Mona Baumgarten

The psychological and physical health of family members caring for an elderly person with dementia

Most elderly persons with dementia are cared for at home, usually by the spouse or an adult child. The objective of the present study was to determine whether there is an excess of psychological and physical health problems among family caregivers (CGs) of elderly persons with dementia. Data were obtained by interview from close family members of dementia patients (CGs), and from a comparison group made up of close family members of patients undergoing cataract surgery (non-caregivers, NCGs). CGs had significantly higher levels of depression and physical symptoms than NCGs. The association between caregiving and the health variables was stronger among subjects who were the patients spouse than among those who were the patients child. Furthermore, greater behavioral disturbance in the demented patient was associated with higher levels of morbidity in the CG. The results suggest that CGs might benefit from careful monitoring of their health status, and from greater access to specialized support services.

Dementia as a risk factor for falls and fall injuries among nursing home residents.

Objectives: To compare rates of falling between nursing home residents with and without dementia and to examine dementia as an independent risk factor for falls and fall injuries.

Side effects of opioids during short‐term administration: Effect of age, gender, and race

Little is known about risk factors that increase the risk of development of opioid side effects. Our objective was to evaluate the effect of the type of opioid, age, gender, and race on the incidence of side effects from short‐term opioid use.

The Use and Interpretation of Quasi-Experimental Studies in Infectious Diseases

Quasi-experimental study designs, sometimes called nonrandomized, pre-post-intervention study designs, are ubiquitous in the infectious diseases literature, particularly in the area of interventions aimed at decreasing the spread of antibiotic-resistant bacteria. Little has been written about the benefits and limitations of the quasi-experimental approach. This article outlines a hierarchy of quasi-experimental study design that is applicable to infectious diseases studies and that, if applied, may lead to sounder research and more-convincing causal links between infectious diseases interventions and outcomes.

Validity and reliability of the dementia behavior disturbance scale

Behavioral disturbance is a common and distinctive feature of Alzheimers disease and other dementias. Existing instruments designed to quantify behavior disturbance among patients with dementia tend to be quite heterogeneous, including many items that do not refer to behavioral disturbance as such, but rather to cognitive, psychological, or somatic symptoms, or functional impairments. A 28‐item Dementia Behavior Disturbance (DBD) scale was developed to avoid some of the problems encountered with the older instruments. In two samples of patients with dementia (n = 50 and n = 46), the most common symptoms were repetitive questions, losing or hiding things, lack of interest in daily activities, nocturnal wakefulness, unwarranted accusations, excessive daytime sleeping, and pacing. The coefficient of internal consistency was greater than .80 in both samples, and the correlation between scores obtained from the same subjects at a two‐week interval was moderately high (Pearsons correlation coefficient = .71). There was a relatively high correlation between DBD scores and scores on Greenes Behavior and Mood Disturbance scale, and higher DBD scores were associated with increased duration and severity of disease. These preliminary results indicate that the DBD may be a useful and valid measure of one dimension of the dementia syndrome.

The health of persons giving care to the demented elderly: A critical review of the literature

The majority of the demented elderly live at home, usually cared for by their spouse or an adult child. Clinical impressions suggest that caring for an older person suffering from a dementing disorder may lead to physical and mental health problems for the caregiver. A critical review of the research literature on this topic was carried out. The review revealed that a multitude of physical and mental health outcomes as well as numerous correlates of health problems have been studied in relation to caregiving. Furthermore, several methodological problems were identified in the studies reviewed: inadequate sample size, unrepresentative study samples, uncontrolled confounding factors, inappropriate study design, multidimensional outcome measures, and absence of comparison groups. The diversity of outcomes studied and the numerous methodological problems make it difficult to make statements about the causal effect of caregiving on health, or to assess the public health impact of caring for a demented elderly person. Nevertheless, the work done to date suggests interesting directions for future research.

Undetected Dementia in Community‐Dwelling Older People: The Canadian Study of Health and Aging

OBJECTIVE: To estimate the frequency and correlates of undetected dementia in community‐dwelling older people.

The incidence and prevalence of pressure ulcers among elderly patients in general medical practice.

PURPOSE The objective of this study was to estimate the period prevalence and incidence of pressure ulcer among those 65 years of age and older. METHODS We used a patient-record database called the General Practice Research Database (GPRD). Subjects were 65 years of age and older and cases were ascertained based on strict inclusion and exclusion criteria. The accuracy of the ascertainment strategy was estimated using mailed physician-answered questionnaires. Annual period prevalence and age-specific incidence were estimated per 100 person-years with exact 95% confidence intervals (CI). RESULTS The accuracy of our ascertainment strategy was excellent, with a positive predictive value of 100% (95% CI: 92%,100%) and negative predictive value of 95% (85%, 95%). Over 200,000 person-years of data were analyzed. The annual period prevalence of pressure ulcer among those 65 years of age and older varied from 0.31% to 0.70%. The incidence varied significantly with advancing patient age from 0.18 to 3.36 per 100-person years (p < 0.001) but was not associated with gender (p = 0.95). CONCLUSIONS Pressure ulcers are seen in the general practice setting. They are most likely to occur in those over 85 years of age. Preventative strategies within the general practice setting should concentrate on the oldest of the elderly.

Adult day care for the frail elderly: outcomes, satisfaction, and cost.

Objectives: To assess outcomes and satisfaction among frail elderly day care clients and their informal caregivers and the impact of adult day care on the cost of health services. Methods:One-hundred eight elderly participants were randomly assigned to the experimental group (immediate admission to an adult day care center) and 104 participants to the control group (3 months on a waiting list). Results:Participants’ and caregivers’ subjective perceptions of the day center’s effects were positive. However, using standard research instruments, there was no evidence of an effect of day center attendance on the client’s anxiety, depression, or functional status; on caregiver burden; or on the cost of health services. Discussion:It is difficult to demonstrate objectively the benefits of programs and interventions that are perceived by clients, caregivers, and staff to have positive effects. In future studies, maintenance of high levels of participation should be incorporated as an explicit program goal.

Predictors of continued physical restraint use in nursing home residents following restraint reduction efforts.

OBJECTIVES: To examine predictors of continued restraint use in nursing home residents following efforts aimed at restraint reduction.