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Ross R, Prater LC, Cole A, Mustafa A, Pham K, Gallagher A, Rowhani-Rahbar A, Phelan EA. Provider Perspectives on Addressing Firearm Safety with Older Adults in Primary Care. Clin Gerontol 2024; 47:555-570. [PMID: 37791738 PMCID: PMC10991080 DOI: 10.1080/07317115.2023.2264291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVES Chronic conditions, including mild cognitive impairment and depression, place older adults at high risk of firearm suicide. Approximately 40% of older adults have access to a firearm, and many do not store their firearms safely. However, firearm counseling occurs infrequently in clinical settings. Using by the Ottawa Decision Support Framework (ODSF) to conceptualize the decisional support needed by patients and their providers to facilitate firearm counseling, we explore provider perspectives on desired resources for addressing firearm safety with older adult patients. METHODS From March - August 2022, we conducted 21 semi-structured interviews with primary care providers caring for older adults. We report deductive concepts as well as emergent themes. RESULTS Major themes were identified from the three components of the ODSF; decisional needs, decision support and decisional outcomes. Themes included: provider self-efficacy to conduct firearm counseling, clinical workflow considerations, stories for change, patient diagnosis implications, and caregiver involvement. CONCLUSIONS There is a need for decision aids in the clinical setting that facilitate firearm counseling and promotes shared decision-making about firearm storage. CLINICAL IMPLICATIONS Implementing a decision aid in the clinical setting can improve provider self-efficacy to conduct firearm counseling and help reduce risk factors associated with firearm-related harm among older adults.
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Affiliation(s)
- Rachel Ross
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
| | - Laura C. Prater
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
- Department of Psychiatry & Behavorial Sciences, University of Washington, Seattle, WA, USA
| | - Allison Cole
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Ayah Mustafa
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
| | - Kiet Pham
- School of Psychology, University of Washington, Seattle, WA, USA
| | - Amy Gallagher
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Elizabeth A. Phelan
- School of Medicine, Division of Gerontology and Geriatric Medicine, School of Public Health, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
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Etzersdorfer E. [Suicide prevention in old age : Importance of depressive disorders and implications for the discussion on assisted suicide]. Z Gerontol Geriatr 2024; 57:186-191. [PMID: 38639822 DOI: 10.1007/s00391-024-02303-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/11/2024] [Indexed: 04/20/2024]
Abstract
This article gives an overview of possibilities for suicide prevention in old age, with an emphasis on depression. A broad range of approaches are available, which are described differentiated into universal, selective and indicated strategies. In Germany the working group "Old people" of the National Suicide Prevention Program (NaSPro) has worked out these strategies in a differentiated way and with respect to the international discussions. The influence of the debate on assisted suicide and the influence of cognitive changes on suicidal ideation in old age are discussed. A further large need for concrete measures and also the presence of large gaps in the care structures are determined.
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Affiliation(s)
- Elmar Etzersdorfer
- Furtbachkrankenhaus, Klinik für Psychiatrie und Psychotherapie, Furtbachstraße 6, 71078, Stuttgart, Deutschland.
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Mohamad MA, Leong Bin Abdullah MFI, Shari NI. Similarities and differences in the prevalence and risk factors of suicidal behavior between caregivers and people with dementia: a systematic review. BMC Geriatr 2024; 24:254. [PMID: 38486186 PMCID: PMC10941364 DOI: 10.1186/s12877-024-04753-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 01/27/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND People with dementia and their caregivers are prone to suicidal behaviors due to difficulty adjusting to their initial caregiving role and due to emotional disturbances resulting from deterioration of functioning. The present systematic review (1) explored the prevalence of and risk factors for suicidal behavior and (2) assessed the similarities and differences in the prevalence and risk factors for suicidal behavior between people with dementia and their caregivers. METHODS A comprehensive literature search for research articles published between 1950 and 2023 was carried out using major databases, such as Google Scholar, Web of Science, PubMed, Scopus, PsycINFO, EMBASE, the Cochrane Library, and Medline. RESULTS A total of 40 research articles were selected for review. A total of 12 research articles revealed that the prevalence of suicidal behavior among caregivers ranged from 4.7% to 26%. However, the risk of suicidal behavior among people with dementia was inconsistent, as only 17 out of 28 selected studies reported the risk of suicidal behavior among people with dementia. The risk factors associated with suicidal behavior among caregivers of people with dementia could be both self-related and care receiver-related factors, whereas risk factors in people with dementia were self-related factors. Notably, greater cognitive decline, which impairs individuals' ability to carry out complex acts and planning, may lower their suicidal risk. Finally, assessment of the risk of bias indicated that 95% of the selected studies had unclear risk. CONCLUSION Self-related and care receiver-related factors should be assessed among caregivers of people with dementia to evaluate the risk of suicidal behavior. In addition, we recommend evaluating suicidal risk in people with dementia in the early phase of dementia when cognitive decline is less severe. However, as the majority of the selected studies had unclear risk of bias, future studies with improved methodologies are warranted to confirm our study findings.
