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1.
S. Beyermann R.H. Trippe A.A. Bähr R. Püllen 《Zeitschrift für Gerontologie und Geriatrie》2013,46(8):740-747
Background
Several studies have identified moderate reliability and validity for the Mini-Mental State Examination (MMSE). Some researchers showed the superiority of other dementia screening tests over the MMSE considering the test quality criteria. The aim of this study was the evaluation of MMSE, especially in the area of geriatrics.Patients and methods
MMSE and DemTect were carried out with 154 geriatric patients: 71 persons without cognitive impairment and 83 persons without delirium showed cognitive impairments as revealed by the DemTect. In addition, we also applied the Clock-Drawing-Test (CDT), Reisberg-Scale, Geriatric Depression-Scale (GDS, 15-item version) and the Confusion-Assessment-Method (CAM).Results
According to the multitrait?multimethod approach, MMSE’s convergent and divergent validity is similar to that of the DemTect. Both tests correlate only moderately with Spearman (r?=?0.609) and revealed similar results for dementia in 57.1?% of the patients. MMSE showed low reliability and moderate reliability (Cronbach’s α?=?0.82) when ten items with low discriminatory power were excluded from the total test score. Difficulty of all items is only moderate (p?=?0.86) and only eight items of the MMSE showed good test difficulty.Conclusion
All in all, DemTect and MMSE are not interchangeable. The MMSE estimates the average cognitive impairment of patients as considerably less pronounced than the DemTect. MMSE is, thus, not an instrument that would be recommended for the identification of mild cognitive impairment. In this case, tests with higher reliability and validity should be used. 相似文献2.
Fay E. Bolsover Elaine Murphy Lisa Cipolotti David J. Werring Robin H. Lachmann 《Journal of inherited metabolic disease》2014,37(2):177-187
Background
Fabry disease, an X-linked lysosomal storage disorder, leads to multi-organ dysfunction, including cerebrovascular disease and psychological disorders. However, the prevalence and pattern of associated cognitive dysfunction is not well understood.Objectives
To investigate whether there is reliable evidence for neuropsychological impairment in patients with Fabry disease and which cognitive domains are affected. To estimate the prevalence of and factors associated with depression in patients with Fabry disease.Method
Qualitative systematic review of the literature of studies conducting neuropsychological assessment or measuring the prevalence of depression in adults with Fabry disease using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines where appropriate.Results
There is some evidence for neuropsychological impairment in Fabry disease in executive functioning, information processing speed and attention, with preservation of: general intellectual functioning, memory, naming, perceptual functioning and global cognitive functioning. Prevalence rates of depression in Fabry disease ranged from 15 % to 62 %, with the largest study to date reporting a prevalence rate of 46 %. The most common factor associated with depression was neuropathic pain, both directly and indirectly by affecting social and adaptive functioning.Conclusion
Our review suggests that Fabry disease may be associated with a characteristic pattern of cognitive deficits and a high prevalence of psychological disorders such as depression but highlights the limited available data. Exploring the nature of cognitive impairment in Fabry disease using standardised neuropsychological assessment, brain imaging and measures of depression is an important task for future research. 相似文献3.
Dr. A. Bahrmann Al. Abel N. Specht-Leible Am. Abel E. Wörz E. Hölscher T. Zieschang P. Oster A. Zeyfang 《Zeitschrift für Gerontologie und Geriatrie》2010,43(6):386-392
Objective
The goal of the present study was to systematically assess treatment quality, perceptions, and cognitive function of elderly patients with diabetes admitted to an acute geriatric hospital from different home environments (nursing home residents, home care, assisted living, family caregivers, self-sufficient).Methods
Quality of diabetes treatment, metabolic control (HbA1c), nutrition, treatment satisfaction, cognition, disability, and level of dependency were assessed in 128 patients with diabetes.Results
Out of 128 patients, 87 patients (68%) showed an HbA1c ≤8% according to the guidelines for aging people with diabetes of the German Diabetes Association (DDG). Compared to patients living independently at home, the metabolic control in nursing home residents and their treatment satisfaction were as good. They had a higher degree of dependency though (Barthel, p<0.001), more strongly impaired mobility (Tinetti, p<0.01), less diabetes knowledge (p<0.001), inferior cognitive performance (MMSE, SPMSQ, p<0.01), and a higher prevalence of depression (GDS) (p<0.01). Better cognitive function correlated with better diabetes knowledge (r=0.49; p<0.001), but not with better metabolic control.Conclusion
The treatment of geriatric patients with diabetes mellitus requires individual considerations and interdisciplinary care. Particularly the continuing education of geriatric nurses could contribute to improved diabetes treatment quality in nursing home residents. 相似文献4.
