Susan Gee

Children's recall 1 or 2 years after an event.

In Study 1, children were reinterviewed about an event they had taken part in 2 years earlier when they were 6 years old (M.-E. Pipe & J. C. Wilson, 1994). In Study 2, children were reinterviewed about an event in which they had participated 1 year earlier when they were 6 or 9 years of age (S. Gee & M.-E. Pipe, 1995). Interviews were conducted with or without cue items and distractors, as in the original studies. The amount of information reported in free recall decreased over the 1- or 2-year delays, and for 6-year-olds, there was also a small decrease in accuracy of free recall. Reinstating specific cue items in Study 2 maintained recall when attention was drawn to them, but prompting children led to a decrease in accuracy. Whereas information repeated across interviews was highly accurate, information reported for the first time at the long delays was not.

‘What colour is your pet dinosaur?’ The impact of pre-interview training and question type on children's answers

Purpose. Two studies evaluated the effects of question type and of brief pre-interview training, involving instructions and practice, on the number of correct answers and errors given by children in a structured interview. Methods. A total of 157 children aged from nine to 13 were interviewed about a visit to a science centre with both misleading and non-misleading open and closed questions. The children also rated their confidence in each of their answers. Half the children received pre-interview training designed to discourage compliance and guessing. Results. In Study 1 pre-interview training decreased commission errors to misleading questions, but also decreased the number of correct responses to non-misleading questions. In Study 2 a revised training package decreased errors for misleading questions without impacting on correct responses. Conclusions. Brief pre-interview interventions can reduce childrens compliance with misleading questions in experimental situations. Both studies provided some support for the cognitive processing hypothesis that the confidence-accuracy relationship will be stronger for open than for closed questions.

Measuring Outcomes in Mental Health Services for Older People: An evaluation of the Health of the Nation Outcome Scales for elderly people (HoNOS65+)

The Health of the Nation Outcome Scales (HoNOS) family of measures is routinely used in mental health services in the New Zealand, Australia, and the United Kingdom. However, the psychometric properties of the HoNOS65+ for elderly people have not been extensively evaluated. The aim of the present study was to examine the validity, reliability, and sensitivity to change of the HoNOS65+. Routinely collected HoNOS65+ data from a psychiatric service for older people (n = 2065) were collated, and a subsample (n = 66) of older service users were assessed with an additional battery of established measures. The individual HoNOS65+ items generally showed adequate concurrent validity and sensitivity to change. Estimates of inter‐rater reliability across settings indicated areas of concern however, and confirmatory factory analysis did not support models based on existing subscales. These findings indicate some limitations of the HoNOS65+ as an outcome scale for older people.

Developing a dementia-friendly Christchurch: Perspectives of people with dementia.

Christchurch, New Zealand has a unique opportunity to potentially rebuild as a dementia‐friendly city in the wake of the 2010 and 2011 earthquakes. The present study gathered insights from people with dementia about what would make it possible for them to live better in Christchurch.

Performance of three cognitive screening tools in a sample of older New Zealanders.

BACKGROUND With the ubiquitous Mini-Mental State Exam now under copyright, attention is turning to alternative cognitive screening tests. The aim of the present study was to investigate three common cognitive screening tools: the Montreal Cognitive Assessment (MoCA), the Rowland Universal Dementia Assessment Scale (RUDAS), and the recently revised Addenbrookes Cognitive Assessment Version III (ACE-III). METHODS The ACE-III, MoCA and RUDAS were administered in random order to a sample of 37 participants with diagnosed mild dementia and 47 comparison participants without dementia. The diagnostic accuracy of the three tests was assessed. RESULTS All the tests showed good overall accuracy as assessed by area under the ROC Curve, 0.89 (95% CI = 0.80-0.95) for the ACE-III, 0.84 (0.75-0.91) for the MoCA, and 0.86 (0.77-0.93) for RUDAS. The three tests were strongly correlated: r(84) = 0.85 (0.78-0.90) between the ACE-III and MoCA, 0.70 (0.57-0.80) between the ACE-III and RUDAS; and 0.65 (0.50-0.76) between the MoCA and RUDAS. The data derived optimal cut-off points for were lower than the published recommendations for the ACE-III (optimal cut-point ≤76, sensitivity = 81.1%, specificity = 85.1%) and the MoCA (≤20, sensitivity = 78.4%, specificity = 83.0%), but similar for the RUDAS (≤22, sensitivity = 78.4%, specificity = 85.1%). CONCLUSIONS All three tools discriminated well overall between cases of mild dementia and controls. To inform interpretation of these tests in clinical settings, it would be useful for future research to address more inclusive and potentially age-stratified local norms.

Perceptions of a cognitive rehabilitation group by older people living with cognitive impairment and their caregivers: A qualitative interview study

Cognitive rehabilitation has been developed to improve quality of life, activities of daily living and mood for people with cognitive impairment, but the voice of people with cognitive impairment has been underrepresented. This study aimed to understand the experience of people living with cognitive impairment, as well as their caregivers who took part in a cognitive rehabilitation intervention programme. Twelve individuals with cognitive impairment and 15 caregivers participated in individual qualitative interviews. The interview data were analysed in three steps: 1) familiarisation of the transcripts; 2) identification of themes; 3) re-interpretation, refinement and integration of themes with methodological auditors. Both participants living with cognitive impairment and caregivers valued the comfortable environment with friendly, caring and supportive group leaders who taught practical tips and strategies. The participants living with cognitive impairment enjoyed socialising with like others. Caregivers benefited from learning about memory problems and sharing their challenges with other caregivers. The participants living with cognitive impairment emphasised the benefits of relational and practical aspects, whereas the caregivers valued the informational and emotional support. In conclusion, both participants living with cognitive impairment and caregivers found the cognitive rehabilitation group useful.

