Mental status of the elderly receiving home health services and the associated stress of home helpers

One hundred and ninety elderly people receiving home health service were investigated. The intellectual levels, depressive state evaluated by the Cornell scale for depression in dementia (CSDD) scale, abnormal behaviors evaluated by the dementia behavior disturbance (DBD) scale, and activities of daily living (ADL) were examined. These assessments were performed by 72 skilled home helpers who also assessed the severity of their own level of stress using the Burnout scale. The intellectual level and mood-related signs, based on the CSDD scale, of the elderly living with families or with a spouse were diminished significantly as compared to the elderly living alone. The elderly living with families also performed worse on all ADL categories except for visual acuity as compared to the elderly living with a spouse or living alone. There was no significant correlation between the Burnout scale score and age or frequency of working as a home helper. These results suggest that elderly people living with families as compared to the elderly living with a spouse or living alone have greater mental health needs as well as more profound physical limitations. © 1998 John Wiley & Sons, Ltd.     

Depression and Quality of Life in the Elderly in a Special Nursing Home

Abstract: Using a Japanese version of the Self-Rating Depression Scale by Zung (SDS) and the Quality of Life (QOL) rating scale designed by Iida et al. (QOL scale), we compared the QOL and depressive state of special nursing home residents and the elderly in the general community. The QOL scale has four categories: physical functioning, emotional adjustment, interpersonal relationships and attitudes toward life. High scores in either examination indicate a greater impairment. The SDS scores of the residents in the special nursing home were significantly lower than those of the elderly in the community, but the scores in 3 categories and the total score, except for those of physical functioning of the QOL, were significantly higher in the nursing home residents. In the nondepressed elderly rated by the SDS, the physical functioning score of the elderly in the community significantly exceeded that of the special nursing home residents. In the depressed elderly, all the scores including the total score were significantly higher than those in the special nursing home residents. Our results suggest that while the QOL of the depressed elderly in a special nursing home was poorer than that of the elderly in the community, their depression could be treated. However, the QOL cannot be improved by treatment alone.     

A survey of the living conditions and psychological states of elderly people admitted to nursing homes in Japan.

We investigated the living conditions and the prevalence of depression in 920 elderly subjects admitted to 32 nursing homes. Their prevalence of depression was compared with that of 1153 elderly subjects living in the community. The prevalence of depression was determined by the Zung Self-Rating Depression Scale. Over half of the nursing home subjects were admitted directly from their familial residence and had been under supervision for more than 3 years. Most subjects participated in outdoor leisure activities, attended recreational events, communicated freely with others, and were visited by their children and relatives. Only 10% had living spouses. We evaluated 61% of the elderly people in the nursing homes and 36% of the elderly people in the community as depressed, a statistically significant difference.     

焦虑症认知行为治疗与药物治疗对照研究

目的：比较认知行为治疗、抗焦虑药及二者结合治疗焦虑症的临床疗效、社会功能、生活满意度及生活质量改善情况。方法：焦虑症患者100例按随机区组法分为认知行为组、抗焦虑药物组、二者结合治疗组,疗程12周。分别于治疗前和治疗结束时采用汉密尔顿焦虑量表（HAMA）评定临床疗效,功能大体评定量表（GAF）、生活满意度量表（ISR）和生活质量综合评定问卷（GQOLI-74）评定患者的社会功能、生活满意度、生活质量情况。结果：治疗后,3组HAMA总分显著低于治疗前,社会功能、生活满意度和生活质量总分显著高于治疗前。认知行为组的不良反应显著低于药物治疗组和结合治疗组。结论：认知行为治疗、抗焦虑药和二者结合治疗焦虑症均有显著疗效,安全性好,结合治疗显示出一定的优势。3种治疗方法对患者的社会功能、生活满意度、生活质量均有明显改善。     

Yoga-plus exercise mix promotes cognitive,affective, and physical functions in elderly people

ABSTRACT

Objectives: Increased attention is being paid to Asian medicine in balanced total health care. We investigated the effects of mixed exercise including yoga (‘Yoga-plus’) among elderly individuals.

Methods: A total of 385 subjects (72 males and 313 females, 75.5 ± 8.7 years old) participated in a 12-month (M) exercise program at a health and welfare center, a day service center, and a nursing home. Cognitive, affective, and physical functions, and activities of daily living (ADL), were compared at baseline (0M), 6M and 12M of exercise intervention.

Results: Mean scores on the frontal assessment battery, clock drawing test, cube copying test, letter fluency, and category fluency significantly improved after the Yoga-plus intervention, while mini-mental state examination, Hasegawa dementia score-revised, and trail-making test performance were relatively stable. Affective scores on the geriatric depression scale (GDS), apathy scale (AS) and Abe’s behavioral and psychological symptoms of dementia were not significantly affected by exercise therapy, but subgroups with higher baseline GDS (GDS ≥ 5) and AS (AS ≥ 16) scores showed a significant improvement after intervention. One-leg standing time and 3-m timed up and go test performance significantly improved after 12M intervention.

Discussion: Yoga-plus improved cognitive, affective, ADL, and physical functions in a local elderly population, particularly among below-baseline individuals, indicating the benefits of dementia prevention among elderly individuals.     

Bereavement among elderly people: grief reactions,post-bereavement hallucinations and quality of life

Ratings of grief reactions, post-bereavement hallucinations and illusions and quality of life were made during the first year after the death of a spouse among 14 men and 36 women in their early seventies. In both sexes, the reactions were generally moderate or mild and characterized by loneliness, low mood, fatigue, anxiety and cognitive dysfunctioning. Feeling lonely was the most persistent problem during the year. Post-bereavement hallucinations or illusions were very frequent and considered helpful. Half of the subjects felt the presence of the deceased (illusions); about one third reported seeing, hearing and talking to the deceased (hallucinations). Former marital harmony was found to make a person more prone to loneliness, crying and hallucinations or illusions. The quality of life was significantly lower among the bereaved than among married people and those who never married, but equalled that found among divorcees.     

