CONCLUSION: Historical, cultural and socio-economic factors underpin the attraction of some Pacific men to boxing as a sport. Given that New Zealand Pacific peoples may have an earlier onset of dementia than their European counterparts, further research is required to establish whether boxing is a contributory factor. Sports physicians should advise young New Zealand Pacific boxers about the long-term risks associated with their sport.

Do clinicians assess patients' religiousness? An audit of an aged psychiatry community team.

OBJECTIVES: To determine the frequency and quality of religious history taking of patients by clinicians working in an old age psychiatry service. METHODS: A retrospective audit of 80 randomised patient files from the Koropiko Mental Health Services for Older People (MHSOP) in Middlemore Hospital, Auckland, New Zealand. RESULTS: A total of 66 clinical records were available for analysis. A religious history was taken in 33/66 (50%) patients. However, when such histories were evaluated using the FICA assessment tool, only 10/33 (30.3%) histories contained detailed information regarding the patient's religiousness. CONCLUSIONS: The infrequency and low quality of religious histories discovered in this audit suggest that clinicians need more training in taking a religious history from patients.

The importance of taking a religious and spiritual history.

OBJECTIVE: The objective of this study was to explain the reasons for taking a religious and spiritual history, which is often neglected by psychiatrists, and to introduce some religious and spiritual assessment tools to assist those psychiatrists who feel inexperienced in this area. CONCLUSION: Religious and spiritual assessment enhances quality of patient care. Training programs for psychiatry registrars need to include modules on religious and spiritual assessment of patients.

Falling for her psychiatrist: an unusual cause of falls in the elderly.

We describe the case of an elderly woman with auditory hallucinations of her psychiatrist commanding her to fall. The case highlights an unusual cause of falls in the elderly, not previously described in the falls literature.

Psychotherapeutic treatments in late life.

PURPOSE OF REVIEW: To assess recent research in psychotherapies for the elderly. RECENT FINDINGS: There is preliminary evidence for the effectiveness of cognitive-behaviour therapy in panic disorder, and problem-solving therapy in depression with cognitive impairment. Significant advances have been made showing the benefits of cognitive-behaviour therapy in the medically ill. Examples of public and private psychotherapy services are also described. SUMMARY: There remain many virgin territories awaiting exploration. Psychotherapists and researchers working with the elderly are encouraged to report case studies and to embark on randomized controlled trials. Cognitive-behaviour therapy is the dominant paradigm, but other therapies, such as interpersonal psychotherapy and brief psychodynamic psychotherapy, are also worthy of further study.

Religiousness and recovery from inpatient geriatric depression: Findings from the PEJAMA Study.

OBJECTIVE: To determine whether religiousness, in particular intrinsic religiosity, influences the prognosis of elderly inpatients with major depression, and, if so, whether this effect is related to social support. METHOD: A total of 94 patients (71% women; mean age = 76) with DSM-IV major depression were assessed on admission to a psychogeriatric unit in Melbourne, and then reviewed at 6, 12 and 24 months. Depression was measured using the Geriatric Depression Rating Scale - short form, religiousness, using the five-item Duke University Religion Index, and social support using the Social Support Questionnaire. RESULTS: Just over one-third of the sample was highly intrinsically religious. High intrinsic religiosity on admission predicted lower depression scores at 24 months (standardised beta = 0.252; P < 0.05). Intrinsic religiosity's effect was independent of social support as well as other demographic, treatment and health variables. CONCLUSION: Intrinsic religiosity (i.e. a person's commitment to and motivation by religious beliefs) predicts lower depression scores over time among inpatients with geriatric depression. Psychogeriatricians should consider a patient's religious history in order to make informed judgements about depression prognosis.

Confabulation: a spontaneous and fantastic review.

Confabulation can be of two types: provoked or spontaneous. The former is the more common and can occur on challenge to an amnesic patient's memory. Spontaneous confabulation involves an unprovoked outpouring of unbelievable autobiographical claims. The purpose of the present paper is to synthesize the current literature on confabulation for the use of treating clinicians. There is a focus on the spontaneous form, which is less common, but more memorable when encountered. In this paper the history, phenomenology, incidence, anatomical underpinnings and theoretical mechanisms of spontaneous confabulations will be reviewed, and then the paper will conclude by addressing prognostic and treatment issues. A systematic literature review of electronic databases was conducted to identify the key articles, reviews and books that have shaped the understanding of spontaneous confabulation.

Religiosity of depressed elderly inpatients.

OBJECTIVES: To determine the prevalence of religious practices and beliefs of depressed elderly Australian inpatients and their relationship to physical, social, and cognitive variables known to influence the prognosis of depression in the elderly. To compare the results obtained with those from similar North American studies. METHODS AND PROCEDURES: Inpatients with a DSM-IV diagnosis of major depression were interviewed on admission to the psychogeriatric unit of a Melbourne geriatric centre. Information collected included patient demographics, intrinsic and extrinsic religiosity, cognitive function, severity of depression, number of chronic illnesses, physical function, and numbers and quality of social support. Pearson correlation and multivariate analysis using a standard regression model were used to examine relationships between the religious and other variables. RESULTS: Of the 86 patients who completed the assessment, 25% attended church regularly and 37% prayed, meditated, or read the Bible, at least once a day. Just over half rarely or never engaged in such behaviours. Three out of every eight patients were 'intrinsically' religious. Religious patients expressed higher levels of social support and physically disabled patients were more likely to be religious. CONCLUSIONS: Depressed elderly Australian inpatients are less religious than their North American counterparts. Nevertheless, religion remains important for a large minority of such individuals. Clinicians need to be aware that such individuals may turn to religion when depressed, especially to cope with the presence of physical disability.