Individual risk factors for possible undetected dementia amongst community-dwelling older people in New Zealand:

There is general acknowledgement of the importance of early diagnosis of dementia, yet there are still high rates of undetected dementia internationally. The aim of this cross-sectional study was to determine the sociodemographic characteristics associated with possible undetected dementia in a large sample of community-dwelling older New Zealanders. The sample consisted of older people (age ≥ 65) who had received the homecare version of the international Residential Home Care Assessment version 9.1 over a two-year period and who were screened positive for possible dementia on the international Residential Assessment’s Cognitive Performance Scale. People with possible alternative explanations for impaired cognitive performance such as depression and other neurological conditions were excluded from analysis. The 5202 eligible individuals were categorized into two groups: (1) those with a recorded diagnosis of dementia (64%) and (2) those without a recorded diagnosis of dementia (i.e. possible undetected dementia group) (36%). Logistic regression was used to evaluate the association between individual characteristics and possible undetected dementia. Significant risk factors for being in the possible undetected dementia group included Asian ethnicity, living alone, not having participated in long-standing social activities recently, major life stressors, and limited accessibility of their house. The knowledge gained from this study could enable targeting of services and resources for the groups at risk of undetected dementia to have a more equitable access to early diagnosis.

INDIVIDUAL RISK FACTORS FOR POSSIBLE UNDETECTED DEMENTIA AMONGST COMMUNITY-DWELLING OLDER PEOPLE IN NEW ZEALAND

Background: Convergence insufficiency, an inability to coordinate binocular eye movements to maintain single vision during near target viewing, is increasingly recognized as a cause of disabling visual dysfunction for near tasks (i.e. reading) in parkinsonian conditions, and is most often reported by patients as double vision. While cognitive complaints may be more common in patients with Parkinson’s disease who report diplopia, the relationship between cognitive impairment, subjective visual symptoms, and objectively measured convergence insufficiency has not previously been investigated. Methods: Twenty-four participants with parkinsonian disorders (21 Parkinson’s disease, 4 progressive supranuclear palsy) referred for neuro-ophthalmologic evaluation with objective findings of convergence insufficiency (near point of convergence of 10 cm or a near/ distance exotropia disparity of 10 prism diopters), with visual acuity better than 20/40 best corrected, were included in this analysis. Subjective reports of visual symptoms of convergence insufficiency (i.e. near task symptoms of blurred or double vision or eye strain) were recorded. Participants completed the SelfAdministered Gerocognitive Examination (SAGE) as a global

Predictors for repeat self-harm and suicide among older people within 12 months of a self-harm presentation

BACKGROUND A past history of self-harm is a significant risk factor for suicide in older people. The aims of this study are to (i) characterize older people who present with self-harm to emergency departments (EDs); and (ii) determine the predictors for repeat self-harm and suicide. METHODS Demographic and clinical data were retrospectively collected on older people (age 65+ years), who presented to seven EDs in New Zealand following an episode of self-harm between 1st July 2010 and 30th June 2013. In addition, 12-month follow-up information on repeat self-harm and suicide was collected. RESULTS The sample included 339 older people (55.2% female) with an age range of 65-96 years (mean age = 75.0; SD = 7.6). Overdose (68.7%) was the most common method of self-harm. 76.4% of the self-harm cases were classified as suicide attempts. Perceived physical illness (47.8%) and family discord (34.5%) were the most common stressors. 12.7% of older people repeated self-harm and 2.1% died by suicide within 12 months. Older people who had a positive blood alcohol reading (OR = 3.87, 95% Cl = 1.35-11.12, p = 0.012) and were already with mental health services at the index self-harm (OR = 2.73, 95% Cl = 1.20-6.25, p = 0.047) were more likely to repeat self-harm/suicide within 12 months. CONCLUSION Older people who self-harm are at very high risk of repeat self-harm and suicide. Screening and assessment for alcohol use disorders should be routinely performed following a self-harm presentation, along with providing structured psychological treatment as an adjunct to pharmacological treatment for depression and interventions to improve the persons resilience resources.

Convergent Validity, Concurrent Validity, and Diagnostic Accuracy of the interRAI Depression Rating Scale:

Aims: Depression Rating Scale (DRS) is one of the clinical outcome measures of the International Resident Assessment Instrument (interRAI) assessment. The primary aim of this study is to investigate the diagnostic accuracy and concurrent validity of the 3-day assessment window version of the DRS. Methods: The performance of DRS was compared with a gold standard clinical diagnosis of depression in 92 patients (age ≥65) who had interRAI version 9.1 Home Care assessment completed within 30 days of discharge from psychogeriatric inpatient care or memory clinic assessment. Results: The DRS had poor diagnostic accuracy for depression diagnosis with an area under the curve of 0.68 (95% confidence interval [CI] = 0.57-0.77). The DRS score had a poor to moderate correlation with the Health of the Nation Outcome Scale 65+ depression item score (rs = 0.30, 95% CI = 0.09-0.48, P = .006). Conclusion: This study and the existing literature raise concerns that the DRS is not an adequate measure of depression.