Carol Rancourt Jocelyne Moisan Lucie Baillargeon René Verreault Danielle Laurin Jean-Pierre Grégoire 《BMC geriatrics》2004,4(1):1-9
Background
Regular physical activity may improve different aspects of wellbeing in older people, such as quality of life, vitality and depression. However, there is little experimental evidence to support this assumption. Therefore, we examined the effect of different training protocols on quality of life, vitality and depression of older adults living in long-term care facilities.Methods
Subjects (n = 173, aged 64 to 94 years, living in long-term care facilities), were randomized to six months of three different moderate-intensity group exercise training protocols, or to an 'educational' control condition. Exercise consisted of two 45–60-minute training sessions per week of 1) resistance training; 2) all-round, functional training; or 3) a combination of both. Perceived health, the Geriatric Depression Scale (GDS), the Vitality Plus Scale (VPS) and the Dementia Quality of Life questionnaire (DQoL) were administered at baseline and after six months.Results
In the combined training group a small but significant decline was seen in perceived health, DQoL and VPS score compared to the control group.Conclusions
We conclude that neither strength training nor all-round, functional training of moderate intensity is effective in improving quality of life, vitality or depression of older people living in long-term care facilities. 相似文献5.
Philippe Voyer René Verreault Ginette M Azizah Johanne Desrosiers Nathalie Champoux Annick Bédard 《BMC geriatrics》2005,5(1):1-13
Background
Verbal and physical aggressive behaviours are among the most disturbing and distressing behaviours displayed by older patients in long-term care facilities. Aggressive behaviour (AB) is often the reason for using physical or chemical restraints with nursing home residents and is a major concern for caregivers. AB is associated with increased health care costs due to staff turnover and absenteeism.Methods
The goals of this secondary analysis of a cross-sectional study are to determine the prevalence of verbal and physical aggressive behaviours and to identify associated factors among older adults in long-term care facilities in the Quebec City area (n = 2 332).Results
The same percentage of older adults displayed physical aggressive behaviour (21.2%) or verbal aggressive behaviour (21.5%), whereas 11.2% displayed both types of aggressive behaviour. Factors associated with aggressive behaviour (both verbal and physical) were male gender, neuroleptic drug use, mild and severe cognitive impairment, insomnia, psychological distress, and physical restraints. Factors associated with physical aggressive behaviour were older age, male gender, neuroleptic drug use, mild or severe cognitive impairment, insomnia and psychological distress. Finally, factors associated with verbal aggressive behaviour were benzodiazepine and neuroleptic drug use, functional dependency, mild or severe cognitive impairment and insomnia.Conclusion
Cognitive impairment severity is the most significant predisposing factor for aggressive behaviour among older adults in long-term care facilities in the Quebec City area. Physical and chemical restraints were also significantly associated with AB. Based on these results, we suggest that caregivers should provide care to older adults with AB using approaches such as the progressively lowered stress threshold model and reactance theory which stress the importance of paying attention to the severity of cognitive impairment and avoiding the use of chemical or physical restraints. 相似文献6.
