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ABSTRACT: Inappropriate and widespread prescribing of antipsychotics in LTCF is of concern. This study aimed to explore the association of resident and room characteristics with antipsychotic use in this setting. This is cross-sectional secondary analysis of the baseline data of 280 residents ≥ 65 years old, from a prospective, observational, LTCF multi-site (n=7) cohort study on delirium. Demographic data included age, sex and length of stay. Resident characteristics assessed were presence of dementia, disruptive behavior, delirium and use of restraints. Room characteristics assessed were single room, clock/calendar, and telephone. Separate logistic regression models were used to explore the association of resident and room characteristics with antipsychotic use, adjusting for demographic variables. Mean age was 84.9 ± 7.0 years (± S.D.) with 56% female. The mean prevalence of antipsychotics use was 31.1% (range: 25.6-50.0%). The regression model of resident characteristics revealed a significant association between disruptive behavior (OR=1.18, 95% CI=1.12-1.25) and antipsychotic use. The model of room characteristics revealed a significant association between absence of a clock or calendar (OR=1.93, 95% CI=1.04-3.56) and absence of a telephone (OR=2.79, 95% CI=1.48-5.25). Our results suggest that behavior problems are associated with a higher likelihood of antipsychotic use. Absence of a clock/calendar and of a telephone was related to antipsychotic use. Further research is needed to confirm these findings.
Archives of gerontology and geriatrics 08/2011; 55(1):66-9. · 1.36 Impact Factor
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ABSTRACT: The study of mental disorders in the elderly presents substantial challenges due to population heterogeneity, coexistence of different mental disorders, and diagnostic uncertainty. While reliable tools have been developed to collect relevant data, new approaches to study design and analysis are needed. We focus on a new analytic approach.
Our framework is based on latent class analysis and hidden Markov chains. From repeated measurements of a multivariate disease index, we extract the notion of underlying state of a patient at a time point. The course of the disorder is then a sequence of transitions among states. States and transitions are not observable; however, the probability of being in a state at a time point, and the transition probabilities from one state to another over time can be estimated.
Data from 444 patients with and without diagnosis of delirium and dementia were available from a previous study. The Delirium Index was measured at diagnosis, and at 2 and 6 months from diagnosis. Four latent classes were identified: fairly healthy, moderately ill, clearly sick, and very sick. Dementia and delirium could not be separated on the basis of these data alone. Indeed, as the probability of delirium increased, so did the probability of decline of mental functions. Eight most probable courses were identified, including good and poor stable courses, and courses exhibiting various patterns of improvement.
Latent class analysis and hidden Markov chains offer a promising tool for studying mental disorders in the elderly. Its use may show its full potential as new data become available.
International Psychogeriatrics 06/2011; 23(10):1659-70. · 2.24 Impact Factor
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ABSTRACT: The long-term cognitive effect of antidepressant medications in older persons is not well understood, especially in those with minor depression and complex medical conditions. The objective of this study is to examine this relationship in older medical patients with different depression diagnoses.
281 medical inpatients aged 65 years and older from 2 acute care hospitals in Montreal, Canada, were diagnosed as with major or minor depression or without depression according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. They were followed up with the Mini-Mental State Examination for cognitive function and the Hamilton Depression Rating Scale for depressive symptoms at baseline and 3, 6, and 12 months after discharge. Antidepressant medication was ascertained from a provincial prescription database and quantified as cumulative exposures over each follow-up interval.
During the 12-month follow-up period, 1027 antidepressant prescriptions were filled. The most frequently prescribed antidepressant agents were citalopram (0.81 prescriptions per person), sertraline (0.76), and paroxetine (0.66). Antidepressant use was not associated with cognitive changes among patients with major depression or without depression but was associated with an increased Mini-Mental State Examination score in patients with minor depression (1.4 points; 95% confidence interval, 0.1-2.6), independent of change in the severity of depression symptoms, concomitant benzodiazepine or psychotropic drug use, and other potentially important confounders.
In this cohort of older medical patients, antidepressant use for 12 months did not lead to significant cognitive impairment. The small cognitive improvement among minor depression associated with antidepressant use deserves further investigation.
Journal of clinical psychopharmacology 06/2011; 31(4):429-35. · 5.09 Impact Factor
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ABSTRACT: To determine the relation between level of depression and psychoactive medication use and nonadherence in Canadian seniors, given that late-life depression is a common, serious mental health problem in Canada.
Canadian Community Health Survey-Mental Health and Well-Being respondents aged 65 years and older (n = 7,736) comprised the study sample. Using the Composite International Diagnostic Interview to assess depressive symptoms, we created 4 depression levels to capture a spectrum of depressive disorders and (or) symptoms: major depression, comorbid major depression, depressive symptoms, and no depressive symptoms. Psychoactive medications assessed included sleep aids, anxiolytics, and mood stabilizers and (or) antidepressants (AD). Nonadherence was defined as either not taking medication as recommended or taking medication at a lower dosage than prescribed.
In total, 22.5% of respondents took psychoactive medication for a mental health problem in the previous 12 months. Psychoactive medication use was 46.8% for major depression, 43.1% for comorbid major depression, 34.0% for depressive symptoms, and 17.6% for no depressive symptoms. Rates of psychoactive medication use ranged from 46.5% of those with major depression, to 17.6% of those with no depressive symptoms. Overall, the rate of nonadherence to psychoactive medication was 31%; rates were highest among those with depressive symptoms (37.4%) and lowest among those with no depressive symptoms (27.4%). All 3 depressive categories were associated with greater odds of use and nonadherence.
All 3 depression categories were associated with increased use of and nonadherence to psychoactive medication; however, rates of AD and (or) mood stabilizer use for clinically significant depression were low.
Canadian journal of psychiatry. Revue canadienne de psychiatrie 10/2008; 53(9):609-20. · 2.42 Impact Factor
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ABSTRACT: To examine the temporal relationship between depression diagnoses and cognitive function in older medical patients.
Prospective cohort study with repeated follow-up assessments at 3, 6, and 12 months after hospitalization.
The medical services of two acute care hospitals in Montreal, Quebec, Canada.
Two hundred eighty-one medical inpatients aged 65 and older without apparent cognitive impairment at study entry.
Diagnostic Interview Schedule for depression and Mini-Mental State Examination (MMSE) for cognitive function.
At study entry, 121 (43.1%) and 51 (18.1%) patients, respectively, met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for major or minor depression. Based on a mixed effects regression model, depression diagnoses were associated with poorer cognitive function, independent of age, education, baseline cognitive and physical function, cardiovascular diseases and other comorbidities, previous history of depression and antidepressant treatment, and fluctuation in the severity of depression symptoms over time. On average across three follow-up assessments, patients with major or minor depression, respectively, had a 0.8 (95% confidence interval: 0.1-1.5) and 1.0 (0.3-1.8) point lower performance on the MMSE than those without depression. In contrast, there was no significant association when depression diagnoses and cognitive function were assessed over shorter intervals or cross-sectionally. A general linear regression model yielded consistent results, with adjusted effect estimates of 0.9 (0.03-0.8) for major and 1.5 (0.5-2.5) for minor depression over 12 months.
A diagnosis of major or minor depression at hospital admission is an independent risk factor for poorer cognitive function during the subsequent 12 months in older medical patients.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 10/2008; 16(9):742-51. · 3.35 Impact Factor
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ABSTRACT: To describe patient and caregiver perceptions of the nature of informal caregiving in a sample of older medical inpatients with and without depression.
One hundred and fifty-four patient-caregiver pairs were recruited from a larger prospective observational study of three groups of medical inpatients aged 65 and over, with major, minor, and no depression, respectively, and with at most mild cognitive impairment. Interviews were conducted at the time of hospital admission to assess characteristics of patients (disability, comorbidity, perceptions of support) and caregivers (relationship, residence, types of assistance and time spent caregiving). Time spent on the physical tasks of caregiving (assistance with activities of daily living, physical care, transport) was estimated by all caregivers. Time spent on emotional or other support was estimated only for non-coresident caregivers
In multivariable analyses, neither major nor minor depression was associated with time spent on physical support; major depression was associated with significantly increased time spent by non-coresident caregivers on emotional or other support; minor depression was associated with perceived inadequacy of support.
