RESUMO
Normal, depressed, and demented elderly persons who were identified by means of a community survey were asked to assess their memories and to complete a battery of memory tests. Depressed elderly persons reported memory problems more often than normal subjects and reported indecisiveness, impaired concentration, and mental slowing more often than demented subjects. However, memory complaints and memory performance correlated poorly in the normal and depressed groups. Normal and demented elderly persons who reported memory problems achieved higher scores on a series of questions about depression than those who denied memory problems.
Assuntos
Demência/diagnóstico , Transtorno Depressivo/diagnóstico , Transtornos da Memória/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Atitude Frente a Saúde , Demência/complicações , Transtorno Depressivo/complicações , Diagnóstico Diferencial , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Transtornos da Memória/complicações , Escalas de Graduação Psiquiátrica , Testes PsicológicosRESUMO
BACKGROUND: Incidence studies have been relatively neglected in psychiatric epidemiology. They are particularly important for dementia, since prevalence rates are affected by length of survival, which itself falls with increasing age and presence of dementia. METHODS: Two-wave community study of 1195 elderly subjects aged older than 75 years, restudied 2.4 years after a community prevalence study. A two-stage method was used, comprising the Mini-Mental State Examination followed in a stratified sample by the Cambridge Examination for Mental Disorders of the Elderly (CAM-DEX) interview. Incidence rates were based on person-years at risk. RESULTS: Annual incidence rates for dementia were 2.3% for subjects initially aged 75 to 79 years, 4.6% for ages 80 to 84 years, and 8.5% for ages 85 to 89 years, approximately doubling every 5 years. Rates did not differ significantly by sex, educational level, or social class. Twice as many additional individuals received a diagnosis of minimal dementia not reaching case threshold. CONCLUSIONS: The findings show high rates of new onset dementia, increasing markedly with age, and suggest rapid acceleration of one or more processes that is common in advanced age.
Assuntos
Demência/epidemiologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Demência/diagnóstico , Escolaridade , Feminino , Humanos , Incidência , Masculino , Prevalência , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Distribuição por Sexo , Classe Social , Reino Unido/epidemiologiaRESUMO
Many epidemiologists base their diagnoses of dementia on scores on brief cognitive tests, but the border between normal aging and mild dementia is so poorly understood that simple demarcations cannot adequately encapsulate the wealth of clinical material that needs to be taken into account in assigning diagnostic labels. Data from a British study of the prevalence and natural history of dementia, in which diagnoses of dementia were made by clinicians using a new, standardized interview schedule, are presented to demonstrate the effects of physical disability, psychiatric illness, and other factors on memory impairment and performance in everyday life. Our purpose is not to insist that clinicians are always correct but rather to highlight the complexities involved and the need for investigators to be more open about the way in which they distinguish between physical, psychiatric, and cognitive infirmities.
Assuntos
Medicina Comunitária , Demência/diagnóstico , Inquéritos Epidemiológicos , Idoso , Avaliação da Deficiência , Feminino , Humanos , Entrevista Psicológica , Masculino , Memória , Testes Neuropsicológicos , Reino UnidoRESUMO
Thirty-one subjects aged 75 years and over who were identified as suffering from mild, idiopathic dementia in a large community survey were reviewed at annual intervals for 2 years. Diagnoses and severity ratings were based on defined criteria following a mental state examination, a medical and psychiatric history, detailed cognitive testing, and an interview with relatives or other key informants. Fourteen subjects became more severely demented within 2 years. The initial cognitive test battery failed to reveal any differences between respondents whose dementia advanced and those whose condition remained unchanged, but, in the former group, subjects' symptoms had been present for longer, and a greater proportion had been recognised as demented, or possibly demented, by their general practitioners. We suggest that subjects whose dementia progressed had actually been more severely disabled at the time of identification.