Dimitry S. Davydow M.D. M.P.H. Kara Zivin Ph.D. Wayne J. Katon M.D. Gregory M. Pontone M.D. Lydia Chwastiak M.D. M.P.H. Kenneth M. Langa M.D. Ph.D. Theodore J. Iwashyna M.D. Ph.D. 《Journal of general internal medicine》2014,29(10):1362-1371
BACKGROUND
The relative contributions of depression, cognitive impairment without dementia (CIND), and dementia to the risk of potentially preventable hospitalizations in older adults are not well understood.OBJECTIVE(S)
To determine if depression, CIND, and/or dementia are each independently associated with hospitalizations for ambulatory care-sensitive conditions (ACSCs) and rehospitalizations within 30 days after hospitalization for pneumonia, congestive heart failure (CHF), or myocardial infarction (MI).DESIGN
Prospective cohort study.PARTICIPANTS
Population-based sample of 7,031 Americans?>?50 years old participating in the Health and Retirement Study (1998–2008).MAIN MEASURES
The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. The Modified Telephone Interview for Cognitive Status and/or ICD-9-CM dementia diagnoses were used to identify baseline CIND or dementia. Primary outcomes were time to hospitalization for an ACSC and presence of a hospitalization within 30 days after hospitalization for pneumonia, CHF, or MI.KEY RESULTS
All five categories of baseline neuropsychiatric disorder status were independently associated with increased risk of hospitalization for an ACSC (depression alone: Hazard Ratio [HR]: 1.33, 95 % Confidence Interval [95%CI]: 1.18, 1.52; CIND alone: HR: 1.25, 95%CI: 1.10, 1.41; dementia alone: HR: 1.32, 95%CI: 1.12, 1.55; comorbid depression and CIND: HR: 1.43, 95%CI: 1.20, 1.69; comorbid depression and dementia: HR: 1.66, 95%CI: 1.38, 2.00). Depression (Odds Ratio [OR]: 1.37, 95%CI: 1.01, 1.84), comorbid depression and CIND (OR: 1.98, 95%CI: 1.40, 2.81), or comorbid depression and dementia (OR: 1.58, 95%CI: 1.06, 2.35) were independently associated with increased odds of rehospitalization within 30 days after hospitalization for pneumonia, CHF, or MI.CONCLUSIONS
Depression, CIND, and dementia are each independently associated with potentially preventable hospitalizations in older Americans. Older adults with comorbid depression and cognitive impairment represent a particularly at-risk group that could benefit from targeted interventions. 相似文献7.
PD Dr. R. Püllen M. Coy B. Hunger G. Koetter M. Spate A. Richter 《Zeitschrift für Gerontologie und Geriatrie》2013,46(3):233-236
Introduction
In nursing homes animal-assisted therapy has been applied in demented elderly patients for several years. There are no studies on this treatment in hospitals, especially in geriatric departments.Methods
From September 2010 to November 2011 105 in-patients, among them 77 female, participated in a 30 min dog-assisted group therapy (mean age 84,4?±?6,56 years). The patients had cognitive and functional impairments (mean MMSE 18 points, mean Barthel Index 34,6 points).Results
Adverse events were not observed. Thirteen patients discontinued the treatment early, due to different reasons. The psychologist, who attended the treatment, observed an improvement of mood in 58?% and an improvement in activity in 54?%.Discussion and conclusion
Animal assisted therapy can be safely established in a hospital among patients with cognitive impairment. The data support the hypothesis that animal assisted therapy improves mood, communication and activity in patients with cognitive impairment. 相似文献8.