Major depression is independently associated with greater time spent by non-coresident caregivers on emotional or other support; minor depression is associated with perceived inadequacy of support.
International Journal of Geriatric Psychiatry 07/2008; 24(3):239-46. · 2.42 Impact Factor
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ABSTRACT: No longitudinal studies have addressed the effect of late life depression on the physical and mental health status of their informal caregivers.
To examine whether a diagnosis of depression in older medical inpatients is associated with the physical and mental health status of their informal caregivers after 6 months, independent of the physical health of the care recipient.
Longitudinal observational study with 6-month follow-up.
Two Montreal acute-care hospitals.
A sample of 97 cognitively intact medical inpatients aged 65 and over and their informal caregivers, with oversampling of patients with a diagnosis of major or minor depression.
Patient data included depression (current diagnosis, duration of current diagnosis, severity of symptoms, and history of depression), physical health (severity of illness, comorbidity, premorbid disability), and cognitive impairment. Caregiver data included relationship to patient, co-residence, and the physical and mental health status subscales of the SF-36. Multivariate linear regression analyses were conducted to determine the relationship between patient depression and caregiver 6 month SF-36 physical and mental scores, adjusting for baseline values, patient comorbidity, disability, and other patient and caregiver variables.
Patient characteristics included: mean age 79.3, 62% female, 46% major depression, 18% minor depression, 36% no depression. Caregiver characteristics included: 73% female, 35% co-resident spouse, 15% other co-resident relation, 50% not residing with the patient. Results of the multivariate analyses showed that in comparison with caregivers of patients without a current diagnosis of depression, caregivers of those with major depression had a lower mental health score at follow-up (-9.54, 95% CI -16.66, -2.43), even though their physical health was slightly better (5.42 95% CI 0.04, 10.81).
A diagnosis of major depression in older medical inpatients is independently associated with poor mental health in their informal caregivers 6 months later.
Age and Ageing 08/2007; 36(4):400-6. · 3.09 Impact Factor
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ABSTRACT: The study aimed: (1) to describe the 12-month course of depressive symptoms among medical inpatients aged 65+, and (2) to investigate predictors of a more severe course that could be identified easily by non-psychiatric staff.
Patients were recruited at two Montreal hospitals. Inclusion criteria were: aged 65+, admitted to medical service, at most mild cognitive impairment. Patients were screened for major and minor depression (DSM-IV criteria). All depressed patients and a random sample of non-depressed patients were invited to participate in the prospective study. The Hamilton Depression Scale (HAMD) was administered at admission, 3, 6, and 12 months. Individual patient trajectories of depressive symptoms over time were grouped using hierarchical clustering into three patient groups with a minimal, mild, and moderate/severe course of symptoms, respectively. The baseline predictors of a more severe clinical course were identified using ordinal logistic regression.
Two hundred and thirty-two patients completed baseline and one or more follow-up interviews. Baseline patient characteristics that independently predicted a more severe symptom course included higher initial HAMD score, depressive core symptoms lasting 6 months or more, and female sex.
The 12-month course of depression symptoms in this medically ill older sample was generally stable. Patients who will experience a more severe course can be identified by non-psychiatric staff at admission to hospital.
International Journal of Geriatric Psychiatry 06/2007; 22(5):411-7. · 2.42 Impact Factor
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ABSTRACT: To describe and classify individual trajectories of 15-day changes in delirium severity.
A longitudinal hospital-based study was carried out with 230 medical inpatients aged 65 and over admitted to St Mary's Hospital in Montreal, Canada, between 1996 and 1999, diagnosed with delirium at enrollment, and who had at least four measurements of delirium severity during the next 15 days. Delirium severity was assessed using the Delirium Index (DI). To classify patients' individual trajectories, we applied a new method that relies on principal factor analysis and cluster analysis. We used multiple linear regression to investigate if clusters were associated with DI scores measured at an 8-week follow-up. Multivariable Cox's proportional hazards regression was used to assess whether the clusters were associated with survival over the next 12 months.
