W. Padoani

Alternative medicine in a sample of 655 community-dwelling elderly

OBJECTIVE Use and satisfaction with herbal/homeopathic remedies, acupuncture and relaxation techniques were examined in an Italian elderly population. METHODS Data were collected as part of a survey on an elderly population, conducted in 1996--1997 in the urban centre of Padua, Italy. A total of 1362 elderly received a letter inviting them to participate and to accept the visit of an interviewer at home. Of these, 212 were unable to do so for insurmountable reasons and 666 gave consent to take part in the study with a response rate of 65%. Eleven participants were excluded from the study because cognitively impaired. RESULTS Among the 655 respondents, overall use of at least one alternative medicine was 29.5%. Herbs/phytotherapeutics (47%) and acupuncture (34%) were the most frequently cited therapies. The use of alternative medical practices seems rather widespread among the elderly population in Padua, especially among females with depressive symptoms, pain and discomfort, but not suffering from chronic somatic disease. A percentage of 3.7% of the sample used exclusively alternative medicines; those subjects seemed to be younger, less likely to be physically ill and to report functional disorders and chronic somatic disease. CONCLUSION Alternative medicines seem to have a complementary role for the elderly with self-perceived psychological symptomatology or disorders, particularly of depressive nature. They may constitute an attempt at self-treatment, probably concealing the difficulties encountered by the elderly subjects in seeking specialist advice for these problems.

Repetition of suicidal behaviour in elderly Europeans : a prospective longitudinal study.

The aim of this study was to assess any predictive factors for repeated attempted suicide and completed suicide in a 1-year follow-up on a sample of elderly European suicide attempters (60 years and over). From 1990 to 1993, 63 subjects completed the first interview and were recontacted after 1 year. At follow-up, eight subjects (12.7%) had taken their lives and seven (11.1%) had repeated at least one suicide attempt. On comparison of repeaters and non-repeaters, differences emerged in terms of death of the father in childhood and for mean Suicidal Intent Score. At the end of follow-up period, repeaters reported a more frequent desire to repeat suicidal behaviour and judged their mental health and social assistance received to be worse. Suicides and non-repeaters differed especially in relation to death of father during childhood and number of contacts with General Practitioner. Interpretation of the results must take into account the smallness of the test sample, the difficulties in obtaining complete data for the follow-up interview, the lack of a control group and a diagnosis formulated in a hospital consultation setting. The study confirms, however, the high risk of repetition of suicidal behaviour in the elderly. In old age suicidal ideation is often sustained over long periods of time and requests for help are addressed to relatives and GPs. An interesting finding is the more frequent death of the father during childhood among repeaters.

Sexual feelings and sexual life in an Italian sample of 335 elderly 65 to 106-year-olds

Summary This study analyses various aspects of sexual interest and activity in a sample of 335 elderly people, recruited at the consulting rooms of 21 general practitioners in the town of Padua (Italy) among elderly subjects taking part in an international, multicentric study on the quality of life, conducted in cooperation with the World Health Organization (Quality of life assessment, instrument to measure self-perceived functioning and well-being in the elderly. LEIPAD Project) and considers a complete age range, including subjects of both sexes, aged between 65 and 106 years, with a view to providing a global, reliable image of sexuality up to a very advanced age. Roughly one-third of the subjects in the sample reported being still interested in sex. Results of logistic analysis demonstrate the most important variables in maintenance of sexual activity; they are listed as follows: being male, married, younger and cognitively unimpaired, in addition to having a higher educational level, being self-sufficient and satisfied with the present life. Educational level, age and social functioning, on the other hand, lose importance in the case of sexual interest, which remains more present than activity, even in very advanced age. Analyzing males and females separately, moreover, the absence of arthrosis, and maintenance of good social-relational functions gain predictive importance for men, and absence of depression and anxiety for women, in relation to both sexual interest and activity.

Personality Disorders and Self-Perceived Quality of Life in an Elderly Psychiatric Outpatient Population

The aim of this work was to assess the impact of personality disorder and traits on the subjective assessment of quality of life by a sample of elderly psychiatric outpatients (60 years or more). Sixty of the total number of subjects interviewed were included in the test sample since they met the Vragenlijst Klinishe Persoonlijkheid (VKP) criteria for personality disorder. A control sample was also formed, composed of 50 subjects without personality disorders or traits. Quality of life was assessed using the LEIPAD questionnaire. Personality disorder diagnoses were prevalently distributed in cluster C (25%) and in cluster A (20%). A total of 48.3% of patients (n = 29) had more than 1 personality disorder. Sixty percent of the sample (n = 36) presented with comorbid Axis I psychiatric disorders, in most cases depressive pathologies. Comparing the case and control groups, worse LEIPAD scores were achieved by subjects with personality disorders. Between clusters of personality disorders, the worst scores were observed in subjects with more than 1 personality disorder diagnosis. Elderly people who presented with a personality disorder were more vulnerable to late-life distress, especially those with more than one diagnosis. In keeping with linear regression analysis, widowhood, divorcehood and living with others appear to be variables able to negatively influence quality of life in this population. While the VKP needs to be adapted to the application in the elderly, it does seem to be a particularly useful screening instrument.