Kenneth B. Wells MD MPH Loretta Jones MA Bowen Chung MD Elizabeth L. Dixon RN PhD Lingqi Tang PhD Jim Gilmore MBA Cathy Sherbourne PhD Victoria K. Ngo PhD Michael K. Ong MD Susan Stockdale PhD Esmeralda Ramos BA Thomas R. Belin PhD Jeanne Miranda PhD 《Journal of general internal medicine》2013,28(10):1268-1278
BACKGROUND
Depression contributes to disability and there are ethnic/racial disparities in access and outcomes of care. Quality improvement (QI) programs for depression in primary care improve outcomes relative to usual care, but health, social and other community-based service sectors also support clients in under-resourced communities. Little is known about effects on client outcomes of strategies to implement depression QI across diverse sectors.OBJECTIVE
To compare the effectiveness of Community Engagement and Planning (CEP) and Resources for Services (RS) to implement depression QI on clients’ mental health-related quality of life (HRQL) and services use.DESIGN
Matched programs from health, social and other service sectors were randomized to community engagement and planning (promoting inter-agency collaboration) or resources for services (individual program technical assistance plus outreach) to implement depression QI toolkits in Hollywood-Metro and South Los Angeles.PARTICIPANTS
From 93 randomized programs, 4,440 clients were screened and of 1,322 depressed by the 8-item Patient Health Questionnaire (PHQ-8) and providing contact information, 1,246 enrolled and 1,018 in 90 programs completed baseline or 6-month follow-up.MEASURES
Self-reported mental HRQL and probable depression (primary), physical activity, employment, homelessness risk factors (secondary) and services use.RESULTS
CEP was more effective than RS at improving mental HRQL, increasing physical activity and reducing homelessness risk factors, rate of behavioral health hospitalization and medication visits among specialty care users (i.e. psychiatrists, mental health providers) while increasing depression visits among users of primary care/public health for depression and users of faith-based and park programs (each p?<?0.05). Employment, use of antidepressants, and total contacts were not significantly affected (each p?>?0.05).CONCLUSION
Community engagement to build a collaborative approach to implementing depression QI across diverse programs was more effective than resources for services for individual programs in improving mental HRQL, physical activity and homelessness risk factors, and shifted utilization away from hospitalizations and specialty medication visits toward primary care and other sectors, offering an expanded health-home model to address multiple disparities for depressed safety-net clients. 相似文献9.
Seong-Yi Baik PhD Benjamin F. Crabtree PhD Junius J. Gonzales MD MBA 《Journal of general internal medicine》2013,28(11):1430-1439
BACKGROUND
Depression is prevalent in primary care (PC) practices and poses a considerable public health burden in the United States. Despite nearly four decades of efforts to improve depression care quality in PC practices, a gap remains between desired treatment outcomes and the reality of how depression care is delivered.OBJECTIVE
This article presents a real-world PC practice model of depression care, elucidating the processes and their influencing conditions.DESIGN
Grounded theory methodology was used for the data collection and analysis to develop a depression care model. Data were collected from 70 individual interviews (60 to 70 min each), three focus group interviews (n?=?24, 2 h each), two surveys per clinician, and investigators’ field notes on practice environments. Interviews were audiotaped and transcribed for analysis. Surveys and field notes complemented interview data.PARTICIPANTS
Seventy primary care clinicians from 52 PC offices in the Midwest: 28 general internists, 28 family physicians, and 14 nurse practitioners.KEY RESULTS
A depression care model was developed that illustrates how real-world conditions infuse complexity into each step of the depression care process. Depression care in PC settings is mediated through clinicians’ interactions with patients, practice, and the local community. A clinician’s interactional familiarity (“familiarity capital”) was a powerful facilitator for depression care. For the recognition of depression, three previously reported processes and three conditions were confirmed. For the management of depression, 13 processes and 11 conditions were identified. Empowering the patient was a parallel process to the management of depression.CONCLUSIONS
The clinician’s ability to develop and utilize interactional relationships and resources needed to recognize and treat a person with depression is key to depression care in primary care settings. The interactional context of depression care makes empowering the patient central to depression care delivery. 相似文献10.
