ISSN:0885-6230    

DOI:10.1002/gps.930090702

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe day hospital in old age psychiatry has many supporters and is widely felt to be la ‘good thing’. This article suggests there is an opposing view and that more hard data are required before the argument is resolved. Other models of care are mentioned which may be equally valid—comparison between different models is n

ISSN:0885-6230    

DOI:10.1002/gps.930090703

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe day hospital constitutes an integral and valued component of the old age psychiatry service provided by the majority of units in the United Kingdom. Changes in the political climate, vogues for alternative forms of care provision and a lamentable lack of hard evidence that day hospitals present the best use of resources have led to serious questioning of their future by most who have written in recent years on the subject. The issue should not be ‘day hospitals are wonderful; other systemls are not’ (or vice versa), but that the day hospital should be seen as an available option with its own particular benefits alongside other hospital‐based and community components of a good service. Advocates of day hospitals should continually review staffing mix and structure to ensure the best use of professional s

ISSN:0885-6230    

DOI:10.1002/gps.930090704

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe goal of this article was to review the literature on visual hallucinations (VH) and, more specifically, the association of visual perceptual disorders with age, specific pathologies that are etiologically related to the VH, the anatomical location of the pathology, and the relation of the characteristics of the VH to the pathology and location of the lesions and, in addition, the importance of insight in the differential diagnosis of the VH. A total of 45 articles, representing 117 cases dating from 1940 to 1991, were reviewed. This review, although relying on information provided retrospectively, includes cases of VH from all disciplines and attempts to identify characteristics associated with this disorder. Our review does show an increased frequency of VH in the elderly, with almost 50% of the case reports in the past 50 years occurring in patients in their seventh and eighth decades. There was a large differential diagnosis of VH and there may be multifactorial causality. Eye pathology was the most frequent association with VH in patients over age 60 in our review, with cataracts accounting for over half of the cases reported within this group. Our review confirms that VH can occur as a result of a lesion anywhere within the visual perceptual system—from the lens to the association corte

ISSN:0885-6230    

DOI:10.1002/gps.930090705

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractFunctional decline and mortality after 1‐year follow‐up of 93 demented elderly subjects from a random population sample (N=795) were studied in Helsinki, Finland. Seventeen (18%) of the demented patients died as compared to only 5% of the non‐demented subjects. The age‐adjusted risk ratio for 1‐year mortality of demented patients was 3.2 (95% confidence interval 1.8–5.6). Forty‐four per cent (26/59) of the surviving patients who were not bedridden and incontinent at the very beginning of the study suffered further impairment in the following functions: institutionalization (6/21), losing the ability to walk (5/57) or beginning of incontinence (17/30). Sixteen (21%) surviving subjects were already bedbound, incontinent and institutionalized at the beginning of the study. Age, sex or the degree of dementia did not correlate to mortality or functional decline. The number of patients who were institutionalized during the follow‐up was small. The appearance of incontinence and other recorded risk factors (age, degree of dementia or motility) did not seem to predispose to institutionalization. Subjective factors, such as caretaker's burden, probably have a great influence on the endi

ISSN:0885-6230    

DOI:10.1002/gps.930090706

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractThis study focused on two aspects of the validity of the judgement of general practitioners (GPs) on dementia: criterion and construct validity. The Cambridge Mental Disorder of the Elderly Examination (CAMDEX) was used as the gold standard to assess the specificity and sensitivity of the GP judgement. Construct validity was studied by comparing patient characteristics that were hypothesized to predict the GP judgement by predictive variables from our data, using logistic regression analysis. In addition, the patient characteristics that predicted a ‘falsel positive’ or ‘falsel negative’ GP judgement were determined. Thirty‐six GPs participated in the study, as well as 475 community‐dwelling patients. The overall agreement between CAMDEX diagnosis and GP judgement was 72%. The sensitivity and speciticity of the GP judgement in making the distinction between ‘normal cognitive functioning + minimall dementia’ versus ‘mild + moderate + severel dementia’ were 52% and 94% respectively. Patient characteristics that predicted the GP judgement on dementia were: age, sex, cognitive functioning, IADL functioning (Instrumental Activities of Daily Living) and memory complaints. All these characteristics, except sex, were hypothesized to do so. Patient characteristics predicting a ‘falsel positive’ or a ‘falsel negative’ GP judgement were cognitive and IADL functioning. Both groups of patients (‘overldiagnosed’ and‘ missed’ by the GP) belong to the in‐between group with some impaired functioning. The finding that impaired IADL functioning is so important in the GP's judgement reflects the significance of dementia diagnosis in general practic

ISSN:0885-6230    

DOI:10.1002/gps.930090707

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractExplicit operational definitions of the DSM‐3 criteria for delirium have recently been published. In this study, the reliability of the Delirium Assessment Scale (DAS), which uses the operationalized criteria to determine the severity of delirium symptoms, was examined. Three independent assessors examined four groups of patients —patients with delirium, patients with delirium and dementia, patients with dementia alone and patients without cognitive impairment. Sensitivity (83–88%) and specificity (79–88%) of the operationalized definitions for the diagnosis of delirium were high. Satisfactory interrater agreement was obtained for all individual symptoms of the DAS (kappa = 0.66–0.99). These results suggest that the DAS may be suitable for monitoring the severity of delirium; prospective studies are required to confirm this h

ISSN:0885-6230    

DOI:10.1002/gps.930090708

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe prevalence and clinical diagnosis of iron deficiency was studied in 55 long‐stay psychogeriatric patients. Iron deficiency was found in 29% of the sample and there was a trend for iron deficiency to be more common among patients with functional as opposed to organic psychiatric conditions. There were no clinical signs that could reliably detect iron deficiency and neither serum ferritin nor iron saturation studies detected more than 63% of iron‐deficient patients. The importance and cost of detecting iron deficiency is discussed together with the need for attention to patients' dietary intake and physical st

ISSN:0885-6230    

DOI:10.1002/gps.930090709

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe question of detaining elderly mentally ill patients against their wishes raises many ethically difficult questions. The author conducted a survey of the extent and purpose of the use of the Mental Health Act (1983) in a particular psychogeriatric hospital, focusing on the circumstances in which it was used, how often patients or relatives appealed against its use and the outcome of the appeal. The author found that the Mental Health Act was used in only 5% of patients, and Section 5(2) was used only once. This stands in marked contrast to the use of Section 5(2) in adult general psychiatry, where one survey found it to be used in 7.2% of patients (pourgourideset al., 1992). The powers of the Mental Health Act in the population the author studied were most frequently evoked to detain and treat patients who were suffering from self‐neglect secondary to their mental illness rather than to prevent them from wandering and coming to harm. It would appear that in this population, the Mental Health Act is used to facilitate admission for assessment and treatment; once admitted, patients can successfully be managed without the need for further recourse to the Mental Health Act. Very few patients or relatives appealed against their detention, and in no case was the appeal successfu

ISSN:0885-6230    

DOI:10.1002/gps.930090710

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe results of the Nottingham electroconvulsive therapy (ECT) trial were examined to compare the response of patients aged 60 and over to real versus simulated ECT. The outcome of patients given real compared to simulated ECT was significantly better immediately after six study treatments. Unilateral ECT was an effective as bilateral treatment. The small number of patients studied did not allow for definitive conclusions on whether patients responded sooner to bilateral relative to unilateral treatment.

ISSN:0885-6230    

DOI:10.1002/gps.930090711

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY