Recognition, attitudes and causal beliefs regarding dementia in Italian, Greek and Chinese Australians

BACKGROUND/AIM

To investigate recognition, attitudes and causal beliefs regarding dementia in Italian, Greek and Chinese Australians in comparison with 3rd generation Australians. Little is known about dementia literacy in these racial and ethnic minority groups.

METHODS

A cross-sectional telephone survey was conducted of 350 Italian, 414 Greek, 437 Chinese and 500 3rd generation Australians randomly selected from the telephone directory.

RESULTS

Third generation participants (85%) were more likely to recognize dementia symptoms in a vignette in comparison to Italian (61%), Greek (58%) and Chinese (72%) participants. Overall, the racial and ethnic minority groups had more negative attitudes about persons with dementia. The racial and ethnic minority groups were more likely to suggest old age and psychosocial risk factors caused dementia, whereas 3rd generation Australians were more likely to suggest brain disease. Differences between ethnic minority and 3rd generation groups remained after controlling for sociodemographic variables. There were differences between Italian, Greek and Chinese participants on markers of acculturation associated with knowledge and beliefs within each group.

CONCLUSIONS

Racial and ethnic minority groups have poor dementia literacy in comparison to 3rd generation Australians. There is a need for dementia education targeted to and tailored for these groups.

Provincial differences in infant deaths in South Africa – an effect of antiretroviral interventions?

Original article

A test for mental capacity to request assisted suicide

The mental competence of people requesting aid-in-dying is a key issue for the how the law responds to cases of assisted suicide. A number of cases from around the common law world have highlighted the importance of competence in determining whether assistants should be prosecuted, and what they will be prosecuted for. Nevertheless, the law remains uncertain about how competence should be tested in these cases. This article proposes a test of competence that is based on the existing common law but which is tailored to cases of assisted suicide. The test will help doctors, other health professionals and lawyers determine whether the suicidal person was able to competently request assistance. Such knowledge will help to reduce some of the current uncertainty about criminal liability in cases of assisted suicide.

A computer model of dementia prevalence in Australia: foreseeing outcomes of delaying dementia onset, slowing disease progression, and eradicating dementia types

BACKGROUND

A computer model was designed to test hypothetical scenarios regarding dementia prevalence in Australia (2001-2040).

METHODS

The study implemented 3 scenarios: delaying dementia onset, slowing disease progression and, in a previously unpublished experiment, eradicating dementia types. Sensitivity analysis and parameter variation were the main methods of experimentation.

RESULTS

The model predicts that delaying dementia onset by 5 years will reduce the 2040 prevalence by 37%. An onset delay of 2 years, introduced in 2010, will reduce the 2040 prevalence by 16%. Slowing disease progression increases the 2040 prevalence by 4-7%. Total eradication of Alzheimer's disease (currently approximately 50% of all dementia cases) in 2020 will decrease the 2040 prevalence by 42%.

CONCLUSION

Computer modeling of future scenarios and interventions helps health and aged care planners understand the likely challenges society will face with the ageing of the world's population.

Workforce and advanced training survey of the RANZCP Faculty of Psychiatry of Old Age: issues and challenges for the field

OBJECTIVES

There is concern that there are insufficient old age psychiatrists in an ageing population. We aim to describe the work patterns of old age psychiatrists in Australia and New Zealand in order to identify barriers to training and practice.

METHODS

Members of the Faculty of Psychiatry of Old Age (FPOA) and other psychiatrists who have completed the Certificate of Psychiatry of Old Age were notified of the online survey by email in October 2008.

RESULTS

Two hundred and twenty FPOA members resident in Australia and New Zealand were surveyed and 87 responded (56% male, mean age 49.2 years). While 82% had a public appointment, 34% worked in private practice where barriers included the lack of a multidisciplinary team and remuneration. Only 18% of clinical time was in a rural or regional setting. High levels of job satisfaction (88%) were found, with the main factors being working with older people, working in a multidisciplinary team and the intellectual challenge. Advanced training was felt to be beneficial, though some weaknesses were identified.

CONCLUSIONS

Old age psychiatry is a satisfying career with an advanced training program that is reported to be beneficial to practice. Because the old age psychiatry workforce will face mounting challenges over the next decades, it is imperative that planning for the future mental health needs of older Australians be commenced immediately.

Future research on dementia relating to culturally and linguistically diverse communities

About one in five older Australians were born overseas. However, there has been very little information published in Australia or internationally about dementia in persons from culturally and linguistically diverse (CALD) backgrounds. This limits our ability to plan for and provide evidence-based medical care, social care and aged care services to persons from CALD backgrounds. This paper describes challenges to conducting CALD dementia research; these include sampling, having valid instruments and costs. Nine key research recommendations in the areas of epidemiology, community knowledge, carers, service delivery, screening and assessment, medical management, residential aged care and minority CALD reached by consensus by an expert group are presented. The paper closes with some strategies to encourage CALD research. The material presented here will provide guidance for future research endeavours.

The community prevalence of depression in older Australians

OBJECTIVE

To estimate the prevalence of depression among older adults in Australia.