Influence of cognitive status on the sexual life of 352 elderly Italians aged 65-105 years.

Background: Various factors are considered to influence sexual behavior in the elderly, but the role played by preservation of adequate cognitive functioning has not been adequately explored. Objective: The aim of this research, conducted on 352 older adults aged between 65 and 105 years, was to identify the specific role played by cognitive functioning in sexual activity and sexual interest in the elderly. Methods: The data were collected from elderly people attending the surgeries of 21 general practitioners in the city of Padua (Italy). Analysis of sexual functioning was based on two items, from the LEIPAD questionnaire: ‘Are you interested in sex?’ and ‘Do you have sexual relations?’. Subjects cognitive status was assessed objectively through the Mini Mental State Examination (MMSE) and subjectively by the LEIPAD subscale on cognitive functioning. Results: Subjects who were sexually active and interested in sex were more highly represented among the married elderly. The elderly who reported being active and interested in sex were significantly younger and had a significantly superior educational level and MMSE score. Mean scores for cognitive functioning and all quality-of-life indicators were in general significantly better for the active and interested. Univariate logistic regression analysis indicated that a higher MMSE score and cognitive functioning score influenced the maintenance of sexual interest. Conclusions: One third of the subjects reported being still sexually active and 40% being still interested in sex. This study seems to suggest that a significant role may be played by cognitive functioning in the maintenance of sexual interest in the elderly, especially older females in whom this dimension is evidently linked to far more diversified experiences than their male peers.

Assessment of quality of life in the oldest-olds living in nursing homes and at home

Summary The aim of the study was to assess any differences in perception of quality of life in oldest-old subjects living in nursing homes and at home. The elderly people staying in the Nursing Home for the Elderly of Padova or at home were interviewed, after a recruitment at recreational centers for the aged from the same town. Twenty-nine oldest-old people resident in nursing homes (mean age 95.0 ± 6.42 years) and 37 oldest-old people resident at home [mean age 95.8 ±7.4) were included in the study. The data were collected through administration of two questionnaires designed to assess quality of life in the elderly (PEQOL and LEIPAD). The two groups of subjects produced overlapping scores in all comparable scales in the two questionnaires on the quality of life, except for the LEIPAD self care scale, corresponding to PEQOLs ADL and IADL scales, for which there are statistically significant differences between institutionalized subjects and those living at home. On the LEIPAD self care scale, institutionalized subjects report greater impairment of self-sufficiency (p

Cognitive performance and quality of life in a sample of 220 nondemented elderly people

Summary The aim of the study was to analyze the influence of cognitive performance, assessed objectively through administration of the mini mental state examination (MMSE), on the subjective perception of quality of life, in a sample of nondemented elderly people, interviewed at the consulting rooms of general practitioners. A questionnaire on the quality of life directly designed for the elderly (LEIPAD) was administered to 220 subjects aged 65 years and over. In the sample, 100 men and 120 women were included. The women produced lower (worse) mean scores than their male counterparts for all the variables considered. Concerning marital status, the most unsatisfied groups in terms of sexual interest and life satisfaction appeared to be people living alone (bachelors/spinsters and the widowed). The mean MMSE score was 26.91 ± 2.15 (range 24–30) for the total sample, 26.82 ± 2.17 (range 24–30) for the females,and 27.03 ± 2.12 (range 24–30) for the males. Analysis of the covariance between the mean global score and subscale scores and age, educational level and MMSE scores, was conducted for the total sample, the subsamples of males and females and of subjects with and without a somatic pathology. High MMSE scores are linked to a lower tendency to refer anxious-depressive and cognitive disorder symptoms and a better perception of quality of life in general, suggesting that cognitively unimpaired elderly people have superior adaptive skills, especially the males. The presence of a clinically significant somatic pathology appears to bring about a change in the relationship between cognitive status and self-perception of quality of life. In this case, the very awareness of the somatic problem is what appears to most objectively influence the various subscales, thereby reducing the role of cognitive performance in favor of educational level.

Severe and persistent regressive behaviour in three elderly subjects without cognitive decline

The appearance of regressive behaviours in the elderly is relatively common. Among these regressive attitudes, there is a relatively high frequency of situations which mimic dementia in the absence of demonstrable organic alterations that justify the presence of a neurodegenerative profile. These generally stem from a primary psychiatric disorder and are referred to as ‘pseudodementia’. All these conditions, which are generally accompanied by a marked increase in dependency on the environment, are distinguished by the presence of cognitive impairment and behavioural traits typical of dementia but which are fully reversible on treatment of the primary psychiatric disorder. Here we describe three cases, characterized by their striking discrepancy between clinical profile, with pronounced behavioural alterations similar to dementia‐related conduct disorders, culminating in almost complete dependency on the environment, and almost stably intact cognitive performance (assessed through the MMSE), over a mean observation period of approximately five years. Copyright