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Affiliation(s)
- Mohd Afifuddin Mohamad
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, 13200, Malaysia
| | | | - Nurul Izzah Shari
- School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities (FSSH), Universiti Teknologi Malaysia, Skudai, Johor, 81310, Malaysia
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Talaslahti T, Ginters M, Palm A, Kautiainen H, Vataja R, Elonheimo H, Suvisaari J, Koponen H, Lindberg N. Suicides in degenerative neurocognitive disorders and traumatic brain injuries. Eur Psychiatry 2024; 67:e10. [PMID: 38228325 PMCID: PMC10897829 DOI: 10.1192/j.eurpsy.2024.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Neuropsychiatric symptoms in major neurocognitive disorders have been strongly associated with suicidality. METHODS The objectives were to explore suicide rates in degenerative neurocognitive disorders (DNDs), alcohol-related neurocognitive disorders (ARNDs), and traumatic brain injuries (TBIs). Patients who received these diagnoses between 1998 and 2015 (N = 231,817) were identified from nationwide registers, and their mortality was followed up until December 31, 2018. We calculated incidences of suicides per 100,000 person-years, types of suicides, and suicide rates compared with the general population (standardized mortality ratio [SMR]). RESULTS During the follow-up, 0.3% (95% confidence interval [95% CI]: 0.2-0.5) of patients with DNDs, 1.1% (0.7-1.8) with ARNDs, and 1.0% (0.7-1.3) with TBIs committed suicide. Suicide mortality rate was higher in men (58.9, 51.3, to 67.4 per 100,000) than in women (9.8, 7.5, to 12.5 per 100,000). The highest suicide rate was in ARNDs (98.8, 65.1, to 143.8 per 100,000), followed by TBIs (82.0, 62.4, to 105.8 per 100,000), and DNDs (21.2, 18.3, to 24.5 per 100,000). The SMRs (95% CI) were 3.69 (2.53-5.38), 2.99 (2.31-3.86), and 1.31 (1.13-1.51), respectively, and no sex difference emerged. The most common cause of death was self-inflicted injury by hanging or drowning (12.4, 10.3, to 14.8 per 100,000). CONCLUSIONS Suicide rates were higher in all three patient groups than the general population. Suicide risk remained elevated for more than 10 years after diagnosis. The suicide methods were mostly violent.
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Affiliation(s)
- Tiina Talaslahti
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Milena Ginters
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Anniina Palm
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
- Department of Biostatistics, Folkhälsan Research Center, Helsinki, Finland
| | - Risto Vataja
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Henrik Elonheimo
- The Department of Government Services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jaana Suvisaari
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hannu Koponen
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Nina Lindberg
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
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Lanctôt KL, Hviid Hahn-Pedersen J, Eichinger CS, Freeman C, Clark A, Tarazona LRS, Cummings J. Burden of Illness in People with Alzheimer's Disease: A Systematic Review of Epidemiology, Comorbidities and Mortality. J Prev Alzheimers Dis 2024; 11:97-107. [PMID: 38230722 PMCID: PMC10225771 DOI: 10.14283/jpad.2023.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/05/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is the most common neurodegenerative disease worldwide, and an updated quantification of its impact on morbidity, disability, and mortality is warranted. We conducted a systematic literature review, focusing on the past decade, to characterize AD and assess its impact on affected individuals. METHODS Searches of Embase, MEDLINE, and the Cochrane Library were conducted on August 7, 2020 and updated on November 10, 2021. Observational studies from any country reporting incidence, prevalence, comorbidities, and/or outcomes related to disability and mortality/life expectancy, in people with mild cognitive impairment (MCI) due to AD, or mild, moderate, or severe AD dementia, were considered relevant. RESULTS Data were extracted from 88 studies (46 incidence/prevalence; 44 comorbidities; 25 mortality-/disability-related outcomes), mostly from Europe, the USA, and Asia. AD dementia diagnosis was confirmed using biomarkers in only 6 studies. Estimated 5-year mortality in AD was 35%, and comorbidity prevalence estimates varied widely (hypertension: 30.2-73.9%; diabetes: 6.0-24.3%; stroke: 2.7-13.7%). Overall, people with AD dementia were more likely to have cardiovascular disease or diabetes than controls, and 5-year mortality in people with AD dementia was double that in the age- and year-matched general population (115.0 vs 60.6 per 1,000 person-years). CONCLUSIONS AD is associated with excess morbidity and mortality. Future longitudinal studies of population aging, incorporating biomarker assessment to confirm AD diagnoses, are needed to better characterize the course of MCI due to AD and AD dementia.
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Affiliation(s)
- K L Lanctôt
- Krista L. Lanctôt, Hurvitz Brain Sciences Program, Sunnybrook Research Institute; and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, Email address: Telephone: +1 416 480-6100; Ext: 2241
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McDaniels B, Pontone GM, Keener AM, Subramanian I. A Prescription for Wellness in Early PD: Just What the Doctor Ordered. J Geriatr Psychiatry Neurol 2023; 36:461-469. [PMID: 36911924 DOI: 10.1177/08919887231164358] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND Being diagnosed with a neurodegenerative disease is a life-changing event and a critical time to help patients cope and move forward in a proactive way. Historically, the main focus of Parkinson's disease (PD) treatment has been on the motor features with limited attention given to non-motor and mental health sequelae, which have the most impact on quality of life. Although depression and anxiety have been described at the time of PD diagnosis, demoralization, intolerance of uncertainty, decreased self-efficacy, stigma and loneliness can also present and have negative effects on the trajectory of the disease. Hence, understanding the psychological impact of the diagnosis and how to provide better counselling at this critical time point may be the key to a better long-term trajectory and quality of life. FOCUS There has been a paradigm shift in the treatment of chronic illness moving beyond the medical model, which focuses on fighting illness with the physician being in charge of the treatment process and the patient being the passive recipient, toward a more holistic (i.e., physical, psychological, social, and spiritual health) biopsychosocial approach that emphasizes behavioral factors with the patient being an active collaborator in their treatment. Hence, we propose that fostering resilience, social support, and psychological flexibility offer promise toward attenuating negative reactions and improving overall well-being. CONCLUSION Through a proactive wellness approach incorporating lifestyle choices, people with PD (PwP) can not only achieve improved states of health, well-being, and quality of life, but actually thrive.
