Psychosocial impact of being diagnosed with mild cognitive impairment: patient and carer perspective.

BACKGROUND: Mild cognitive impairment (MCI) may represent an intermediate, prodromal phase of dementia. Although persons with MCI (PwMCI) are able to function independently, they often experience reduced ability to carry out their usual activities. This can result in social, emotional and functional challenges. AIMS: To explore the understanding and psychosocial impact of receiving a diagnosis of MCI on patients and carers. METHOD: A cross-sectional cohort study was conducted at St James's Hospital Memory Clinic involving patients who attended the clinic for assessment from 1 January 2020 to 30 April 2021 and received a diagnosis of MCI. We completed questionnaires with patients and a nominated family member or friend of each patient (FwMCI). RESULTS: Forty-seven PwMCI participated in the study, and 36 nominated family members and/or friends completed the FwMCI questionnaire. In our cohort of PwMCI, most of the participants were not aware of their diagnosis; only 21% used the term MCI, and only 25% attributed their problems to a pathological cause. The majority of participants had no recollection of any discussion around the likelihood of progression. One-third of participants expressed relief that they did not have dementia. Most PwMCI reported positive psychological well-being and did not endorse symptoms of depression or anxiety. There was slight discordance of illness perception among the PwMCI-FwMCI dyads. Forty-seven per cent of FwMCI reported at least a mild degree of carer burden on the Zarit Burden Scale. CONCLUSIONS: Patients' awareness of being diagnosed with MCI is relatively limited. Public education campaigns raising awareness about MCI can help influence the 'illness representation' for MCI and enable people to seek timely advice and support.

Risk factors and outcomes of delirium in hospitalized older adults with COVID-19: A systematic review and meta-analysis.

Background: Older adults with COVID-19 are more likely to present with atypical symptoms, notably delirium. The main objective of this meta-analysis is to identify risk factors for delirium and outcomes of delirium in hospitalized older adults (65 years or above) with COVID-19. Methods: Comprehensive literature search of Embase, CINAHIL, Medline and Web of Science was performed for published literature until 31st August 2021. Two independent researchers evaluated study eligibility and assessed study quality using the Newcastle Ottawa Scale (NOS) for cohort studies and Joanna Briggs Institute (JBI) critical appraisal tools for case series. The association of various predisposing factors with delirium in this cohort was reported as odds ratio (OR) and its 95% confidence interval (CI). Results: A total of 31 studies from 11 countries were included in this review. Most of the included studies investigated patients from non-ICU settings (n = 24; 77.4%). Frailty (OR 3.52, 95% CI: 1.96-6.31, p<0.0001, I2=71.63%), cognitive impairment including dementia (OR 6.17, 95% CI: 2.92-13.07, p<0.00001, I2=88.63%) and being nursing home residents (OR 1.72, 95% CI: 1.31-2.24, p<0.0001, I2=0) were significantly associated with increased likelihood of developing delirium in older adults with COVID-19. The presence of delirium also significantly increases mortality risk in hospitalized older adults with COVID-19 (OR 2.51, 95% CI: 1.51-4.17, p<0.0001, I2=89.3%). Conclusion: Our review identifies key factors associated with increased risk of developing delirium in hospitalized older adults with COVID-19. Identification of patients at risk of delirium and attention to these factors early during admission may improve outcomes for this vulnerable cohort.

Old age liaison psychiatry during COVID-19; an audit of pre- and mid-pandemic service provision.

Older adults in acute hospitals are uniquely vulnerable to mental illness during the COVID-19 pandemic. We describe two eighteen-week periods of specialised liaison psychiatry for older inpatients in a large teaching hospital, pre- and mid-pandemic. Service delivery went from almost completely via face-to-face consultation in the Routine period, to majority remote work in the Pandemic period. During the Routine period, 195 patients were assessed, and patients received a mean number of 2.6 consultations (range 1-15). In the Pandemic period, 197 patients were assessed and received 3.1 consultations on average (range 1-19). Patient age trended toward older in the Pandemic period, mean 77 years (SD 6.9) vs 78 years (SD 1.32) in the Routine period. There were more referrals for behavioural disturbance and confusion during the Pandemic period, and more diagnoses of Behavioural and Psychological Symptoms of Dementia, Delirium and Adjustment Disorder during the Pandemic period vs the Routine period.