METHOD

All general practitioners in Australia's five most populous states who satisfied certain eligibility criteria (e.g., sufficient weekly working hours, sufficient numbers of elderly patients) were invited to participate. Those who consented were asked to identify all of their patients aged 60+ and invite them (either directly or via the study team) to complete a questionnaire. The questionnaire identified those who had experienced 'clinically significant depression' and those who had experienced a 'major depressive episode' in the past two weeks, via the Patient Health Questionnaire (PHQ-9). Consenting patients completed the questionnaire and returned it to the study team in a reply-paid envelope.

RESULTS

In total, 22,251 patients returned questionnaires. Overall, the age-adjusted rate of clinically significant depression was 8.2% (95%CI=7.8%-8.6%), with the age-adjusted rates for males being 8.6% (95%CI=7.9%-9.2%) and for females being 7.9% (95%CI=7.4%-8.4%). The overall, male and female age-adjusted rates for a major depressive episode were 1.8% (95%CI=1.6%-2.0%), 1.9% (95%CI=1.6%-2.2%) and 1.7% (95%CI=1.5%-2.0%), respectively.

DISCUSSION

Our study suggests that depression among older people is a major public health problem. The above estimates provide guidance for efficient planning of services, and establish a baseline against which preventive and treatment interventions can be assessed. Armed with this information, we can progress efforts at reducing this major health problem and its consequences.

Substitute consent for nursing home residents prescribed psychotropic medication

BACKGROUND

Prescribing psychotropic medications for persons with dementia who lack capacity to give informed consent requires proxy consent under NSW Guardianship legislation.

OBJECTIVE

To survey current practice in complying with legislation and regulations in prescribing psychotropic medications for nursing home residents.

METHOD

In three Sydney nursing homes, the files of 77 residents identified as having dementia, being on a psychotropic medication and not having capacity to give informed consent, were audited.

RESULTS

In only 6.5% of cases were all regulations adhered to; a further 6.5% attempted and partially completed substitute consent requirements. The problem and the nature of the treatment were documented in 70.1% of cases. In 16.9% of files the only documentation of the prescribed medication was in the medication chart. Doses of medications prescribed were within accepted guidelines.

CONCLUSION

Current regulations and legislation are not being observed. Recommendations are made as to how to make them more practicable.

Hospitalization patterns for psychiatric disorders across the lifespan in Australia from July 1998 to June 2005

OBJECTIVE

This study examined specialized psychiatric hospitalization in Australia.

METHODS

Data from July 1998 to June 2005 from the National Hospital Morbidity Database, which includes all public and most private hospital stays in Australia, were analyzed.

RESULTS

Over the study period, there were 1,343,584 psychiatric discharges (including transfers, deaths, and changes in care type). There was an 18.0% increase in discharges per 1,000 persons and a 20.3% reduction in average length of stay. The rate of discharges decreased with age, and length of stay increased with age. Psychiatric admission rates were higher and length of stay was lower for women than for men. Hospitalization rates fell with age for schizophrenia, manic disorders, and substance use disorders; increased with age for organic disorders; and peaked midlife for alcohol abuse and mood disorders. A late-life increase in hospitalization for depressive and personality disorders was observed for men.

CONCLUSIONS

Planning for specialized psychiatric hospital services needs to take into account the mix of clinical needs by age, gender, and diagnosis.

A pilot study of the suicide victim's last contact with a health professional

Suicide victims frequently have contact with health care professionals in the months before death. The primary aims of this pilot psychological autopsy study were to determine the feasibility of undertaking a full study and to describe the characteristics of the last health care professional contacts with suicide victims aged > 34 years. We interviewed the informants of 52 suicides. Interviews were obtained from 37 health care professionals who had contact with 28 of the suicides during the 3 months before death. The primary reasons for the last contact with the health care professional were mental health (62%), physical health (22%), and social (14%). 87% of health care professional contacts occurred within 1 month of death. Symptoms of depression were noted in 49% of health care professional contacts. Consensus psychological autopsy diagnoses of depression were made in 64% of suicide victims. Overall suicide risk was assessed by 38% of health care professionals during their last contact. This was more likely to occur when the deceased presented as depressed, was aged < 60 years or seen by a psychiatrist. None was assessed to be suicidal. The family informants regarded nine of the suicide victims to have been suicidal before death but informed a health care professional in only one third of the cases. Critical information that might have altered the management is not often accessed from family members.

Differing management of people with advanced cancer and delirium by four sub-specialties

INTRODUCTION

Delirium in advanced cancer is prevalent, with limited prospective data to guide management. The aim was to survey current practice of specialists using two contrasting cases of delirium in cancer.

METHODS

A questionnaire was designed to identify investigations and treatment used, in relation to two cases.

RESULTS

Overall response rate (n = 270) was 30%. Place of care: Only 35% of medical oncologists would consider care at home for a patient with reversible delirium compared with 66% of other specialists.

INVESTIGATIONS

85% specialists would order basic bloods, however, medical oncologists were more likely to use oxygen saturation and head computed tomography, psychogeriatricians more likely to order thyroid function and palliative medicine specialists less likely to order chest X-ray and urine culture. Greater than 40% of specialists would do no investigations for terminal delirium.

TREATMENT

Medical oncologists use more pre-emptive therapies and more likely to use a benzodiazepine as agent of choice, and Palliative medicine specialists used significantly more neuroleptics to treat hypoactive symptoms of delirium.

DISCUSSION

The survey emphasise significant areas of variability in the management of delirium in advanced cancer. Furthermore, evidence to guide management in ways that draw on the strengths and knowledge of each specialty is urgently needed.