J. Labad J. F. Price M. W. J. Strachan F. G. R. Fowkes J. Ding I. J. Deary A. J. Lee B. M. Frier J. R. Seckl B. R. Walker R. M. Reynolds 《Diabetologia》2010,53(3):467-471
Aims/hypothesis
The aim of the study was to identify risk factors for depression and anxiety in a well-characterised cohort of individuals with type 2 diabetes mellitus.Methods
We used baseline data from participants (n?=?1,066, 48.7% women, aged 67.9?±?4.2 years) from the Edinburgh Type 2 Diabetes Study. Symptoms of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Obesity was characterised according to both overall (body mass index, fat mass) and abdominal (waist circumference) measurements. Cardiovascular disease was assessed by questionnaire, physical examination and review of medical records. Stepwise multiple linear regression was performed to identify explanatory variables related to either anxiety or depression HADS scores.Results
Abdominal obesity (waist circumference) and cardiovascular disease (ischaemic heart disease and ankle–brachial pressure index) were related to depression but not anxiety. Lifetime history of severe hypoglycaemia was associated with anxiety. Other cardiovascular risk factors or microvascular complications were not related to either anxiety or depressive symptoms.Conclusions/interpretation
Depression but not anxiety is associated with abdominal obesity and cardiovascular disease in people with type 2 diabetes mellitus. This knowledge may help to identify depressive symptoms among patients with type 2 diabetes who are at greatest risk. 相似文献11.
12.
Mary E. Margaretten MD MS Patricia Katz PhD Gabriela Schmajuk MD MS Edward Yelin PhD 《Journal of general internal medicine》2013,28(12):1637-1642
BACKGROUND
Arthritis affects 20 % of the adult US population and is associated with comorbid depression. Depression screening guidelines have been endorsed for high-risk groups, including persons with arthritis, in the hopes that screening will increase recognition and use of appropriate interventions.OBJECTIVE
To examine national rates of depression and depression screening for patients with arthritis between 2006 and 2010.PARTICIPANTS AND DESIGN
We used nationally representative cross-sections of ambulatory visits in the United States from the National Ambulatory Medical Care Survey from 2006 to 2010, which included 18,507 visits with a diagnosis of arthritis. When weighted to the US population, this total represents approximately 644 million visits.MEASUREMENTS
Visits where arthritis was listed among diagnoses. Outcomes were survey-weighted estimates of depression and prevalence of depression screening among patients with arthritis across patient and physician characteristics.KEY RESULTS
Of the 644,419,374 visits with arthritis listed, 83,574,127 (13 %) were associated with a comorbid diagnosis of depression. The odds ratio for comorbid depression with arthritis was 1.42 (95 % CI 1.3, 1.5). Depression screening occurred at 3,835,000 (1 %) visits associated with arthritis. When examining the rates of depression screening between ambulatory visits with and without arthritis listed, there was no difference in depression screening rates; both were approximately 1 %. There was no difference in screening rates by provider type. Compared to visits with other common, chronic conditions, the prevalence of depression at arthritis visits was high (13 per 100 visits), although the prevalence of depression screening at arthritis visits was low (0.68 per 100 visits).CONCLUSIONS
Despite the high prevalence of depression with arthritis, screening for depression was performed at few arthritis visits, representing missed opportunities to detect a common, serious comorbidity. Improved depression screening by providers would identify affected patients, and may lead to appropriate interventions such as mental health referrals and/or treatment with anti-depressants. 相似文献13.