Consultation-Liaison Psychiatry Services in Ireland: A National Cross-Sectional Study.

Objective: This study aimed to describe the provision of consultation-liaison psychiatry (CLP, also known as liaison psychiatry) services in acute hospitals in Ireland, and to measure it against recommended resourcing levels. Methods: This is a survey of all acute hospitals in Ireland with Emergency Departments, via an electronic survey sent by email and followed up by telephone calls for missing data. Data were collected on service configuration, activity, and resourcing. Data were collected from CLP or proxy services at all acute hospitals with an Emergency Department in Ireland (n = 29). This study measured staffing and activity levels where available. Results: None of the services met the minimum criteria set out by either national or international guidance per 500 bed general hospital. Conclusions: CLP is a relatively new specialty in Ireland, but there are clear international guidelines about the staffing levels required to run these services safely and effectively. In Ireland, despite clear national guidance on staffing levels, no services are staffed to the levels suggested as the minimum. It is likely that patients in Ireland's acute hospitals have worse outcomes, and hospitals have unnecessary costs, due to this lack. This is the first study of CLP provision in Ireland and demonstrates the resource constraints under which most services work and the heterogeneity of services nationally.

What is the effect of larval therapy on the debridement of venous leg ulcers? A systematic review.

AIM: To determine the impact of larval therapy on the debridement of venous leg ulcers, in comparison to other debridement methods or no debridement. METHOD: Using systematic review methodology, published quantitative studies focusing on the effect of larval therapy on the debridement of venous leg ulcers were included. The search was conducted in January 2020 and updated in May 2021 using CINAHL, PubMed, Embase, and the Cochrane library, and returned 357 records, of which six studies met the inclusion criteria. Data were extracted using a predesigned extraction tool and all studies were quality appraised using the RevMan risk of bias assessment tool. RESULTS: Larval therapy was found to debride at a faster rate than hydrogel (p = 0.011, p < 0.001, p = 0.0039), have a similar effect to sharp debridement (p = 0.12, p = 0.62), and was a resource-effective method of debridement (p < 0.05, p < 0.001, p < 0.001). When larval therapy in combination with compression therapy was compared to compression alone, larvae had a greater effect on debridement (p < 0.05), however, it did not improve overall wound healing rates (p = 0.54, p = 0.664, p = 0.02). Pain levels increased during larval therapy and reduced after treatment, when compared to other standard debridement techniques. CONCLUSION: Larval therapy promotes rapid debridement of venous leg ulcers. However, further high quality randomised controlled trials, comparing larval therapy to other debridement methods for venous leg ulcers, incorporating the use of compression is required to determine the long term effects of larval therapy.

Survey of NCHDs in Ireland to assess their views and opinions in relation to participation in health research and the impact of new Irish data protection regulations.

BACKGROUND: Since August 2018, Irish health research is regulated by the European General Data Protection Act (GDPR) 2016 with the (Irish) Data Protection Act and Health Research Regulations (HRR) 2018. The Irish application of GDPR has been criticised by consultants and academics as overly restrictive; however, Non-consultant Hospital Doctor's (NCHD's) perspectives have not been explored. OBJECTIVES/AIMS: This project aimed to collect the views of NCHDs in Ireland in relation to health research and the impact of GDPR and HRR. Internationally barriers to engagement with health research have been identified; however, to our knowledge, no previous studies have been conducted in Ireland. METHODS: Agreeable Irish specialty colleges and faculties distributed an online survey to their NCHDs. Social media platforms were also used to promote the survey. All data collected was anonymised. RESULTS: A total of 192 NCHDs completed the survey; respondents included doctors from 13 specialties, with representation from each NCHD grade. Ninety-nine percent had previously participated in research, and 87% acknowledged the importance for doctors to be involved in research. Forty-four percent of NCHDs stated they would consider travelling abroad to complete research. Eighty-six percent agreed training relating to the new regulations would be useful; however, only 25% had received training. CONCLUSIONS: Our results confirm that NCHDs in Ireland are enthusiastic about engaging in research. The majority acknowledge the value of research in career development. Engaging in research abroad could be further explored as a factor impacting emigration. Our findings show that NCHDs in Ireland are concerned about the impact of GDPR and HRR and are seeking further training.