Individual patterns were classified into five clusters: Steady (n = 89, 38.9%), Fluctuating (n = 36, 15.7%), Worsening (n = 15, 6.6%), Fast Improve-ment (n = 26, 11.3%), and Slow Improvement (n = 63, 27.5%). The Fast Improvement cluster had much lower prevalence of dementia (38.5% vs. 55.6% to 77.8% in other clusters, p = 0.003). Subjects whose 2-week patterns were classified as Fast or Slow Improvement had a significantly lower DI at 8 weeks than those in the Steady or Fluctuating clusters. The Worsening cluster had the largest percentage of deaths. The Fast Improvement and Worsening clusters initially had a high risk of death in the first 2 weeks (adjusted relative risks of approximately 3 and 6, respectively) but that risk decreased rapidly thereafter.
Two-week trajectories of delirium severity were associated with short-term mortality and delirium severity at 8-week follow-up.
International Psychogeriatrics 01/2007; 18(4):667-80. · 2.24 Impact Factor
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ABSTRACT: Epidemiological studies remain inconclusive as to whether old age depression is an independent risk factor, a prodrome, or a clinical concomitant of cognitive impairment. The objective of this study, using repeated measures over a 12-month period, was to examine the short-term temporal relationship between depressive symptoms and cognitive impairment.
Two hundred eighty-one medical inpatients 65 years old or older were followed up with the Hamilton Depression Rating Scale (HDRS) and Mini-Mental State Examination (MMSE) at enrollment and 3, 6, and 12 months later. A repeated-measures mixed linear regression model was used to evaluate the association between HDRS scores and MMSE changes over time and to test competing hypotheses about their temporal sequence.
After adjusting for age, cardiovascular risk, illness severity, baseline physical and cognitive function, and other covariates, a one-point increase in HDRS score (baseline mean +/- standard deviation: 14.4 +/- 7.4) was associated with a lower MMSE score (-0.03, 95% confidence interval, -0.07 to 0.00) at the same time points, but not with the MMSE at subsequent time points (all p values >.40). There were no statistically significant interactions detected between follow-up time and HDRS scores measured at baseline or during follow-up. These results were confirmed in alternative models using dynamic measures of both HDRS and MMSE changes over each successive follow-up interval.
These findings suggest that the short-term relationship between depression symptoms and cognitive functioning may be concurrent or temporary, rather than prospective or protracted, consistent with the clinical concomitant hypothesis.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences 01/2007; 61(12):1319-23. · 4.60 Impact Factor
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ABSTRACT: Previous studies of the effect of depression on mortality among older medical inpatients have yielded inconsistent results. We examined the effects on mortality of both a diagnosis of depression at hospital admission and a history of previous depression, taking into account potential sources of bias (sample selection and confounding).
Medical inpatients aged 65+ with at most mild cognitive impairment were recruited at two Montreal hospitals and were screened for depression. All those with a diagnosis of major or minor depression (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV] criteria) and a random sample of nondepressed patients were invited to participate. Baseline data included: history of previous depression, severity of physical illness, comorbidity, and health services utilization. Cox proportional hazards methods were used to analyze survival during the 16- to 52-month follow-up period.
Five hundred patients were enrolled; 116 (23.2%) had a history of previous depression. After adjustment for demographic factors, physical illness, cognitive impairment, and prior service utilization, the only depression group with significantly different mortality was patients with both current major depression and a history of depression, who had lower mortality than all other patient groups (hazard ratio 0.42; 95% confidence interval: 0.25, 0.70).
Among patients with no history of depression, a diagnosis of depression was not associated with mortality after adjustment for confounding by physical illness and other factors. Coincident major depression and history of depression was associated with decreased mortality.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences 10/2006; 61(9):975-81. · 4.60 Impact Factor
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ABSTRACT: To describe the prevalence of and characteristics associated with major and minor depression in older medical inpatients and to compare associated characteristics by sex and history of depression.
Cross-sectional study of two patient samples, with and without a screening diagnosis of major or minor depression.
The medical services of two acute care hospitals.