John T. Ratelle MD Denise M. Dupras MD PhD Patrick Alguire MD Philip Masters MD Arlene Weissman PhD Colin P. West MD PhD 《Journal of general internal medicine》2014,29(7):1026-1030
BACKGROUND
Hospital medicine is a rapidly growing field of internal medicine. However, little is known about internal medicine residents’ decisions to pursue careers in hospital medicine (HM).OBJECTIVE
To identify which internal medicine residents choose a career in HM, and describe changes in this career choice over the course of their residency education.DESIGN
Observational cohort using data collected from the annual Internal Medicine In-Training Examination (IM-ITE) survey.PARTICIPANTS
16,781 postgraduate year 3 (PGY-3) North American internal medicine residents who completed the annual IM-ITE survey in 2009–2011, 9,501 of whom completed the survey in all 3 years of residency.MAIN MEASSURES
Self-reported career plans for individual residents during their postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2) and PGY-3.KEY RESULTS
Of the 16,781 graduating PGY-3 residents, 1,552 (9.3 %) reported HM as their ultimate career choice. Of the 951 PGY-3 residents planning a HM career among the 9,501 residents responding in all 3 years, 128 (13.5 %) originally made this decision in PGY-1, 192 (20.2 %) in PGY-2, and 631 (66.4 %) in PGY-3. Only 87 (9.1 %) of these 951 residents maintained a career decision of HM during all three years of residency education.CONCLUSIONS
Hospital medicine is a reported career choice for an important proportion of graduating internal medicine residents. However, the majority of residents do not finalize this decision until their final year. 相似文献14.
Nolte F Schumann C Klein S Reinwald M Hofmann WK 《Journal of cancer research and clinical oncology》2012,138(6):953-957
Background
Myelodysplastic syndromes (MDS) are mainly a disease of the elderly. Commonly, MDS patients are treated in an outpatient setting making hematological/oncological private practices (PP) an important backbone in the management of MDS patients.Methods
To gain more insights into the characteristics of patients with MDS treated in hematological/oncological PP and to evaluate the daily diagnostic routines and classification systems used, we performed questionnaire-based analyses. Moreover, to investigate whether characteristics of MDS in PP differ from patients treated in specialized MDS centers in university hospitals (UH), we compared both cohorts of MDS patients.Results
In total, 197 patients in PP and 165 patients in UH were enrolled. Patients in UH were significantly younger as compared to PP. Furthermore, in UH, a greater proportion of patients with international prognostic scoring system (IPSS) higher risk were found, whereas patients with IPSS lower risk were more frequent in PP. In addition, patients in UH had significantly lower hemoglobin levels and platelet counts compared to PP.Conclusion
Our data show that PP and UH are approached by different MDS patient cohorts resulting in different diagnostic workups of MDS patients. 相似文献15.
H. C. Looker S. O. Nyangoma D. T. Cromie J. A. Olson G. P. Leese S. Philip M. W. Black J. Doig N. Lee A. Briggs E. J. Hothersall A. D. Morris R. S. Lindsay J. A. McKnight D. W. M. Pearson N. A. Sattar S. H. Wild P. McKeigue H. M. Colhoun 《Diabetologia》2013,56(8):1716-1725
Aims/hypothesis
The aim of our study was to identify subgroups of patients attending the Scottish Diabetic Retinopathy Screening (DRS) programme who might safely move from annual to two yearly retinopathy screening.Methods
This was a retrospective cohort study of screening data from the DRS programme collected between 2005 and 2011 for people aged ≥12 years with type 1 or type 2 diabetes in Scotland. We used hidden Markov models to calculate the probabilities of transitions to referable diabetic retinopathy (referable background or proliferative retinopathy) or referable maculopathy.Results
The study included 155,114 individuals with no referable diabetic retinopathy or maculopathy at their first DRS examination and with one or more further DRS examinations. There were 11,275 incident cases of referable diabetic eye disease (9,204 referable maculopathy, 2,071 referable background or proliferative retinopathy). The observed transitions to referable background or proliferative retinopathy were lower for people with no visible retinopathy vs mild background retinopathy at their prior examination (respectively, 1.2% vs 8.1% for type 1 diabetes and 0.6% vs 5.1% for type 2 diabetes). The lowest probability for transitioning to referable background or proliferative retinopathy was among people with two consecutive screens showing no visible retinopathy, where the probability was <0.3% for type 1 and <0.2% for type 2 diabetes at 2 years.Conclusions/interpretation
Transition rates to referable diabetic eye disease were lowest among people with type 2 diabetes and two consecutive screens showing no visible retinopathy. If such people had been offered two yearly screening the DRS service would have needed to screen 40% fewer people in 2009. 相似文献16.
17.