Assuntos
Demência/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/fisiopatologia , Demência/fisiopatologia , Feminino , Humanos , Masculino , Prognóstico , Testes PsicológicosRESUMO
The Mini-Mental State (MMSE) was administered to 2302 general practice patients aged 75 yr and over. Those scoring 23 or less and a sample of those scoring 24 or 25 were selected for further investigation using the Cambridge Mental Disorders of the Elderly Examination. Inter-observer reliability was high with a mean kappa value of 0.97. Eighty-six per cent of respondents judged to have organic mental disorders scored 23 or less on the MMSE and 92% of those judged to be cognitively intact scored 24 or more. However, only 55% of respondents who scored 23 or less were demented or delirious while a number of relatively well educated, mildly demented subjects scored 24 and 25. The customary cut-off point of 23/24 may need to be revised in future community studies. MMSE scores cannot be used to make even tentative psychiatric diagnoses; more detailed investigation of low scorers is essential.
Assuntos
Demência/diagnóstico , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Delírio/diagnóstico , Delírio/psicologia , Demência/psicologia , Feminino , Hospitalização , Humanos , Masculino , Psicometria , Sensibilidade e Especificidade , Gravação em FitaRESUMO
OBJECTIVE: To test whether early diagnosis and practical help reduce the number of elderly people with dementia admitted to institutions. DESIGN: Controlled trial of effect of help from a multidisciplinary team on admission rates of people with dementia. SETTING: Seven general practices in Cambridge. SUBJECTS: 2889 subjects aged 75 and over, of whom 159 were identified as having dementia with a two stage community survey. Eighty six subjects were referred for extra help if they or their supporters wished. The other 73 subjects had access to the usual services and served as controls. INTERVENTION: Subjects and families in the action group were offered a wide range of help, including financial benefits, physical aids, home helps, respite admissions, practical advice, and psychiatric assessments. MAIN OUTCOME MEASURE: Permanent admission to long term care within two years after diagnosis. RESULTS: Early intervention did not affect admission rates in subjects who lived with supporters. By contrast, nine of the 14 (64%) subjects with moderate or severe dementia living alone were admitted in the action group in the study's second year compared with only one of 13 (8%) controls (p = 0.004). CONCLUSIONS: Some people with moderate or severe dementia who lived alone and were at serious risk may have been identified earlier by the resource team. Without the team these people would not have become known to the responsible authorities until families, neighbours, and wardens became unable to cope. The study was conducted during the team's formative period, however, and greater experience might have allowed some subjects to remain at home for longer.
Assuntos
Demência/enfermagem , Institucionalização , Idoso , Idoso de 80 Anos ou mais , Demência/diagnóstico , Feminino , Serviços de Assistência Domiciliar , Assistência Domiciliar , Habitação , Humanos , Assistência de Longa Duração , Masculino , Equipe de Assistência ao Paciente , Encaminhamento e Consulta , Fatores de RiscoRESUMO
General practitioners and community nurses were asked to rate the likelihood of dementia for each of their elderly patients. Cases of dementia were identified by research psychiatrists using the Cambridge mental disorders of the elderly examination (CAMDEX), a new structured diagnostic interview. General practitioners correctly identified dementia as at least a possibility in 121 of the 208 cases found. Nevertheless, they mistakenly rated as demented several patients suffering from functional psychiatric disorders, in particular depression. Community nurses correctly identified dementia as at least a possibility in 64 of the 74 demented patients known to them, but they incorrectly suspected dementia in a greater proportion of instances. Both general practitioners and families appeared to have low expectations of what general practice has to offer demented elderly people. General practitioners should take the initiative in diagnosing dementia in very elderly patients who show signs of the condition. In some cases it may be secondary to treatable disorders, and in others all that may be required are understanding, support, and advice to families.
Assuntos
Demência/diagnóstico , Medicina de Família e Comunidade , Idoso , Competência Clínica , Enfermagem em Saúde Comunitária , Erros de Diagnóstico , Inglaterra , Humanos , Diagnóstico de Enfermagem , Escalas de Graduação PsiquiátricaRESUMO
This article traces the beginning of African Americans in the nursing profession in the state of North Carolina with particular emphasis on the origin and demise of the St. Agnes School of Nursing at St. Augustine's College in Raleigh, NC.