Medical admissions of people aged 65 and older with at most mild cognitive impairment (N=380).
Diagnoses of major and minor depression (Diagnostic Interview Schedule), cognitive impairment (Mini-Mental State Examination), premorbid disability, sociodemographic variables (including social networks and support), comorbidity, severity of illness, history of depression.
The prevalence of major depression differed by hospital, ranging from 14.2% (95% confidence interval (CI)=11.7-17.1) in Hospital A to 44.5% (95% CI=33.1-56.4) in Hospital B. The prevalence of minor depression was similar in the two hospitals, ranging from 9.4% (95% CI=7.4-11.9) in Hospital A to 7.9% (95% CI=2.9-16.3) in Hospital B. After adjustment for hospital, the same characteristics (history of depression, premorbid disability, cognitive impairment, perceived adequacy of support, and visits from friends) were associated with major and minor depression, although most of these associations tended to be weaker for minor depression. Most of these factors were also associated with depression in multivariate analyses. The most important characteristics in women were premorbid disability, history of depression, and adequacy of emotional support; in men they were history of depression, cognitive impairment, and adequacy of emotional support. A cerebrovascular or other cardiovascular diagnosis did not explain the association between depression and cognitive impairment.
Major and minor depression occur frequently in older medical inpatients and are associated with similar patient characteristics. A history of depression and the patient's sex should be considered in the identification and interpretation of these associated factors.
Journal of the American Geriatrics Society 09/2005; 53(8):1344-53. · 3.74 Impact Factor
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ABSTRACT: Abstract
Background
Family practitioners take care of large numbers of seniors with increasingly complex mental health problems. Varying levels of input may be necessary from psychiatric consultants. This study examines patients'/family, family practitioners', and psychiatrists' perceptions of the bi-directional pathway between such primary care doctors and consultants.
Methods
An 18 month survey was conducted in an out-patient psychogeriatric clinic of a Montreal university-affiliated community hospital. Cognitively intact seniors referred by family practitioners for assessment completed a satisfaction and expectation survey following their visits with the psychiatric consultants. The latter completed a self-administered process of care questionnaire at the end of the visit, while family doctors responded to a similar survey by telephone after the consultants' reports had been received. Responses of the 3 groups were compared.
Results
101 seniors, referred from 63 family practitioners, met the study entry criteria for assessment by 1 of 3 psychogeriatricians. Both psychiatrists and family doctors agreed that help with management was the most common reason for referral. Family physicians were accepting of care of elderly with mental health problems, but preferred that the psychiatrists assume the initial treatment; the consultants preferred direct return of the patient; and almost 1/2 of patients did not know what to expect from the consultation visit. The rates of discordance in expectations were high when each unique patient-family doctor-psychiatrist triad was examined.
Conclusion
Gaps in expectations exist amongst family doctors, psychiatrists, and patients/family in the shared mental health care of seniors. Goals and anticipated outcomes of psychogeriatric consultation require better definition.
BMC Family Practice. 01/2005;
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ABSTRACT: To describe the clinical course and outcomes of delirium up to 12 months after diagnosis, the relationship between the in-hospital clinical course and post-discharge outcomes, and the role of dementia in both the clinical course and outcomes of delirium.
Prospective cohort study.
Medical wards of a 400-bed, university-affiliated, primary acute care hospital in Montreal.
Cohort of 193 medical inpatients aged 65 and over with delirium diagnosed at admission or during the first week in hospital, who were discharged alive from hospital.
Study outcomes included cognitive impairment and activities of daily living (standardized, face-to-face clinical instruments at 1-, 2-, 6-, and 12-month follow-up), and mortality. Dementia, severity of illness, comorbidity, and sociodemographic variables were measured at time of diagnosis. Several measures of the in-hospital course of delirium were constructed. The mean numbers of symptoms of delirium at diagnosis and 12-month follow-up, respectively, were 4.5 and 3.5 in the subgroup of patients with dementia and 3.4 and 2.2 among those without dementia. Inattention, disorientation, and impaired memory were the most persistent symptoms in both subgroups. In multivariate analyses, pre-morbid and admission level of function, nursing home residence, and slower recovery during the initial hospitalization were associated with worse cognitive and functional outcomes but not mortality.
