Elaine Greene

Loneliness, social support networks, mood and wellbeing in community‐dwelling elderly

Both loneliness and social networks have been linked with mood and wellbeing. However, few studies have examined these factors simultaneously in community‐dwelling participants. The aim of this study was to examine the relationship between social network, loneliness, depression, anxiety and quality of life in community dwelling older people living in Dublin.

Late life depression: a comparison of risk factors and symptoms according to age of onset in community dwelling older adults

It has been reported that late onset depression is more frequently associated with acquired organic pathology and that patients are less likely to report a family history of depression. Differences in phenomenology according to age of onset have been described although these have not been consistently replicated. The majority of these studies have been in hospital populations. The aim of this study is to address this question in a sample of community dwelling older adults.

The spectrum of worry in the community-dwelling elderly

Objectives: In this study, we examine the prevalence and distribution of worry, its content, and its associations with quality of life and depression, based on a large sample of community-dwelling elderly. We will attempt to distinguish between pathological and non-pathological worry based on these associations. Design: Community survey. Setting: Inner-city population. Participants: A total of 2136 people aged between 65 and 96, of whom 66% were women, were recruited through general practitioners and interviewed in their own homes. Measurements: The GMS-AGECAT structured psychiatric interview was used to rate symptoms which were classified into five levels of severity of worry ranging from simple, non-excessive to generalised anxiety disorder (GAD). Results: In this study, 79% of the participants reported worrying, 37% worrying excessively, while 20% reported excessive, uncontrollable worry and 6.3% met criteria for GAD. Prevalence of all types of worry declined with age and was lower in men. The prevalence of depressed mood was similar in those without worry and those with non-severe worry (Wald post hoc test, p = 0.06) but rose significantly with each level of severe worry (Wald post hoc tests, all p < 0.05). Major depressive disorder was absent in those who did not worry, and had a prevalence of only 0.2% in those with non-severe worry (p = 0.552, Fishers exact test). It has a significantly elevated prevalence at all levels of excessive worry, and a significantly higher prevalence in those with GAD. All levels of excessive worry were associated with reduced quality of life. Conclusion: Severe worry is highly prevalent in the elderly; most severe worriers do not meet criteria for GAD, but have a reduced quality of life and an increased prevalence of depression.

Self-reported alcohol consumption in the Irish community dwelling elderly.

OBJECTIVES To examine the associations of self-reported alcohol consumption in a community based sample of elderly subjects. METHODS A total of 518 non-institutionalised community dwelling elderly identified from general practice registers were interviewed in their own homes using the Geriatric Mental State (GMS-AGECAT), the Mini-Mental State Examination and the sociodemographic questionnaire. Physical health was rated on a six-point scale. Self reported alcohol consumption was recorded in units per week. The group was then divided according to the presence or absence of excessive alcohol consumption (ie. consumption of over 14 units per week for females and 21 units per week for males). Results were analysed using multivariate regression analysis with excessive alcohol consumption as the dependent variable. RESULTS The mean age of the sample was 73 (range 65-95), 63% (n = 329) were female. Thirty-six per cent of the population were abstinent and 7% reported excessive alcohol consumption. Analysis of the data revealed no association between excessive alcohol consumption and diagnosis, age, cognitive function or poor physical health. Excess consumption was found to be significantly associated with gender (male) and widowed status (p < 0.001, p = 0.013 respectively). CONCLUSIONS As alcohol misuse is commonly missed in the elderly identifying high risk groups is important for the development of intervention strategies. Our results suggest that elderly widowers may be more at risk than their peers of alcohol misuse.

The detection, diagnosis, and impact of cognitive impairment among inpatients aged 65 years and over in an Irish general hospital – a prospective observational study

BACKGROUND The diagnosis of dementia remains inadequate, even within clinical settings. Data on rates and degree of impairment among inpatients are vital for service planning and the provision of appropriate patient care as Irelands population ages. METHODS Every patient aged 65 years and over admitted over a two-week period was invited to participate. Those who met inclusion criteria were screened for delirium then underwent cognitive screening. Demographic, functional, and outcome data were obtained from medical records, participants, and family. RESULTS Consent to participate was obtained from 68.6% of the eligible population. Data for 143 patients were obtained. Mean age 78.1 years. 27.3% met criteria for dementia and 21% had mild cognitive impairment (MCI). Only 41% of those with dementia and 10% of those with MCI had a previously documented impairment. Between-group analysis showed differences in length of stay (p = 0.003), number of readmissions in 12 months (p = 0.036), and likelihood of returning home (p = 0.039) between the dementia and normal groups. MCI outcomes were similar to the normal group. No difference was seen for one-year mortality. Effects were less pronounced on multivariate analysis but continued to show a significant effect on length of stay even after controlling for demographics, personal and family history, and anxiety and depression screening scores. Patients with dementia remained in hospital 15.3 days longer (p = 0.047). A diagnosis is the single biggest contributing factor to length of stay in our regression model. CONCLUSIONS Cognitive impairment is pervasive and under-recognized in the acute hospital and impacts negatively on patient outcomes.

Use of the Geriatric Anxiety Inventory–short form as a screening tool for detection of generalised anxiety in a memory clinic population

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Interaction of duloxetine with warfarin; a cautionary report

Warfarin is primarily cleared by the liver through the cytochrome P450 system. Many of the isoenzymes involved are also involved in the metabolism of psychotropic agents.2 Drug interactions with Warfarin are generally well described. Data regarding the interaction of warfarin with duloxetine are limited. There are only two case reports in the literature which report conflicting findings.3,4 Additionally, a small open-label study reported no significant interaction between the two agents. 5

Reasons for poor attendance at an MRCPsych academic programme

Objectives: To examine potential reasons for poor attendance at the lecture programme and exploring possible alternatives to existing course structures. Method: A postal questionnaire was circulated to all basic specialist trainees and consultants in the Irish Psychiatric training committee Eastern Region Results: Response rates were 73% and 44% for consultants and trainees respectively. Respondents expressed concern about the content, relevance and structure of the current lecture programme. Conclusion: Change is required to the current lecture programme which should give due consideration to the opinions of trainees and consultants. A number of suggestions are made based on the study findings.