Assuntos
Negro ou Afro-Americano/história , Escolas de Enfermagem/história , Cristianismo/história , Docentes de Enfermagem/história , História do Século XIX , História do Século XX , Hospitais Religiosos/história , Humanos , North CarolinaRESUMO
Trained and inspired by the Henry Street Settlement, this Pennsylvania-born nurse made the health of the people of remote Mitchell County, North Carolina, her life's work. Her courage and persistence attracted the attention of the national press and President Hoover, yet today she is all but forgotten.
Assuntos
Enfermagem em Saúde Comunitária/história , História do Século XX , Humanos , North Carolina , Saúde da População Rural/históriaRESUMO
Nursing history is largely unknown, even by practicing professional nurses. The lives and work of our nursing predecessors can serve as inspiration as we deal with the current issues that confront us. The story of Lina Rogers Struthers, the first school nurse in North America, should be of particular interest to today's school nurses.
Assuntos
Serviços de Enfermagem Escolar/história , História do Século XIX , História do Século XX , Humanos , Ontário , Estados UnidosRESUMO
This paper examines the assumption that dementia in old age is a universal phenomenon that will vary in its prevalence and manifestation because of social and cultural factors. It finds that while researchers have been successful in demonstrating the commonality of dementia, they have been less successful in showing whether or not it varies across cultures and between social and ethnic groupings. The inconclusiveness of findings may, in part, be a function of diagnostic differences and the research methodologies employed. New instruments and measures are being devised to overcome these problems. However, the sociocultural context in which dementia occurs and the meaning of the disorder to those involved (as sufferers and caregivers) are often missing dimensions. In particular, there is little knowledge about how the disorders of old age in non-Western settings are experienced and understood. In this respect anthropology has a special contribution to make to research on dementia.
Assuntos
Envelhecimento/etnologia , Atitude Frente a Saúde/etnologia , Comparação Transcultural , Demência/etnologia , Idoso , Envelhecimento/psicologia , Antropologia Cultural/métodos , Demência/diagnóstico , Demência/epidemiologia , Demência/etiologia , Países em Desenvolvimento/estatística & dados numéricos , Etnicidade/psicologia , Etnicidade/estatística & dados numéricos , Psiquiatria Geriátrica/métodos , Humanos , Testes Neuropsicológicos/normas , Percepção Social , Terminologia como Assunto , OcidenteRESUMO
The concept of dementia in old age in Australian Aboriginal and Torres Strait Islander communities is intrinsically paradoxical. Firstly, few indigenous people reach old age. Secondly, from some indigenous points of view, dementia is either not recognized as a condition or as a problem, or, in the case of the more disruptive manifestations of cognitive impairment, is perceived as 'madness'. Moreover, in the wider context of profound political, social and economic inequality experienced by most indigenous people, the western medical category of dementia may appear to be of relatively minor importance. However, government initiatives in aged care generally and dementia care in particular which are designed to address the ageing of the Australian population as a whole also include the nation's older indigenous people. This article-based on a review of published work, supplemented by discussions with indigenous and non-indigenous individuals involved in indigenous aged care and mental health-examines some of the issues surrounding cognitive decline in old age for Aborigines and Torres Strait Islanders. More specifically, it looks at the problems involved in assessing and diagnosing cognitive decline and dementia, especially among people who follow more traditional ways of life, and in providing services to sufferers and their carers. In doing so, it considers some of the relative meanings of "old age', "abnormal old age', "mental disorder', "sickness' and "dementia'.