Jeanne Miranda PhD Michael K. Ong MD PhD Loretta Jones MA Bowen Chung MD Elizabeth L. Dixon RN PhD Lingqi Tang PhD Jim Gilmore MBA Cathy Sherbourne PhD Victoria K. Ngo PhD Susan Stockdale PhD Esmeralda Ramos BA Thomas R. Belin PhD Kenneth B. Wells MD MPH 《Journal of general internal medicine》2013,28(10):1279-1287
BACKGROUND
As medical homes are developing under health reform, little is known regarding depression services need and use by diverse safety-net populations in under-resourced communities. For chronic conditions like depression, primary care services may face new opportunities to partner with diverse community service providers, such as those in social service and substance abuse centers, to support a collaborative care model of treating depression.OBJECTIVE
To understand the distribution of need and current burden of services for depression in under-resourced, diverse communities in Los Angeles.DESIGN
Baseline phase of a participatory trial to improve depression services with data from client screening and follow-up surveys.PARTICIPANTS
Of 4,440 clients screened from 93 programs (primary care, mental health, substance abuse, homeless, social and other community services) in 50 agencies, 1,322 were depressed according to an eight-item Patient Health Questionnaire (PHQ-8) and gave contact information; 1,246 enrolled and 981 completed surveys. Ninety-three programs, including 17 primary care/public health, 18 mental health, 20 substance abuse, ten homeless services, and 28 social/other community services, participated.MAIN MEASURES
Comparisons by setting in 6-month retrospective recall of depression services use.KEY RESULTS
Depression prevalence ranged from 51.9 % in mental health to 17.2 % in social-community programs. Depressed clients used two settings on average to receive depression services; 82 % used any setting. More clients preferred counseling over medication for depression treatment.CONCLUSIONS
Need for depression care was high, and a broad range of agencies provide depression care. Although most participants had contact with primary care, most depression services occurred outside of primary care settings, emphasizing the need to coordinate and support the quality of community-based services across diverse community settings. 相似文献18.
19.
Background
Food and drink are important determinants of physical and social health in care home residents. This study explored whether a pragmatic methodology including routinely collected data was feasible in UK care homes, to describe the health, wellbeing and nutritional status of care home residents and assess effects of changed provision of food and drink at three care homes on residents' falls (primary outcome), anaemia, weight, dehydration, cognitive status, depression, lipids and satisfaction with food and drink provision.Methods
We measured health, wellbeing and nutritional status of 120 of 213 residents of six care homes in Norfolk, UK. An intervention comprising improved dining atmosphere, greater food choice, extended restaurant hours, and readily available snacks and drinks machines was implemented in three care homes. Three control homes maintained their previous system. Outcomes were assessed in the year before and the year after the changes.Results
Use of routinely collected data was partially successful, but loss to follow up and levels of missing data were high, limiting power to identify trends in the data. This was a frail older population (mean age 87, 71% female) with multiple varied health problems. During the first year 60% of residents had one or more falls, 40% a wound care visit, and 40% a urinary tract infection. 45% were on diuretics, 24% antidepressants, and 43% on psychotropic medication. There was a slight increase in falls from year 1 to year 2 in the intervention homes, and a much bigger increase in control homes, leading to a statistically non-significant 24% relative reduction in residents' rate of falls in intervention homes compared with control homes (adjusted rate ratio 0.76, 95% CI 0.57 to 1.02, p = 0.06).Conclusions
Care home residents are frail and experience multiple health risks. This intervention to improve food and drink provision was well received by residents, but effects on health indicators (despite the relative reduction in falls rate) were inconclusive, partly due to problems with routine data collection and loss to follow up. Further research with more homes is needed to understand which, if any, components of the intervention may be successful.Trial registration
Trial registration: ISRCTN86057119. 相似文献20.
Steffen Christensen Anders Riis Mette Nørgaard Henrik T Sørensen Reimar W Thomsen 《BMC geriatrics》2007,7(1):1-8