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Affiliation(s)
- Bradley McDaniels
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX, USA
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Adrienne M Keener
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
- Parkinson's Disease Research, Education, and Clinical Center (PADRECC), Veterans Administration Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | - Indu Subramanian
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
- Parkinson's Disease Research, Education, and Clinical Center (PADRECC), Veterans Administration Greater Los Angeles Health Care System, Los Angeles, CA, USA
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8
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Mo M, Xu H, Hoang MT, Jurado PG, Mostafaei S, Kåreholt I, Johnell K, Eriksdotter M, Garcia-Ptacek S. External Causes of Death From Death Certificates in Patients With Dementia. J Am Med Dir Assoc 2023; 24:1381-1388. [PMID: 37421971 DOI: 10.1016/j.jamda.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES We aim to analyze the risk of death from specific external causes, including falls, complications of medical and surgical care, unintentional injuries, and suicide, in dementia patients. DESIGN Swedish nationwide cohort study integrating 6 registers from May 1, 2007, through December 31, 2018, including the Swedish Registry for Cognitive/Dementia Disorders (SveDem). SETTING AND PARTICIPANTS Population-based study. Patients diagnosed with dementia from 2007 to 2018 and up to 4 controls matched on year of birth (±3 years), sex, and region of residence. METHODS The exposures of this study were diagnosis of dementia and dementia subtypes. Number of deaths and causes of mortality were obtained from death certificates compiled into the Cause of Death Register. Hazard ratios (HRs) and 95% CIs were estimated using Cox and flexible models, adjusted for sociodemographics, medical and psychiatric disorders. RESULTS The study population included 235,085 patients with dementia [96,760 men (41.2%); mean age 81.5 (SD 8.5) years] and 771,019 control participants [341,994 men (44.4%); mean age 79.9 (SD 8.6) years], over 3,721,687 person-years. Compared with control participants, patients with dementia presented increased risk for unintentional injuries (HR 3.30, 95% CI 3.19-3.40) and falls (HR 2.67, 95% CI 2.54-2.80) during old age (≥75 y), and suicide (HR 1.56, 95% CI 1.02-2.39) in middle age (<65 y). Suicide risk was 5.04 times higher (HR 6.04, 95% CI 4.22-8.66) in patients with both dementia and 2 or more psychiatric disorders relative to controls (incidence rate per person-years, 1.6 vs 0.3). For dementia subtypes, frontotemporal dementia had the highest risks of unintentional injuries (HR 4.28, 95% CI 2.80-6.52) and falls (HR 3.83, 95% CI 1.98-7.41), whereas subjects with mixed dementia were less likely to die from suicide (HR 0.11, 95% CI 0.03-0.46) and complications of medical and surgical care (HR 0.53, 95% CI 0.40-0.70) compared to controls. CONCLUSIONS AND IMPLICATIONS Suicide risk screening and psychiatric disorders management in early-onset dementia and early interventions for unintentional injuries and falls prevention in older dementia patients should be provided.
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Affiliation(s)
- Minjia Mo
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Minh Tuan Hoang
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pol Grau Jurado
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Shayan Mostafaei
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ingemar Kåreholt
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Neurobiology, Aging Research Center, Center for Alzheimer Research, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
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Pilozzi A, Foster S, Mischoulon D, Fava M, Huang X. A Brief Review on the Potential of Psychedelics for Treating Alzheimer's Disease and Related Depression. Int J Mol Sci 2023; 24:12513. [PMID: 37569888 PMCID: PMC10419627 DOI: 10.3390/ijms241512513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023] Open
Abstract
Alzheimer's disease (AD), the most common form of senile dementia, is poised to place an even greater societal and healthcare burden as the population ages. With few treatment options for the symptomatic relief of the disease and its unknown etiopathology, more research into AD is urgently needed. Psychedelic drugs target AD-related psychological pathology and symptoms such as depression. Using microdosing, psychedelic drugs may prove to help combat this devastating disease by eliciting psychiatric benefits via acting through various mechanisms of action such as serotonin and dopamine pathways. Herein, we review the studied benefits of a few psychedelic compounds that may show promise in treating AD and attenuating its related depressive symptoms. We used the listed keywords to search through PubMed for relevant preclinical, clinical research, and review articles. The putative mechanism of action (MOA) for psychedelics is that they act mainly as serotonin receptor agonists and induce potential beneficial effects for treating AD and related depression.
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Affiliation(s)
- Alexander Pilozzi
- Neurochemistry Laboratory, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Simmie Foster
- Neurochemistry Laboratory, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
- Depression Clinical & Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - David Mischoulon
- Depression Clinical & Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Maurizio Fava
- Depression Clinical & Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Xudong Huang
- Neurochemistry Laboratory, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
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Zandbiglari K, Hasanzadeh HR, Kotecha P, Sajdeya R, Goodin AJ, Jiao T, Adiba FI, Mardini MT, Bian J, Rouhizadeh M. A Natural Language Processing Algorithm for Classifying Suicidal Behaviors in Alzheimer's Disease and Related Dementia Patients: Development and Validation Using Electronic Health Records Data. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.21.23292976. [PMID: 37546764 PMCID: PMC10402223 DOI: 10.1101/2023.07.21.23292976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
This study aimed to develop a natural language processing algorithm (NLP) using machine learning (ML) and Deep Learning (DL) techniques to identify and classify documentation of suicidal behaviors in patients with Alzheimer's disease and related dementia (ADRD). We utilized MIMIC-III and MIMIC-IV datasets and identified ADRD patients and subsequently those with suicide ideation using relevant International Classification of Diseases (ICD) codes. We used cosine similarity with ScAN (Suicide Attempt and Ideation Events Dataset) to calculate semantic similarity scores of ScAN with extracted notes from MIMIC for the clinical notes. The notes were sorted based on these scores, and manual review and categorization into eight suicidal behavior categories were performed. The data were further analyzed using conventional ML and DL models, with manual annotation as a reference. The tested classifiers achieved classification results close to human performance with up to 98% precision and 98% recall of suicidal ideation in the ADRD patient population. Our NLP model effectively reproduced human annotation of suicidal ideation within the MIMIC dataset. These results establish a foundation for identifying and categorizing documentation related to suicidal ideation within ADRD population, contributing to the advancement of NLP techniques in healthcare for extracting and classifying clinical concepts, particularly focusing on suicidal ideation among patients with ADRD. Our study showcased the capability of a robust NLP algorithm to accurately identify and classify documentation of suicidal behaviors in ADRD patients.