Among patients with and without dementia, symptoms of delirium persist up to 12 months after diagnosis. Quicker in-hospital recovery is associated with better outcomes.
Journal of General Internal Medicine 10/2003; 18(9):696-704. · 2.83 Impact Factor
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ABSTRACT: OBJECTIVES: To describe the clinical course and outcomes of delirium up to 12 months after diagnosis, the relationship between the in-hospital clinical course and post-discharge outcomes, and the role of dementia in both the clinical course and outcomes of delirium.DESIGN: Prospective cohort study.SETTING: Medical wards of a 400-bed, university-affiliated, primary acute care hospital in Montreal.PATIENTS: Cohort of 193 medical inpatients aged 65 and over with delirium diagnosed at admission or during the first week in hospital, who were discharged alive from hospital.MEASUREMENTS AND MAIN RESULTS: Study outcomes included cognitive impairment and activities of daily living (standardized, face-to-face clinical instruments at 1-, 2-, 6-, and 12-month follow-up), and mortality. Dementia, severity of illness, comorbidity, and sociodemographic variables were measured at time of diagnosis. Several measures of the in-hospital course of delirium were constructed. The mean numbers of symptoms of delirium at diagnosis and 12-month follow-up, respectively, were 4.5 and 3.5 in the subgroup of patients with dementia and 3.4 and 2.2 among those without dementia. Inattention, disorientation, and impaired memory were the most persistent symptoms in both subgroups. In multivariate analyses, pre-morbid and admission level of function, nursing home residence, and slower recovery during the initial hospitalization were associated with worse cognitive and functional outcomes but not mortality.CONCLUSIONS: Among patients with and without dementia, symptoms of delirium persist up to 12 months after diagnosis. Quicker in-hospital recovery is associated with better outcomes.
Journal of General Internal Medicine 09/2003; 18(9):696 - 704. · 2.83 Impact Factor
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ABSTRACT: To determine the prognostic significance of subsyndromal delirium (SSD) presentations.
Cohort study.
University-affiliated primary acute care hospital.
One hundred sixty-four elderly medical inpatients who did not meet Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) criteria for delirium during the first week after admission were classified into three mutually exclusive groups. The first group, prevalent SSD, included those who had two or more of four core symptoms of delirium (clouding of consciousness, inattention, disorientation, perceptual disturbances) at admission. The second group, incident SSD, included those who did not meet criteria for prevalent SSD but displayed one or more new core symptoms during the week after admission. The third group had no prevalent or incident SSD. The three groups were followed up at 2, 6, and 12 months.
Outcomes (length of stay, symptoms of delirium (Delirium index), cognitive (Mini-Mental State Examination) and functional status (instrumental activities of daily living), and mortality) were compared using univariate techniques and multivariate regression models that adjusted for age, sex, marital status, living arrangements before admission, comorbidity, clinical and physiological severity of illness, and dementia status and severity.
Patients with prevalent SSD had longer acute care hospital stay, increased postdischarge mortality, more symptoms of delirium, and a lower cognitive and functional level at follow-up than patients with no SSD. Most of the findings for incident SSD were similar but not statistically significant. Patients with prevalent or incident SSD had risk factors for DSM-defined delirium.
SSD in elderly medical inpatients appears to be a clinically important syndrome that falls on a continuum between no symptoms and DSM-defined delirium.
Journal of the American Geriatrics Society 07/2003; 51(6):754-60. · 3.74 Impact Factor
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ABSTRACT: Delirium has not been found to be a significant predictor of postdischarge mortality, but previous research has methodologic limitations including small sample sizes and inadequate control of confounding. This study aimed to determine the independent effects of presence of delirium, type of delirium (incident vs prevalent), and severity of delirium symptoms on 12-month mortality among older medical inpatients.