The detection, diagnosis, and impact of cognitive impairment among inpatients aged 65 years and over in an Irish general hospital - a prospective observational study.

BACKGROUND: The diagnosis of dementia remains inadequate, even within clinical settings. Data on rates and degree of impairment among inpatients are vital for service planning and the provision of appropriate patient care as Ireland's population ages. METHODS: Every patient aged 65 years and over admitted over a two-week period was invited to participate. Those who met inclusion criteria were screened for delirium then underwent cognitive screening. Demographic, functional, and outcome data were obtained from medical records, participants, and family. RESULTS: Consent to participate was obtained from 68.6% of the eligible population. Data for 143 patients were obtained. Mean age 78.1 years. 27.3% met criteria for dementia and 21% had mild cognitive impairment (MCI). Only 41% of those with dementia and 10% of those with MCI had a previously documented impairment. Between-group analysis showed differences in length of stay (p = 0.003), number of readmissions in 12 months (p = 0.036), and likelihood of returning home (p = 0.039) between the dementia and normal groups. MCI outcomes were similar to the normal group. No difference was seen for one-year mortality. Effects were less pronounced on multivariate analysis but continued to show a significant effect on length of stay even after controlling for demographics, personal and family history, and anxiety and depression screening scores. Patients with dementia remained in hospital 15.3 days longer (p = 0.047). A diagnosis is the single biggest contributing factor to length of stay in our regression model. CONCLUSIONS: Cognitive impairment is pervasive and under-recognized in the acute hospital and impacts negatively on patient outcomes.

The spectrum of worry in the community-dwelling elderly.

OBJECTIVES: In this study, we examine the prevalence and distribution of worry, its content, and its associations with quality of life and depression, based on a large sample of community-dwelling elderly. We will attempt to distinguish between pathological and non-pathological worry based on these associations. DESIGN: Community survey. SETTING: Inner-city population. PARTICIPANTS: A total of 2136 people aged between 65 and 96, of whom 66% were women, were recruited through general practitioners and interviewed in their own homes. MEASUREMENTS: The GMS-AGECAT structured psychiatric interview was used to rate symptoms which were classified into five levels of severity of worry ranging from simple, non-excessive to generalised anxiety disorder (GAD). RESULTS: In this study, 79% of the participants reported worrying, 37% worrying excessively, while 20% reported excessive, uncontrollable worry and 6.3% met criteria for GAD. Prevalence of all types of worry declined with age and was lower in men. The prevalence of depressed mood was similar in those without worry and those with non-severe worry (Wald post hoc test, p = 0.06) but rose significantly with each level of severe worry (Wald post hoc tests, all p < 0.05). Major depressive disorder was absent in those who did not worry, and had a prevalence of only 0.2% in those with non-severe worry (p = 0.552, Fisher's exact test). It has a significantly elevated prevalence at all levels of excessive worry, and a significantly higher prevalence in those with GAD. All levels of excessive worry were associated with reduced quality of life. CONCLUSION: Severe worry is highly prevalent in the elderly; most severe worriers do not meet criteria for GAD, but have a reduced quality of life and an increased prevalence of depression.

Late life depression: a comparison of risk factors and symptoms according to age of onset in community dwelling older adults.

BACKGROUND: It has been reported that late onset depression is more frequently associated with acquired organic pathology and that patients are less likely to report a family history of depression. Differences in phenomenology according to age of onset have been described although these have not been consistently replicated. The majority of these studies have been in hospital populations. The aim of this study is to address this question in a sample of community dwelling older adults. METHODS: 89 subjects with GMS-AGECAT depression were identified from a sample of 1231 community dwelling adults aged 65 years and over. Subjects were analysed across a range of aetiological and phenomenological variables according to age of onset of first depressive episode. RESULTS: Subjects with late onset depression (≥ 60) were significantly less likely to report a family history of depression, were less likely to report previous hospitalisation for depression and had greater cognitive impairment. Late onset subjects were also less likely to report feelings of guilt or thoughts that life was not worth living in the previous month. CONCLUSION: While we found that patients with late onset depression differed from early onset patients according to certain aetiological risk factors, we did not find a distinctive profile of depressive symptomatology which might be considered clinically useful at an individual level. These findings are consistent with studies based in hospital populations.