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Choi NG, Choi BY, Marti CN. Physical Health Problems as a Suicide Precipitant: Associations With Other Risk Factors and Suicide Methods in Three Age Groups of Older Decedents. Innov Aging 2023; 7:igad073. [PMID: 37554949 PMCID: PMC10406434 DOI: 10.1093/geroni/igad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Indexed: 08/10/2023] Open
Abstract
Background and Objectives Physical health problems are a significant late-life suicide precipitant. This study's purpose was to examine differences in (i) other suicide precipitants and psychiatric/substance use problems, and (ii) suicide methods (firearms, hanging/suffocation, and poisoning) in 3 age groups (55-64, 65-74, and 75+) of older suicide decedents who had physical health problems as a suicide precipitant. Research Design and Methods Data came from the 2017-2019 U.S. National Violent Death Reporting System (N = 34,912; 27,761 males [79.5%] and 7,151 females [20.5%]). Generalized linear models for a Poisson distribution with a log link were used to examine the study questions. Results Physical health problems were a suicide precipitant for 25.8%, 41.9%, and 57.7% of the 55-64, 65-74, and 75+ age groups, respectively, and were associated with a higher likelihood of having had depressed mood (IRR = 1.38, 95% CI: 1.33-1.43) and other substance use problems (IRR = 1.22, 95% CI: 1.13-1.31). Interaction effects showed that when job/finance/housing problems, depressed mood, or any psychiatric disorders were co-present with physical health problems, the age group differences in the predicted rates of physical health problems were diminished. Physical health problems were also positively associated with firearm and poisoning use, but negatively associated with hanging/suffocation. Interaction effects indicated that the predicted rates of firearm and poisoning use significantly increased among those aged 55-64 with than without physical health problems. Discussion and Implications In all 3 age groups of older suicide decedents, physical health problems were the predominant suicide precipitant, and those with physical health problems had elevated depressed mood. Assessment of suicide risk, affordable and accessible health, and mental health services, restriction of access to lethal suicide methods, and policy-based suicide prevention approaches for older adults with physical health problems are needed.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
- Department of Emergency Medicine, BayHealth, Dover, Delware, USA
| | - C Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
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Hsu YC, Junus A, Zhang Q, Wong C, Lam TM, Cheung F, Liu J, Lui ID, Yip PS. A network approach to understand co-occurrence and relative importance of different reasons for suicide: a territory-wide study using 2002-2019 Hong Kong Coroner's Court reports. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 36:100752. [PMID: 37547048 PMCID: PMC10398608 DOI: 10.1016/j.lanwpc.2023.100752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/28/2023] [Accepted: 03/15/2023] [Indexed: 08/08/2023]
Abstract
Background Suicide is a complex and multifaceted issue, and suicidal behaviors are often driven by multiple, interacting factors. It has been challenging to identify reasons for suicide using existing scientific methodologies. This study aims to identify critical reasons for suicide and suicidal behaviors through the application of novel network science methods. Methods Based on cases investigated by the Hong Kong Coroner's Court from 2002 to 2019, we modelled identified reasons for 13,001 suicide cases as a co-occurrence network, and calculated each reason's eigencentrality to determine their respective relative importance. We then analyzed the temporal and demographic changes in the structure and eigencentrality of the network. We further conducted simulation studies based on the United Nations population projection to assess potential burden of different reasons for suicide on the population in the coming years. Findings School-related issues had the highest eigencentrality (eigencentrality = 0.49) for individuals younger than 20 years of age. Financial issues were crucial for adults aged 20-59 years, but their importance differed between males (eigencentrality = 0.51) and females (eigencentrality = 0.14). Physical illness (eigencentrality = 0.80) was the core concern for adults over 60 years. Across the Hong Kong population, the reasons for suicide appear to have shifted from financial issues in the early 2000s (eigencentrality = 0.46) to issues related to physical illnesses since 2011 (eigencentrality = 0.58). Simulation findings indicate that, by 2050, most suicides in Hong Kong will be due to physical illness-related issues (eigencentrality = 0.69) due to the rapidly aging population. Interpretation There have been important sex and age differences over time, in reasons for suicide. Given the projected increasing age of the Hong Kong population over the next decades, older adults with physical illnesses appear to be the highest contributors to suicide cases in the overall population. This novel network analysis approach provides important data-driven information upon which to base effective proactive public health suicide prevention strategies and interventions. Funding Hong Kong Jockey Club Charities Trust, Collaborative Research Fund (C7151-20G), and General Research Fund (17606521).
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Affiliation(s)
- Yu Cheng Hsu
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong
| | - Alvin Junus
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong
- Department of Pharmacology and Pharmacy, Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Clifford Wong
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong
| | - Tsz Mei Lam
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong
| | - Florence Cheung
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong
| | - Joyce Liu
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong
| | - Ingrid D. Lui
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong
| | - Paul S.F. Yip
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong
- Musketeers Foundation Institute of Data Science, The University of Hong Kong, Hong Kong
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13
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Tellez-Martinez A, Restrepo-Martinez M, Espinola-Nadurille M, Martinez-Angeles V, Martínez-Carrillo F, Easton A, Pollak T, Ramirez-Bermudez J. Suicidal Thoughts and Behaviors in Anti-NMDA Receptor Encephalitis: Psychopathological Features and Clinical Outcomes. J Neuropsychiatry Clin Neurosci 2023; 35:368-373. [PMID: 37151035 DOI: 10.1176/appi.neuropsych.20220200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVE A wide variety of neuropsychiatric symptoms are described during the acute phase of anti-N-methyl-d-aspartate receptor encephalitis (ANMDARE), including psychosis, mania, depression, and catatonia, but there are few reports on suicidal thought and behaviors in ANMDARE. To address this gap in the literature, the authors measured the presence of suicidal thoughts and behaviors among a large cohort of Mexican patients diagnosed with definite ANMDARE. METHODS This observational and longitudinal study included patients with definite ANMDARE hospitalized at the National Institute of Neurology and Neurosurgery of Mexico between 2014 and 2021. Suicidal thoughts and behaviors were assessed before and after treatment by means of a clinical interview with relatives and a direct clinical assessment with each patient. Thoughts of engaging in suicide-related behavior and acts of suicidal and nonsuicidal self-directed violence before and during hospitalization were recorded. RESULTS From a total sample of 120 patients who fulfilled the diagnostic criteria for definite ANMDARE, 15 patients (13%) had suicidal thoughts and behaviors during the acute phase of the disease. All 15 of these patients experienced psychosis and had suicidal ideation with intention. Three patients engaged in preparatory behaviors and seven carried out suicidal self-directed violence. Psychotic depression and impulsivity were more frequent among those patients with suicidal thoughts and behaviors than among those without any form of suicidality. Four patients engaged in self-directed violence during hospitalization. Remission was sustained in 14 of 15 patients, with suicidal ideation and self-directed violence persisting during follow-up in only one patient. CONCLUSIONS Suicidal thoughts and behaviors are not uncommon during the acute phase of ANMDARE. On the basis of our sample, the persistence of these features after immunotherapy is rare but may be observed. A targeted assessment of suicidal risk should be strongly considered in this population.