Assuntos
Demência/diagnóstico , Avaliação Geriátrica , Havaiano Nativo ou Outro Ilhéu do Pacífico/psicologia , Idoso , Demência/etnologia , Demência/psicologia , Feminino , Serviços de Saúde para Idosos , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Grupos RaciaisRESUMO
The years of the great depression were marked with unemployment and economic ruin for many people. Americans were left feeling helpless and hopeless. After the 1932 presidential election of Franklin Roosevelt, his administration embarked on a course of government known as the New Deal. Many new and innovative programs were established to create jobs and a sense of hope for the public. This article will examine four programs that were of particular interest to nursing: the Federal Emergency Relief Act, the Civil Works Act, the Works Progress Act, and the Social Security Act. Nurses of the time embraced these programs. They participated in their development and implementation and made a difference in the lives of many desperate Americans.
Assuntos
Enfermagem em Saúde Comunitária/história , Programas Governamentais/história , Programas Governamentais/legislação & jurisprudência , História do Século XX , Humanos , North Carolina , Pobreza/história , Socorro em Desastres/história , Socorro em Desastres/legislação & jurisprudência , Estados UnidosRESUMO
We report here on the coexistence of dementia and depression in a community population aged 75 years and older. Complete information about mood and cognition was available for 286 cognitively intact subjects selected for assessment because of their low scores on the Mini-Mental State, and for 158 mildly and moderately demented subjects. Severely demented subjects, who were incapable of providing information, were excluded. Five percent (8/158) of demented subjects also fulfilled criteria for major depressive disorder Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III) compared with 9% (27/286) of cognitively intact subjects. No substantial differences existed in the symptoms reported by demented depressives and nondemented depressives, but subjects who suffered from both disorders were so markedly apathetic that their depression might easily have been overlooked had specific enquiries not been made. Depression was particularly associated with dementia secondary to multi-infarct and Parkinson's disease. When reviewed one year later, 2 of the 18 surviving depressed, nondemented subjects showed evidence of dementia. Both presented unusual diagnostic difficulties, however, and no evidence emerged that large numbers of elderly people will be misclassified in community surveys that include a mental state examination, cognitive testing, and an informant interview.
Assuntos
Demência/epidemiologia , Transtorno Depressivo/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Demência/complicações , Demência/diagnóstico , Transtorno Depressivo/complicações , Transtorno Depressivo/diagnóstico , Diagnóstico Diferencial , Inglaterra/epidemiologia , Feminino , Humanos , Incidência , Masculino , Entrevista Psiquiátrica Padronizada , Escalas de Graduação Psiquiátrica , Qualidade de VidaRESUMO
We have reported previously that poorly educated elderly people and those of low social class were at much increased risk of scoring below the customary cut-point on the Mini-Mental State Examination, a widely-used, brief cognitive screening test. As part of the same study, subjects who scored 23 or less on the MMSE out of a maximum of 30 points, and a sample of those who scored 24 or 25 points, were assessed by psychiatrists using a structured, diagnostic interview. Assuming that persons who scored 26 points or above were cognitively intact (our data suggest that 2% or less were not), neither educational attainment nor social class had any influence on the likelihood that subjects would be diagnosed as demented. Our data suggest that social and psychological factors contribute substantially to cognitive test scores and serve to emphasize the importance of detailed assessment procedures in epidemiological surveys of dementia.
Assuntos
Demência/diagnóstico , Escolaridade , Classe Social , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Demência/epidemiologia , Demência/psicologia , Inglaterra/epidemiologia , Medicina de Família e Comunidade , Feminino , Humanos , Incidência , Masculino , Viés de SeleçãoRESUMO
OBJECTIVE: The aim of this study was to assess health professionals' beliefs about the helpfulness of a broad range of possible interventions for mental disorders. METHOD: The study involved a postal survey of 872 general practitioners (GPs), 1128 psychiatrists and 454 clinical psychologists. These health practitioners were presented with a vignette describing either a person with schizophrenia or one with depression. The vignettes were taken from an earlier survey of the general public. Respondents were asked to rate the likely helpfulness of various types of professional and non-professional help and of pharmacological and non-pharmacological interventions. RESULTS: Two-thirds or more of each profession agreed that the person with schizophrenia would be helped by GPs, psychiatrists, clinical psychologists, antipsychotic agents and admission to a psychiatric ward. Similarly, two-thirds agreed that the person with depression would be helped by GPs, psychiatrists, clinical psychologists, antidepressants, counselling and cognitive-behavioural therapy. However, there were also areas of disagreement. Psychiatrists were less likely than GPs and clinical psychologists to rate psychological and lifestyle interventions as helpful, while clinical psychologists were less likely to rate specifically medical interventions as helpful. Younger members of the professional groups and female members (who also tended to be younger) tended to rate a wider range of interventions for each disorder as likely to be helpful. CONCLUSIONS: Despite areas of broad agreement about treatment, health practitioners were more likely to endorse the interventions associated with their own profession. However, younger members of each profession tended take a broader view. If these age differences represent a cohort effect, health professionals may in the future show greater acceptance of the helpfulness of interventions offered outside their profession. These conclusions are limited by the methodology of the survey, which involved a questionnaire designed for the public rather than professionals.
