Nori Graham

Prevalence and Course of Depression Among Elderly Residential Home Admissions in Mannheim and Camden, London

A longitudinal study based on consecutive admissions to all residential homes for the elderly was conducted in the industrial city of Mannheim (Germany) and in the London borough of Camden (England). Inclusion criteria were that the elderly persons (65 years old and older) came directly from their own home or, if transferred from a hospital, had been there for less than 3 months. At each site, 60 home residents were interviewed at admission and 3 months and 8 months later. Depression and dementia were assessed with the aid of the Brief Assessment Scale. The prevalence of depression (Mannheim: 34.6%; Camden: 47.9%) was already high at admission and did not change significantly over time. Residents in Camden were more demented and more impaired in their activities of daily living at the time of admission, and the percentage of those who died or were transferred to a hospital or nursing home within 8 months thereafter was higher in Camden (30%) than in Mannheim (5%). Multiple regression analysis revealed that, in both study areas, depression at baseline was the best predictor for depression 3 months and 8 months later. This relationship was particularly strong in Camden, where a high percentage of the depressed at admission showed a chronic course of illness. Sex, age, home visits, social isolation, activities of daily living, cognitive impairment, and somatic symptoms at the time of admission were not significantly associated with depression 3 months later. Eight months after admission, a similar pattern was found in Mannheim. In Camden, however, in addition to depression, a lack of home visits by relatives and friends, and somatic symptoms at baseline, were significant predictors of depression 8 months after admission.

Alzheimer's Disease International.

Alzheimers Disease International (ADI) aims to promote and support the work of national Alzheimer associations. Their main purpose is to support carers of people with Alzheimers disease and related dementias, and to raise awareness of the impact of the disease on the individual and the carer.

The Stroud/ADI dementia quality framework: a cross-national population-level framework for assessing the quality of life impacts of services and policies for people with dementia and their family carers.

To generate an internationally applicable framework for the systematic assessment of the quality of life impacts of services and policies for people with dementia and their family carers.

Healthy lifestyle: need for action.

There is massive evidence that a healthy lifestyle, especially involvement in active exercise, reduces the risk of cardiovascular disease, diabetes type 2, and obesity (Taylor et al., 2004). There is less strong but nevertheless good evidence that it reduces the risk of depression in the older adult population (Strawbridge et al., 2002). The evidence that it reduces the risk of Alzheimer’s disease is contestable (Rolland et al., 2008), but if it reduces vascular disease there can be no argument that it must reduce the risk of vascular dementia. It is over 60 years since Morris showed that bus drivers had a distinctly higher rate of heart disease than bus conductors who ran up and down the stairs of London buses as part of their job (Morris et al., 1953). So it is surprising that it is only in very recent times that a report of the Chief Medical Officer (CMO) of England and Wales has advocated the need for a new public health drive to improve the lifestyle of older people in the UK (Department of Health, 2011). In the same year as this statement from the CMO was published, further initiatives were embarked upon. The Centre for Social Justice is a policy unit founded by the current Secretary of State for Work and Pensions, Ian Duncan Smith. Its report “The Forgotten Age” (Centre for Social Justice, 2010) pointed to the need for a healthier lifestyle to improve the quality of life of disadvantaged older people. Following the publication of this report, the Department of Work and Pensions, in collaboration with Age UK, launched the Age Action Alliance (2011), an ambitious, multisectoral approach to combat the disadvantages experienced by older people. The Alliance is an independent association of organizations across the whole of civil society. Its members are drawn from older people’s groups from around the whole country, national and local voluntary organizations, government departments, and the private sector (including the fitness industry, football league, British Gas, and Microsoft). To date, over 200 organizations have joined. As the first national initiative of its kind, Alliance members aim to work together to improve the lives of the most disadvantaged older people and reduce preventable ill health in people in this age group by improving their lifestyle. Older people themselves are the driving force in the work of the Alliance. A high proportion of older people, especially those from socially disadvantaged groups, do not take the levels of physical exercise recommended to maintain health (Scottish Government, 2004). There is a variety of reasons why this is the case. They include health problems (including physical disability), poor access to exercise facilities, inertia, lack of interest, lack of confidence, fear of overdoing it, hostile environment, and cost constraints. A study of civil servants showed that they did more exercise in their leisure time when retired than they did when they were working (Mein et al., 2005). But those employed in low grades in the civil service did much less exercise than those in higher grades. Civil servants are, in large part, a socially privileged group. It is highly likely that socially disadvantaged people employed in manual occupations will do even less physical exercise in retirement than sedentary civil servants. Further, after retirement, the amount of physical exercise taken by the older population reduces markedly with age, especially after the age of 75 (Scottish Government, 2004). Once those in employment have lost the habit of going to work as a result of retirement, many do not develop habits of taking exercise. They lead a life which is not only sedentary but also socially isolated. Unsurprisingly, they have high rates of depressive disorders (McDougall et al., 2007). It is well recognized that in getting the long-term unemployed back to work, it is essential to reestablish a habit of getting up in the morning and appearing at work on time. To achieve similar habits in the long-term retired and sedentary section of the population without the incentive of the monetary rewards that accompany paid employment is quite a challenge. The initial work of this Alliance has been taken forward by several working groups, commissioned by a steering group. There are older people representatives on all groups. One of these groups, which I chair, is focused on public health and active lifestyles. The group took as its theme the “Five Ways to Wellbeing” that emerged from research conducted by the New Economics Forum, commissioned by Foresight (National Economics Forum, 2008). To achieve “Five Ways,” an individual needs to connect, take notice, be active, learn, and give. The group decided that it would identify already existing programs, which support this theme. Programs were expected to meet a set of criteria before they could be recommended. They should

P4-209: ADI-QOL: A population framework for the evaluation of services and policies for people with dementia

ing fewer medications or non pharmacological therapies compared to young subjects, because the treatments are considered less effective, too risky or too expensive. Few studies evaluated drug use in old demented people. Objective: The aim of our research was to evaluate factors associated to drug use and underuse in several diseases in non demented and demented elderly subjects. Methods: We analyzed a populationbased data set of elderly subjects admitted between 2001 to 2005 in 39 Italian Memory Clinics (ReGAl Project-Geriatric Network on Alzheimer Disease). We identified 2020 subjects: 83% demented, 8% non demented, 9% subjects with diagnosis of depression. Mean age was 77 7 years. Mean numbers of drugs used were 3 2. Multivariate logistic regression models, adjusted for co-morbid condition and severity of dementia, were use to identify factors associated with drug use or underuse in the main pathologies. Results: Being “oldest old” ( 85 years) was associated to higher risk of not receiving anticoagulant for atrial fibrillation (OR 0.1, CI 95%) or statins for hypercholesterolemia (OR 0.1, CI 95%). Being “oldest old” with dementia was associated to higher risk of not receiving antidepressants, particularly SSRI (OR 0.3, CI 95%), in presence of diagnosis of depression and at the same stage of dementia, and to receiving typical antipsychotic drugs (OR 1.9, CI 95%). Increase of severity of dementia or living in nursing home was associated to higher risk being treated with typical and atypical antipsychotic drugs (OR 2.9, CI 95%). Demented subjects were more likely to be treated with angiotensin II antagonists in arterial hypertension (OR 0.5, CI 95%) and proton pump inhibitors in peptic disease (OR 0.3, CI 95%). Conclusions: Increasing age and diagnosis of dementia influence drug use. It seems important to define the basis of this medical behavior in order to avoid prejudice and ageiotic attitudes.