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Affiliation(s)
- Alberto Tellez-Martinez
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Miguel Restrepo-Martinez
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Mariana Espinola-Nadurille
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Victoria Martinez-Angeles
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Francisco Martínez-Carrillo
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Ava Easton
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Thomas Pollak
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Jesus Ramirez-Bermudez
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
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14
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Ford E, Milne R, Curlewis K. Ethical issues when using digital biomarkers and artificial intelligence for the early detection of dementia. WILEY INTERDISCIPLINARY REVIEWS. DATA MINING AND KNOWLEDGE DISCOVERY 2023; 13:e1492. [PMID: 38439952 PMCID: PMC10909482 DOI: 10.1002/widm.1492] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 03/06/2024]
Abstract
Dementia poses a growing challenge for health services but remains stigmatized and under-recognized. Digital technologies to aid the earlier detection of dementia are approaching market. These include traditional cognitive screening tools presented on mobile devices, smartphone native applications, passive data collection from wearable, in-home and in-car sensors, as well as machine learning techniques applied to clinic and imaging data. It has been suggested that earlier detection and diagnosis may help patients plan for their future, achieve a better quality of life, and access clinical trials and possible future disease modifying treatments. In this review, we explore whether digital tools for the early detection of dementia can or should be deployed, by assessing them against the principles of ethical screening programs. We conclude that while the importance of dementia as a health problem is unquestionable, significant challenges remain. There is no available treatment which improves the prognosis of diagnosed disease. Progression from early-stage disease to dementia is neither given nor currently predictable. Available technologies are generally not both minimally invasive and highly accurate. Digital deployment risks exacerbating health inequalities due to biased training data and inequity in digital access. Finally, the acceptability of early dementia detection is not established, and resources would be needed to ensure follow-up and support for those flagged by any new system. We conclude that early dementia detection deployed at scale via digital technologies does not meet standards for a screening program and we offer recommendations for moving toward an ethical mode of implementation. This article is categorized under:Application Areas > Health CareCommercial, Legal, and Ethical Issues > Ethical ConsiderationsTechnologies > Artificial Intelligence.
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Affiliation(s)
- Elizabeth Ford
- Department of Primary Care and Public HealthBrighton and Sussex Medical SchoolBrightonUK
| | - Richard Milne
- Kavli Centre for Ethics, Science and the PublicUniversity of CambridgeCambridgeUK
- Engagement and SocietyWellcome Connecting ScienceCambridgeUK
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15
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Maxfield M, Peckham A, James DL, Lathrop L, Fiske A. Anticipated suicidal and death ideation in response to an imagined dementia diagnosis: A qualitative study. DEMENTIA 2023:14713012231171490. [PMID: 37092692 DOI: 10.1177/14713012231171490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Alzheimer's disease and related dementias are prevalent, highly impactful, and feared diagnoses. A mixed methods study using semi-structured interviews was conducted to clarify causes of dementia-related anxiety. Fifty community-dwelling adults aged 58 to 89 (M = 70.92, SD = 6.08) were recruited from a university participant registry and Memory Clinic; none had dementia diagnoses. Analyses revealed that 42% (n = 21) of participants anticipated suicidal or death ideation if diagnosed with dementia. Among participants endorsing anticipated suicidal or death ideation, responses ranged from active, specific plans, including interest in physician-assisted suicide, to more passive wishes to hasten death rather than continue to live with dementia. Within reports of both anticipated suicidal and death ideation, three subthemes emerged. Participants reported concerns about becoming a burden to others, the devaluation of life/loss of self with dementia, and the desire for (and anticipated thwarting of) personal control as factors contributing to their anticipated responses to a dementia diagnosis. Statements of anticipated suicidal and death ideation were contingent on a dementia diagnosis and may reflect errors in affective forecasting. Nevertheless, given the prevalence of dementias and older adults' elevated rates of suicide, the intersection of these two public health issues warrants greater attention.
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Affiliation(s)
- Molly Maxfield
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
- Center for Innovation in Healthy and Resilient Aging, Arizona State University, Phoenix, AZ, USA
| | - Allie Peckham
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
- Center for Innovation in Healthy and Resilient Aging, Arizona State University, Phoenix, AZ, USA
| | - Dara L James
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
- College of Nursing, University of South Alabama, Mobile, AL, USA
| | - Laura Lathrop
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Amy Fiske
- Department of Psychology, West Virginia University, Morgantown, WV, USA
- Injury Control Research Center, West Virginia University, Morgantown, WV, USA
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16
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Schwartz MR. "On Looking Away": Vortex, a film by Gaspar Noé. J Am Geriatr Soc 2023. [PMID: 36722127 DOI: 10.1111/jgs.18253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/27/2022] [Accepted: 01/03/2023] [Indexed: 02/02/2023]
Affiliation(s)
- Maxwell R Schwartz
- Medical School for International Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
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17
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Liu CC, Liu CH, Wang JY, Chang KC. Health-care utilization among dementia patients with or without comorbid depression in Taiwan: A nationwide population-based longitudinal study. Int J Geriatr Psychiatry 2023; 38:e5889. [PMID: 36773286 DOI: 10.1002/gps.5889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/26/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few studies have examined the association of comorbid depression with health-care utilization among dementia patients. This study compared health-care utilization between dementia patients with and without comorbid depression. METHODS Using Taiwan's National Health Insurance Research Database, we identified 10,710 patients with newly diagnosed dementia between 2005 and 2014: 1785 had comorbid depression (group 1) and 8925 did not (group 2). Patients were tracked for 1 year to evaluate outpatient, emergency, and inpatient service utilization and length of hospital stay (LOS). Multivariable regression was applied to examine the association between comorbid depression and health-care utilization and analyze factors associated with inpatient visits and LOS. RESULTS Group 1 had significantly fewer outpatient visits (β = -0.115; p < 0.001), more inpatient visits (β = 0.157; p = 0.005), and a longer LOS (β = 0.191; p < 0.001) than did group 2. The groups did not differ significantly in emergency visits (β = 0.030; p = 0.537). In group 1, age, gender, and specific comorbidities were predictors of inpatient visits; those factors and salary-based insurance premiums were predictors of LOS. CONCLUSION Group 1 utilized less outpatient care but more inpatient care, suggesting health-care service for these patients may be needed to improvement.