A prospective, observational study of 2 cohorts of medical inpatients was conducted with patients 65 years or older: 243 patients had prevalent or incident delirium, and 118 controls had no delirium. Baseline measures included presence of delirium and/or dementia, severity of delirium symptoms, physical function, comorbidity, and physiological and clinical severity of illness. Mortality during the 12 months after enrollment was analyzed with the Cox proportional hazards model with adjustment for covariates.
The unadjusted hazard ratio of delirium with mortality was 3.44 (95% confidence interval, 2.05-5.75); the adjusted hazard ratio was 2.11 (95% confidence interval, 1.18-3.77). The effect of delirium was sustained over the entire 12-month period after adjustment for covariates and was stronger among patients without dementia. Among patients with dementia, there was a weak, nonsignificant effect of delirium on survival. After adjustment for covariates, mortality did not differ between patients with incident and prevalent delirium, but among patients with delirium without dementia, greater severity of delirium symptoms was associated with higher mortality.
Delirium is an independent marker for increased mortality among older medical inpatients during the 12 months after hospital admission. It is a particularly important prognostic marker among patients without dementia.
Archives of Internal Medicine 03/2002; 162(4):457-63. · 11.46 Impact Factor
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ABSTRACT: The objective of this study was to assess the psychometric properties of a new instrument, the Delirium Index (DI), to measure changes in the severity of the symptoms of delirium among patients previously diagnosed with delirium. Subjects were medical inpatients aged 65 and over diagnosed with delirium by the Confusion Assessment Method. Interrater reliability of the DI was .78 between research assistants (concordence coefficient) and was .88 between research assistants and geriatric psychiatrists. Criterion validity, assessed by the correlation between DI and Delirium Rating Scale scores (Spearman's correlation coefficient, r), was .84. Construct validity was assessed using correlations of the DI with two measures of current function for convergent validity (r = −.60, −.70) and two measures of function before admission for discriminant validity (r = .26, −.42). We conclude that the DI has acceptable levels of interrater reliability, criterion validity, and construct validity.
International Psychogeriatrics 11/1998; 10(04):421 - 433. · 2.24 Impact Factor
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ABSTRACT: There is no systematic or standardized approach to assessing higher mental functions in hospitalized elderly patients, despite the constant presence of nursing staff. The Confusion Assessment Method (CAM) is the only valid and reliable clinical tool for detecting symptoms of delirium easily and quickly, even by health professionals with no specialized training in psychiatry. The CAM has been translated into eight languages, but no validated French-language version has been published as yet. It was in response to this need that the researchers took the first steps in validating a French-language version of the CAM and the diagnostic algorithm, and enhanced the description in French of symptoms of delirium and the criteria of the diagnostic algorithm. The validation process was based on the first two steps in the transcultural validation method for psychological questionnaires suggested by Vallerand. The availability of a French-language version of this instrument will lead to greater professional autonomy and help to simplify the recognition of symptoms of delirium and ensure that the appropriate action is taken sooner.
Perspective infirmière: revue officielle de l'Ordre des infirmières et infirmiers du Québec 3(1):12-4, 16-8, 20-2.
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ABSTRACT: This study aimed to examine the recognition of depression in older medical inpatients by nonpsychiatric physicians over a 2-year period.
A cohort of medical inpatients aged 65 and above was recruited at two university-affiliated hospitals, with oversampling of depressed patients. Participants were assessed with research diagnoses of major or minor depression (DSM-IV) at admission and at 3, 6 and 12 months. Indicators of recognition during the 12 months before and the 12 months after admission, derived from administrative databases, included the following: depression diagnosis, antidepressant prescription and psychiatric referral. Multiple logistic regression analyses were used to identify factors associated with recognition.
Among 185 patients with at least one research diagnosis of depression during the study, recognition rates ranged up to 56% during the 12 months before admission among patients with major depression lasting at least 6 months and up to 61% during the 12 months after admission among patients with persistent major depression. In both study periods, a greater number of physician visits and prescription of a psychotropic medication (non-antidepressant) were independently associated with recognition.
A longitudinal approach to measuring recognition of late-life depression in ambulatory care settings indicates that persistent major depression is more likely to be recognized than previously reported.
General Hospital Psychiatry 30(3):245-51. · 2.74 Impact Factor
