Older patients undergoing dialysis treatment: cognitive functioning, depressive mood and health-related quality of life.

An increasing number of older patients receive dialysis treatment to compensate for deficient kidneys due to end-stage renal disease (ESRD). Ethical questions arise about the benefits of dialysis when a patient appears unwilling or unable to comply with this treatment procedure. Such attitudes and behaviour may be due to psychological factors, but these are not routinely assessed. The purpose of this study was to evaluate levels of cognitive impairment, depressive mood and self-reported quality of life in older dialysis patients (>70 years). A total of 51 outpatients receiving dialysis were assessed by psychologists, using a depression scale (MADRS), two cognitive tests (MMSE and BEC 96), and a quality of life questionnaire (NHP). Sixty percent of the patients were depressed, and between 30-47% had cognitive impairment. Almost half of the depressed patients were also cognitively impaired. The scores for self-reported quality of life varied widely within the sample. Cognitive impairment and depressive mood are often overlooked and underestimated in this population. Regular assessments of depressive mood, cognitive ability and quality of life are recommended, given the prevalence of problems in these domains for older dialysis patients. The information obtained should assist staff as they reflect on individual cases where the benefits of continuing treatment are being examined.

Identification of quality of life concerns of patients with obstructive sleep apnoea at the time of initiation of continuous positive airway pressure: a discourse analysis.

BACKGROUND: Obstructive sleep apnoea syndrome (OSAS) is a common condition with multiple symptoms dominated by daytime somnolence. Thus many worries and concerns of patients remain hidden. Treatment by nasal continuous positive airway pressure (CPAP) can be imposing for the individual. An analysis of the freely expressed concerns of such patients is required. OBJECTIVE: To seek an in-depth analysis of how patients live with sleep apnoea by allowing them an open discourse and analysing the text of their statements. DESIGN: A trained psychologist conducted semi-directive interviews with patients attending a pulmonary rehabilitation and convalescent unit around the themes of sleep, health and treatment. An analysis of content and of discourse was carried out by textual analysis and by propositional analysis of discourse (PAD) with the aid of dedicated computer programs (Tropes, Sphinx Lexica). RESULTS: Thirty patients with severe sleep apnoea were interviewed of whom 15 were initiating treatment with CPAP. Patients spoke of abnormal fatigue (22 mentions) and somnolence (21 times). Many have problems with obesity (25 instances), snoring related problems (12). There were 30 mentions of depression with a relationship to alcohol and anti-depressives. Twenty six times the theme of nocturnal waking was raised. There were many instances of problems with CPAP (nasal mask and noise problems raised 21 times). Patients have problems with relationships and sex because of OSAS. Other concerns were loss of memory and fear of dying. CONCLUSION: In a non-directed conversation OSAS patients express concerns not revealed in the standard medical paradigm and such concerns should be addressed in assessing treatment or evaluating quality of life (QOL).

[A French tool for evaluation of home palliative care: adaptation of the Support Team Assessment Schedule]. / Un outil francophone d'évaluation des soins palliatifs à domicile: adaptation du Support Team Assessment Schedule (STAS).

The authors describe the utilisation of a quality assessment tool for palliative care administered at home. The questionnaire entitled Support Team Assessment Schedule (STAS) was translated from English for this study. It was then utilised comparatively with different quality of life evaluation instruments. Only the results of the STAS are described here. The approach allows for the unresolved problems in the care to come to the surface week after week. The STAS comprises nine items pertaining to the patient and his/her family, and seven items concerning the services provided. The study exhibits the results of 107 evaluations completed from 50 patients stricken with cancer or AIDS in an advanced phase. The availability of this auto clinical audit tool, employable at home or in a hospital, constitutes an essential initial step in the field of French-speaking clinical evaluation of palliative care.

[Psychological effects of parental separation on children]. / Conséquences psychologiques de la séparation parentale chez l'enfant.

A study on the psychological consequences of parental separation on children was performed among 3,098 pupils of first year secondary school during the 1995-1996 academic year in the department of Isère. The children family situation was compared with the results of personality test of Coopersmith (SEI). The main characteristics of the children, in particular family condition such as parental death or parental separation are in agreement with the French national data. Among the children with separated parents, 29% were less than 3 years old when their parents broke up. In 85% of the cases the child lived mainly with his/her mother, in 9% of the cases with his/her father, in 4% of cases in a joint-custody arrangement, in 1% of the cases in an other person's home. The overall SEI scores were good. There was a significant overrepresentation of girls with extreme scores. Compared with the scores of the children of unseparated parents, the average SEI scores were low for children with separated parents and for children with one dead parent, but differences were observed between girls end boys. The age of children at the time of the separation did not influence the SEI score and there was little influence of the father-child regular contacts.