Loneliness, social support networks, mood and wellbeing in community-dwelling elderly.

OBJECTIVE: Both loneliness and social networks have been linked with mood and wellbeing. However, few studies have examined these factors simultaneously in community-dwelling participants. The aim of this study was to examine the relationship between social network, loneliness, depression, anxiety and quality of life in community dwelling older people living in Dublin. METHODS: One thousand two hundred and ninety-nine people aged 65 and over, recruited through primary care practices, were interviewed in their own homes using the GMS-AGECAT. Social network was assessed using Wenger's typology. RESULTS: 35% of participants were lonely, with 9% describing it as painful and 6% as intrusive. Similarly, 34% had a non-integrated social network. However, the two constructs were distinct: 32% of participants with an integrated social network reported being lonely. Loneliness was higher in women, the widowed and those with physical disability and increased with age, but when age-related variables were controlled for this association was non-significant. Wellbeing, depressed mood and hopelessness were all independently associated with both loneliness and non-integrated social network. In particular, loneliness explained the excess risk of depression in the widowed. The population attributable risk (PAR) associated with loneliness was 61%, compared with 19% for non-integrated social network. Taken together they had a PAR of 70% CONCLUSIONS: Loneliness and social networks both independently affect mood and wellbeing in the elderly, underlying a very significant proportion of depressed mood.

Screening for dementia in an Irish community sample using MMSE: a comparison of norm-adjusted versus fixed cut-points.

BACKGROUND: The MMSE is a widely-used instrument in screening for dementia in the community. The traditional cut-point of <24/30 may be unsuitable for use in some settings, due to biases in age and education. OBJECTIVES: This study aimed to investigate whether cut-points derived from age- and education-specific norms would improve the performance of the MMSE as a screening tool for dementia and cognitive impairment in an Irish community setting, potentially reducing the number of onward referrals. A secondary aim was to obtain score norms in an Irish sample. METHODS: One thousand one hundred and fifteen people aged over 65 (mean age 74.8+/-6.8 years; 68% female) were assessed in their own homes, using MMSE (world) and the AGECAT computerised diagnostic system for mental illness in the elderly. The performance of the MMSE in identifying case- and sub-case-level dementia was investigated using cut-points of <24 and <23, as well as adjusted cut-points based on published norms and norms derived from the Irish sample. RESULTS: Published norms did not prove useful in improving screening accuracy. Cut-points based on 10th percentile Irish norms and the <23 cut-point performed comparably well, both yielding 93% specificity, with overall accuracy of 90% and 91% respectively (as sensitivity was higher for the <23 cut-point). CONCLUSIONS: Locally-derived norms yielded better screening accuracy than did published norms or the traditional <24 cut-point. The importance of selecting an appropriate percentile cut-off when using norms is discussed. The best results were obtained with a simple <23 cut-point, and this may be optimal when screening for dementia in an Irish community setting.

Self-reported alcohol consumption in the Irish community dwelling elderly.

OBJECTIVES: To examine the associations of self-reported alcohol consumption in a community based sample of elderly subjects. METHODS: A total of 518 non-institutionalised community dwelling elderly identified from general practice registers were interviewed in their own homes using the Geriatric Mental State (GMS-AGECAT), the Mini-Mental State Examination and the sociodemographic questionnaire. Physical health was rated on a six-point scale. Self reported alcohol consumption was recorded in units per week. The group was then divided according to the presence or absence of excessive alcohol consumption (ie. consumption of over 14 units per week for females and 21 units per week for males). Results were analysed using multivariate regression analysis with excessive alcohol consumption as the dependent variable. RESULTS: The mean age of the sample was 73 (range 65-95), 63% (n = 329) were female. Thirty-six per cent of the population were abstinent and 7% reported excessive alcohol consumption. Analysis of the data revealed no association between excessive alcohol consumption and diagnosis, age, cognitive function or poor physical health. Excess consumption was found to be significantly associated with gender (male) and widowed status (p < 0.001, p = 0.013 respectively). CONCLUSIONS: As alcohol misuse is commonly missed in the elderly identifying high risk groups is important for the development of intervention strategies. Our results suggest that elderly widowers may be more at risk than their peers of alcohol misuse.