Assuntos
Atitude do Pessoal de Saúde , Medicina de Família e Comunidade , Transtornos Mentais/terapia , Psiquiatria , Psicologia Clínica , Adulto , Idoso , Antidepressivos/uso terapêutico , Terapia Cognitivo-Comportamental , Aconselhamento , Transtorno Depressivo/terapia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Esquizofrenia/terapia , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: to compare the domiciliary service receipt of cognitively impaired and equally dependent physically impaired elderly women prior to the passing of the UK Community Care Act. METHODS: secondary analysis of a population survey conducted in 1986 in the city of Cambridge. The analysis used data on 1585 women aged 75 and over living in the community. The effect of type of impairment on the receipt of domiciliary services (meals-on-wheels, home help and community nursing) is measured using a multivariate model which allows for adjustment for dependency level and other potential confounding factors. RESULTS: the odds of an elderly woman getting help from any of the domiciliary services whilst not being significantly affected by cognitive impairment (odds ratio 0.7, 95% CI 0.5-1.2) are increased by physical impairment (odds ratio 1.8, 95% CI 1.2-2.5). Similar results were found for the home help service. The differences were exaggerated in the case of the community nursing service, whilst receipt of meals-on-wheels was similar for women of with all types of impairment. CONCLUSIONS: in the late 1980s, cognitively impaired elderly women received less help from the domiciliary services than equally dependent physically frail women who lived in similar household circumstances. The development of specialist services appropriate to the needs of cognitively impaired elderly people presents a challenge to community care policy, especially since this group are at high risk of institutionalization.
Assuntos
Transtornos Cognitivos/epidemiologia , Demência/epidemiologia , Idoso Fragilizado/estatística & dados numéricos , Serviços de Assistência Domiciliar/estatística & dados numéricos , Atividades Cotidianas/classificação , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/reabilitação , Estudos Transversais , Demência/reabilitação , Inglaterra/epidemiologia , Feminino , Previsões , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Incidência , Masculino , Equipe de Assistência ao Paciente/estatística & dados numéricosRESUMO
One hundred and thirty-two people aged 90 years and over were identified in a study of the prevalence of dementia. One third lived in institutions, a third were demented and half were unable to prepare a simple meal or do light housework. None was entirely free of mental or physical disability but many functioned satisfactorily at a simple level with the help of family members and the domiciliary services.
Assuntos
Idoso de 80 Anos ou mais , Nível de Saúde , Saúde Mental , Idoso , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Reino UnidoRESUMO
Elderly Cambridge residents diagnosed as demented using the Cambridge Mental Disorders of the Elderly Examination (CAMDEX) were reviewed approximately 12 months later. Diagnoses were confirmed in 133 of 137 surviving cases (97%). Subjects said to have minimal dementia (cognitive impairment insufficient to warrant a diagnosis of dementia proper) had a varied outcome. Only 6 out of 29 survivors showed progressive intellectual deterioration and 13 were reclassified as normal. Subjects passed as normal in the first year of the study were reviewed using the Mini-Mental State Examination. We cannot be certain how many were actually dementing, but our findings suggest that only a small number of false negative diagnoses were made in the first year of the study.