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Affiliation(s)
- Chih-Ching Liu
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chien-Hui Liu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,New Taipei City Fire Department, Division of Emergency Medical Service, New Taipei, Taiwan
| | - Jiun-Yi Wang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Kun-Chia Chang
- Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan.,Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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18
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Coley RY, Smith JJ, Karliner L, Idu AE, Lee SJ, Fuller S, Lam R, Barnes DE, Dublin S. External Validation of the eRADAR Risk Score for Detecting Undiagnosed Dementia in Two Real-World Healthcare Systems. J Gen Intern Med 2023; 38:351-360. [PMID: 35906516 PMCID: PMC9904522 DOI: 10.1007/s11606-022-07736-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/26/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fifty percent of people living with dementia are undiagnosed. The electronic health record (EHR) Risk of Alzheimer's and Dementia Assessment Rule (eRADAR) was developed to identify older adults at risk of having undiagnosed dementia using routinely collected clinical data. OBJECTIVE To externally validate eRADAR in two real-world healthcare systems, including examining performance over time and by race/ethnicity. DESIGN Retrospective cohort study PARTICIPANTS: 129,315 members of Kaiser Permanente Washington (KPWA), an integrated health system providing insurance coverage and medical care, and 13,444 primary care patients at University of California San Francisco Health (UCSF), an academic medical system, aged 65 years or older without prior EHR documentation of dementia diagnosis or medication. MAIN MEASURES Performance of eRADAR scores, calculated annually from EHR data (including vital signs, diagnoses, medications, and utilization in the prior 2 years), for predicting EHR documentation of incident dementia diagnosis within 12 months. KEY RESULTS A total of 7631 dementia diagnoses were observed at KPWA (11.1 per 1000 person-years) and 216 at UCSF (4.6 per 1000 person-years). The area under the curve was 0.84 (95% confidence interval: 0.84-0.85) at KPWA and 0.79 (0.76-0.82) at UCSF. Using the 90th percentile as the cut point for identifying high-risk patients, sensitivity was 54% (53-56%) at KPWA and 44% (38-51%) at UCSF. Performance was similar over time, including across the transition from International Classification of Diseases, version 9 (ICD-9) to ICD-10 codes, and across racial/ethnic groups (though small samples limited precision in some groups). CONCLUSIONS eRADAR showed strong external validity for detecting undiagnosed dementia in two health systems with different patient populations and differential availability of external healthcare data for risk calculations. In this study, eRADAR demonstrated generalizability from a research sample to real-world clinical populations, transportability across health systems, robustness to temporal changes in healthcare, and similar performance across larger racial/ethnic groups.
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Affiliation(s)
- R Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Julia J Smith
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Leah Karliner
- Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, USA
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Abisola E Idu
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Sei J Lee
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sharon Fuller
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Rosemary Lam
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Deborah E Barnes
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Weill Institute for Neurosciences, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Osher Center for Integrative Health, University of California, San Francisco, San Francisco, CA, USA
| | - Sascha Dublin
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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19
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Leung T, Portz J, Fischer SM, Greenway E, Johnson RL, Knoepke CE, Matlock DD, Omeragic F, Peterson RA, Ranney ML, Betz ME. A Web-Based Decision Aid for Caregivers of Persons With Dementia With Firearm Access (Safe at Home Study): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e43702. [PMID: 36719721 PMCID: PMC9929727 DOI: 10.2196/43702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/17/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Firearm safety among individuals with Alzheimer disease and related dementias (ADRD) is an underdiscussed and underresearched concern in the United States, especially given the growing population of community-dwelling adults with ADRD. The "Safety in Dementia" (SiD) web-based decision aid was developed to support caregivers in addressing firearm access; the efficacy of SiD is unknown. OBJECTIVE Through the SiD decision aid, the Safe at Home (S@H) study aims to support caregivers in making decisions about home safety that align with their goals and values, and behaviors regarding firearm access for persons with ADRD and firearm access. METHODS The S@H study is a 2-armed randomized controlled trial to test the effect of the SiD decision aid on caregivers of community-dwelling adults with ADRD who have firearm access. S@H aims to recruit 500 ADRD caregivers (age ≥18 years, fluent in English or Spanish, and in the United States) through online or social media advertisements and through relevant organizations. Participants are randomized to view SiD or a control website at their own pace; all participants complete web-based questionnaires at baseline, 2 weeks, 2 months, and 6 months. The primary outcome is immediate preparation for decision-making; secondary outcomes include longitudinal decision outcomes and self-reported modifications to firearm access. The relative reach and effectiveness of each recruitment method (online/social media and through relevant organizations) will be assessed by examining differences in caregiver participation, retention rates, and relative cost. RESULTS The study enrollment began in May 2022. As of December 2022, a total of 117 participants had enrolled. CONCLUSIONS The S@H study is the first randomized trial of a firearm safety decision aid for ADRD caregivers. The results from this study will inform how best to support caregivers in decision-making regarding firearm safety. Further, results may guide approaches for recruiting caregivers and for dissemination of resources. TRIAL REGISTRATION ClinicalTrials.gov NCT05173922; https://clinicaltrials.gov/ct2/show/NCT05173922. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/43702.