Development and evaluation of a health-related quality of life questionnaire for the elderly with dementia in Japan

OBJECTIVES: The purpose of this study was the development of the quality of life (QOL) questionnaire for dementia (QOL-D) in Japan. METHODS: We performed a questionnaire survey of QOL assessment in elderly patients with dementia in Japan, and developed QOL-D. RESULTS: The final version consists of only 31 items grouped into six response sets, each with its own scale. Reliability is good to excellent, and validity is, to some extent, established. The six domains of health-related QOL are divided into two groups. One is the positive and the other is the negative aspects of health-related QOL. The positive aspects have been shown to correlate positively with cognitive function and activities of daily living (ADL) score, whereas the negative aspects have not. The concept of QOL for elderly patients with dementia in Japan is similar to that in Western countries. CONCLUSION: We demonstrated that QOL-D is a reliable and valid instrument for QOL assessment in elderly patients with dementia in Japan.     

综合性医院老年住院患者生命质量研究

目的:应用国际通用的标准化工具,通过对综合性医院老年住院患者进行调查,以期研究生命质量指标并探索其相关因素。方法:采用健康状况调查问卷(SF-36)和综合医院焦虑抑郁量表(HAD)对综合性医院中年龄≥65岁的310例住院患者进行调查。结果:老年住院患者的生命质量8个维度分值均显著低于社区常态老人;生命质量水平与躯体疾病伴发的焦虑和抑郁情绪呈显著负相关;与文化程度之间存在显著的正相关与躯体疾病和既往住院次数之间存在着显著负相关。结论:躯体疾病严重影响老年住院患者的生命质量,其相关因素为进一步实施干预提供了依据。     

Prevalence and risk factors of depression in the elderly nursing home residents in Singapore

Objectives: Depression is a common health problem in elderly nursing home (NH) residents and is often under-recognized and under-treated. This study aimed to determine the prevalence rates of depression and identify the risk factors associated with depression in the elderly NH population in Singapore.

Methods: A sample of 375 residents in six NHs in Singapore, aged 55 years and above, was assessed with the Structural Clinical Interview (SCID), based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. The association of demographic, functional and health-related characteristics with depression was examined using multivariate logistic regression analyses.

Results: Overall point prevalence for depression in the elderly NH residents was found to be 21.1% (95% confidence intervals (CI): 17.1%–25.6%). The prevalence rate for minor depression in the elderly NH residents was 14.4% (95% CI: 11.1%–18.5%) and 6.7% (95% CI: 4.5%–9.8%) for major depression. Significant risk factors that were found to be associated with depression were length of stay for more than 2 years, known history of depression, pain, and no or lack of social contact.

Conclusion: The prevalence rates for depression were high among NH residents in Singapore. More attention is needed to care for the psychosocial needs of elderly NH residents in Singapore.     

Comparison of the prevalence and risk factors for depressive symptoms among elderly nursing home residents in Taiwan and Hong Kong

BACKGROUND: Depression in the elderly has become a serious health care issue worldwide. However, no studies have compared the prevalence and risk factors for depressive symptoms among institutionalized Chinese elders living in different regions. OBJECTIVES: To explore and compare the prevalence and risk factors for depressive symptoms among elderly residents of nursing homes in Taiwan and Hong Kong. METHODS: Random sampling was used to recruit participants from eight nursing homes in each region. A total of 150 elders from Taiwan and 214 elders from Hong Kong participated. RESULTS: The prevalence of depressive symptoms was significantly higher in participants from Hong Kong (65.4%) than in Taiwan (43.3%). Logistic regression analysis indicated that gender, satisfaction with living situation, perceived health condition, and perceived income adequacy significantly predicted depressive symptoms in elderly nursing home residents in Taiwan. Significant predictors of depressive symptoms in the Hong Kong sample were satisfaction with living situation, cognitive status, and functional status. CONCLUSIONS: It is important to consider risk factors specific to a target population when developing depression intervention programs.     

A randomized, controlled, clinical trial of activity therapy for apathy in patients with dementia residing in long-term care

BACKGROUND: Apathy is a common symptom in patients with dementia and has adverse consequences for patients and caregivers. Most treatments for apathy, particularly non-pharmacologic interventions, have not been evaluated in controlled trials. OBJECTIVES: This study evaluated the efficacy of a kit-based activity intervention, compared to a time and attention control (one-on-one meetings with an activity therapist) in reducing apathy and improving quality of life in 37 patients with dementia. METHODS: The design was a randomized, controlled, partially masked clinical trial. All outcome measures were administered at baseline and follow-up. The primary outcome measure was the apathy score of the Neuropsychiatric Inventory (NPI). Other outcome measures were the NPI total score, the Alzheimer Disease Related Quality of Life scale(ADQRL), and the Copper Ridge Activity Index (CRAI). RESULTS: There was a significant reduction in NPI apathy scores in both treatment groups. The only significant difference between the two treatment groups was a modest advantage for the control intervention on the CRAI cueing subscale (p = 0.027), but not on the other CRAI subscales. There was also a greater within group improvement in quality of life ratings in the control intervention (p=0.03). CONCLUSIONS: Despite the substantial improvement in apathy scores during the course of the study, there was no clear advantage to the reminiscence-based intervention over the time and attention, one-on-one control intervention. More research is needed to develop specific behavioral interventions for apathy in patients with dementia.