Erin L. Cassidy

Efficacy, Safety, and Tolerability of Sertraline in Patients with Late-Life Depression and Comorbid Medical Illness

Objectives: To report on the efficacy, safety, and tolerability of sertraline in the treatment of elderly depres‐sed patients with and without comorbid medical illness.

Recruitment and Retention of Elderly Patients in Clinical Trials: Issues and Strategies

Clinicians and researchers alike are shifting their focus to elderly patients in order to target the most effective treatments for a variety of psychiatric conditions. Clinical trials with elderly patients are the necessary because they consume the largest number of prescription medications. There are special challenges and considerations in designing and conducting clinical studies. The authors review the various phases of such research, including recruitment of appropriate patients and retention of those enrolled, and they make suggestions, using examples from already completed research studies, illustrating the methods found to be most successful.

Treatment of Anxiety Disorders in the Elderly: Issues and Strategies

Clinical practice for the treatment of anxiety disorders in the elderly in general lacks empirical validation and hence is somewhat inconsistent. Extensive clinical experience, along with the knowledge gleaned from studies with a younger population, has led to the development of the following treatment approach. A thorough diagnostic assessment, crucial in planning subsequent treatment, is discussed first along with more general clinical issues. Next. a detailed review of current pharmacologic and psychologic treatments for each of the diagnostic categories of anxiety is described for application to the older patient. Definitive studies regarding the best treatments for anxiety disorders in the elderly are lacking, and further investigation of this area is emphasized.

Mixed anxiety and depression in older adults: clinical characteristics and management.

The frequent comorbidity of anxiety and depression, particularly among elderly, is widely recognized by clinicians, but the debate continues as to whether the combined diagnostic designation is merited. This article reviews the debate over the mixed diagnosis, discusses treatment implications, and reviews a small treatment study undertaken with elderly patients. Ten community-dwelling, older adults diagnosed with generalized anxiety disorder and subsyndromal depression (n = 6) or generalized anxiety disorder and major depressive disorder (n = 4) were started on a 12-week, open-label trial of nefazodone. Clinicians’ ratings on the Clinical Global Impression of Change and patients’ self-ratings of symptoms on the Beck Depression Inventory and the Beck Anxiety Inventory identified statistically significant gains in patients’ overall pre/post functioning. Nefazodone was efficacious in symptom alleviation in patients with comorbid anxiety and depression. Further double-blind, randomized investigations with newer antidepressant medications are required to extend these preliminary findings with nefazodone.

Pre-intervention assessment for disruptive behavior problems: A focus on staff needs

Mental health professionals are often called upon to assist institutions in their struggle to manage the behavior problems associated with dementia. The current article provides an example of a typical behavioral consultation. The various methods of assessment, including topographical, functional and observational are described in the context of planning future interventions. Results indicate that a large proportion of staff time, approximately 40%, is spent implementing such interventions. Although the time required is great, frontline staff are adept at utilizing less invasive interventions first. Implications for subsequent interventions, need for continued evaluation and reassessing levels of staff burden are discussed.

Behavioral Problems in Older Adults in Acute Care Settings: Challenges for Staff

Abstract The combination of mental and physical changes with age will impact agencies focusing on both acute and chronic problems. One of the biggest challenges for staff new to such patients is contending with agitated and aggressive behaviors. Conducting a needs assessment with staff is one method of mapping the nature and extent of problem behaviors for a specific setting. In the current study, a total of 71 staff members from different disciplines, across three acute care units and two VA health care facilities, completed a survey assessing the type and frequency of reported behavior problems, the extent to which staff members could identify and document relevant patient risk factors and to identify gaps in their training. Staff reported a large range of problem behaviors. They felt highly confident in their ability to respond effectively to the most frequently observed behaviors, such as patients appearing anxious or having difficulty concentrating and trouble sleeping. However, they felt less prepared for less frequent behaviors, such as physical aggression. This information will be used to design follow-up training for the staff in targeted areas, including the management of various behaviors and the recognition of risk factors for problematic behaviors.

Assessment to intervention : Utilizing a staff needs assessment to improve care for behaviorally challenging residents in long term care (Part II)

Abstract This first of two papers illustrates how a staff needs assessment can serve as the foundation for ongoing collaborations between long-term care staff and consulting clinical researchers. The needs assessment was an example of a three-phase model of consultation and intervention to improve resident care and reduce staff burden in a psychiatric nursing home unit managing aggressive and disruptive residents. The first phase of the process involved gathering data via a series of semi-structured interviews with 78 staff members of a long-term care unit at the Palo Alto Veterans Hospital. The second phase, discussed in more detail in the second paper, involved implementation of a series of interventions aimed at supporting staff in dealing with disruptive and aggressive behavior. The final phase, which is continuing, is monitoring and refining the interventions based on staff feedback and the results of program evaluation. Such an approach allows interventions to target the concerns and needs of a particular setting.