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Affiliation(s)
| | - Jennifer Portz
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Stacy M Fischer
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Emily Greenway
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Christopher E Knoepke
- Adult and Child Center for Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Daniel D Matlock
- Adult and Child Center for Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States.,Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Faris Omeragic
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ryan A Peterson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Megan L Ranney
- Brown-Lifespan Center for Digital Health, Brown University, Providence, RI, United States.,School of Public Health, Brown University, Providence, RI, United States.,Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States
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20
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Porter JE, Dabkowski E, Connolly O, Prokopiv V. Compliance with the Zero Suicide Initiative by Mental Health Clinicians at a Regional Mental Health Service: Development and Testing of a Clinical Audit Tool. NURSING REPORTS 2022; 13:29-42. [PMID: 36648977 PMCID: PMC9844327 DOI: 10.3390/nursrep13010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 12/30/2022] Open
Abstract
AIM The aim of this study is to investigate the compliance of mental health clinicians in applying the Zero Suicide (ZS) approach to their clinical practice in a rural and regional health community setting. METHODS A retrospective clinical audit of six mental health teams was undertaken at a single site. A clinical audit tool was developed and validated using a six-step approach. The data was extracted and analysed via descriptive and inferential statistics and compared to a specialised mental health team, experienced with the ZS approach. RESULTS A total of 334 clinical records were extracted for January, April, August, November 2019 and June 2020. The clinical audit and analysis confirmed that the mental health teams are not consistently using the assessments from their training and are therefore not implementing all of these elements into their practice. This could have implications for the risk formulation and treatment for people at risk of suicide. CONCLUSIONS The use of a validated clinical audit tool can be beneficial to establish compliance with the mental health clinicians and to determine any areas requiring further improvement. Further education and reinforcement may be required to ensure consistency with incorporating the elements of ZS into everyday clinical practice.
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Affiliation(s)
- Joanne E. Porter
- Collaborative Evaluation & Research Group, Federation University Australia, Churchill 3842, Australia
- Correspondence: (J.E.P.); (E.D.)
| | - Elissa Dabkowski
- Collaborative Evaluation & Research Group, Federation University Australia, Churchill 3842, Australia
- Correspondence: (J.E.P.); (E.D.)
| | - Owen Connolly
- Mental Health Services, Latrobe Regional Hospital, Traralgon 3844, Australia
| | - Valerie Prokopiv
- Collaborative Evaluation & Research Group, Federation University Australia, Churchill 3842, Australia
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21
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Choi NG, Marti CN. Intent disclosure in late-life suicide: Age group differences in correlates and associations with suicide means. Front Psychol 2022; 13:949333. [PMID: 36275279 PMCID: PMC9580761 DOI: 10.3389/fpsyg.2022.949333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/02/2022] [Indexed: 01/25/2023] Open
Abstract
Age-adjusted suicide rates declined from 2018 to 2020. However, suicide rates among older adults, particularly males 75 and older, have continued to rise, and the evidence base for effective interventions to prevent suicide in late life remains limited. One strategy to prevent older adults' suicidal behavior is to intervene when they reveal suicide intent. Previous research found that a significant proportion of older suicide decedents disclosed their suicide intent close to the fatal incident. In this study, based on the 2017-2019 United States National Violent Death Reporting System (NVDRS) data, we examined: (1) correlates of intent disclosure among three age groups (65-74, 75-84, and 85+) of older suicide decedents (N = 17,917; 14,856 men and 3,061 women); and (2) associations of suicide means with intent disclosure and suicide contributing factors. The results show that 19.9% of all suicide decedents aged 65+ (18.7%, 21.0%, and 22.0% in the 65-74, 75-84, and 85+ age groups, respectively) disclosed their suicide intent to their partner, family/friends, and healthcare providers within a month of their death. Multivariable analyses using generalized linear models for a Poisson distribution with a log link showed that physical and mental health, substance misuse, addiction problems, and relationship/other life stressors were associated with a higher likelihood of intent disclosure in the 65-74 and 75-84 age groups. However, only physical health problems were associated with a higher likelihood of intent disclosure among those aged 85 and older. Intent disclosure was not associated with using firearms and poisoning as suicide means but with a lower likelihood of hanging or suffocation. Mental health and substance misuse problems were associated with higher odds of hanging or suffocation and poisoning, and physical health problems and male sex in the 85+ age group were associated with higher odds of firearm use. Suicide prevention strategies for those who have disclosed their suicide intent or are at risk of suicidal behavior should include more patient-centered comfort and palliative care, mental health/substance misuse/addiction treatment, and restriction of access to potential suicide means. More research on older adults who disclose suicide intent and late-life suicide prevention strategies is needed.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, United States
| | - C Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, United States
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Musgrove R, Carr MJ, Kapur N, Chew-Graham CA, Mughal F, Ashcroft DM, Webb RT. Suicide and other causes of death among working-age and older adults in the year after discharge from in-patient mental healthcare in England: matched cohort study. Br J Psychiatry 2022; 221:468-475. [PMID: 35049478 PMCID: PMC7613106 DOI: 10.1192/bjp.2021.176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Evidence for risk of dying by suicide and other causes following discharge from in-patient psychiatric care throughout adulthood is sparse. AIMS To estimate risks of all-cause mortality, natural and external-cause deaths, suicide and accidental, alcohol-specific and drug-related deaths in working-age and older adults within a year post-discharge. METHOD Using interlinked general practice, hospital, and mortality records in the Clinical Practice Research Datalink we delineated a cohort of discharged adults in England, 2001-2018. Each patient was matched to up to 20 general population comparator patients. Cumulative incidence (absolute risks) and hazard ratios (relative risks) were estimated separately for ages 18-64 and ≥65 years with additional stratification by gender and practice-level deprivation. RESULTS The 1-year cumulative incidence of dying post-discharge was 2.1% among working-age adults (95% CI 2.0-2.3) and 14.1% (95% CI 13.6-14.5) among older adults. Suicide risk was particularly elevated in the first 3 months, with hazard ratios of 191.1 (95% CI 125.0-292.0) among working-age adults and 125.4 (95% CI 52.6-298.9) in older adults. Older patients were vulnerable to dying by natural causes within 3 months post-discharge. Risk of dying by external causes was greater among discharged working-age adults in the least deprived areas. Relative risk of suicide in discharged working-age women relative to their general population peers was double the equivalent male risk elevation. CONCLUSIONS Recently discharged adults at any age are at increased risk of dying from external and natural causes, indicating the importance of close monitoring and provision of optimal support to all such patients, particularly during the first 3 months post-discharge.
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Affiliation(s)
- Rebecca Musgrove
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; Centre for Mental Health and Safety, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK; Manchester Academic Health Science Centre, UK
| | - Matthew J. Carr
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, UK; Manchester Academic Health Science Centre, UK
| | - Nav Kapur
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; Centre for Mental Health and Safety, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK; Manchester Academic Health Science Centre, UK; Greater Manchester Mental Health NHS Foundation Trust, UK
| | | | - Faraz Mughal
- School of Medicine, Keele University, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, UK; Unit of Academic Primary Care, University of Warwick, UK
| | - Darren M. Ashcroft
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, UK; Manchester Academic Health Science Centre, UK
| | - Roger T. Webb
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; Centre for Mental Health and Safety, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK; Manchester Academic Health Science Centre, UK
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23
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Oliveira D, Godoy C, da Mata FAF, Mateus E, Franzon ACA, Farina N, Evans-Lacko S, Ferri CP. Reducing dementia-related stigma and discrimination among community health workers in Brazil: protocol for a randomised controlled feasibility trial. BMJ Open 2022; 12:e060033. [PMID: 38687683 PMCID: PMC9301803 DOI: 10.1136/bmjopen-2021-060033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/28/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Stigma and discrimination among healthcare workers can hinder diagnosis and the provision of appropriate care in dementia. This study is aimed at developing, delivering and evaluating the feasibility of a group antistigma intervention to improve knowledge, attitudes and behaviours in relation to people living with dementia among community health workers (CHWs). METHODS AND ANALYSIS This will be a randomised controlled feasibility trial conducted with 150 CHWs from 14 primary care units (PCUs) in São Paulo, Brazil. PCUs will be randomly allocated (1:1) in two parallel groups-experimental group or control group. Participants from PCUs allocated to the experimental group will receive a 3-day group intervention involving audio-visual and printed materials as well as elements of social contact. The control group will keep their usual routine. Knowledge, attitude and intended behaviour stigma-based outcomes will be assessed at baseline and at follow-up (30 days after intervention) to both groups, with additional questions on feasibility for the experimental group at follow-up. Around 10-15 participants will take part in follow-up semistructured interviews to further explore feasibility. Quantitative analyses will follow an 'intention to treat' approach. Qualitative data will be analysed using content analysis. ETHICS AND DISSEMINATION This study was approved by the National Commission for Ethics in Research in Brazil (n. 5.510.113). Every participant will sign a consent form. Results will be disseminated through academic journals and events related to dementia. The intervention materials will be made available online.
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Affiliation(s)
- Déborah Oliveira
- Department of Psychiatry, School of Medicine, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Carolina Godoy
- Department of Psychiatry, School of Medicine, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Fabiana A F da Mata
- Department of Psychiatry, School of Medicine, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Elaine Mateus
- Brazilian Federation of Alzheimer's Associations (FEBRAZ), Paraná, Brazil
- Applied Linguistics, Department of Modern Languages, Universidade Estadual de Londrina (UEL), Paraná, Brazil
| | | | - Nicolas Farina
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Sara Evans-Lacko
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Cleusa P Ferri
- Department of Psychiatry, School of Medicine, Universidade Federal de São Paulo, Sao Paulo, Brazil
- Health Technology Assessment Unit, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
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24
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Patel D, Andersen S, Smith K, Ritter A. Completed Suicide by Firearm in an Individual With the Agrammatic Variant of Primary Progressive Aphasia: Case Report. Front Neurol 2022; 13:828155. [PMID: 35370921 PMCID: PMC8965452 DOI: 10.3389/fneur.2022.828155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/15/2022] [Indexed: 11/23/2022] Open
Abstract
The agrammatic or nonfluent variant of Primary Progressive Aphasia (nfvPPA) is a form of Frontotemporal Dementia (FTD) that is characterized by progressive language dysfunction, poor sentence construction, and low verbal fluency. Individuals with nfvPPA have intact insight into their decline, which may manifest as frustration and hopelessness, and show signs of impulsivity and disinhibition. Little is known about suicide risk in this patient population. Here we describe a case of an 84 year-old male with nfvPPA who, over the course of his care, experienced a decline in language and motoric functioning which coincided with increasing irritability and impulsivity. Despite this significant decline, he denied depressive symptoms or showed any suicidal tendencies, and he seemed to be looking forward to future events. His suicide, committed with a handgun during what appeared to be a rather innocuous trip to the garage, came as a significant shock to his spouse, family, and his clinical care team. To our knowledge, this is the first reported case of completed suicide in a patient with the nfvPPA subtype of FTD. Though this patient demonstrated demographic risk factors for suicide (advanced age, retired military veteran with easy access to firearms) there is a lack of data regarding how FTD may have contributed. Retained insight especially seems to be a risk factor for suicide across all forms of dementia. Impulsivity may be key when considering suicidality amongst FTD patients. Additionally, this case demonstrates the importance of addressing gun safety as there are few guidelines around gun ownership in this patient population.
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Affiliation(s)
- Deepal Patel
- Kirk Kerkorian School of Medicine, Las Vegas, NV, United States.,University of Nevada, Reno, NV, United States.,Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | - Shaun Andersen
- Kirk Kerkorian School of Medicine, Las Vegas, NV, United States.,University of Nevada, Reno, NV, United States.,Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | - Kyler Smith
- Kirk Kerkorian School of Medicine, Las Vegas, NV, United States.,University of Nevada, Reno, NV, United States.,Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | - Aaron Ritter
- Kirk Kerkorian School of Medicine, Las Vegas, NV, United States.,University of Nevada, Reno, NV, United States.,Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
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25
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Natural language processing of medical records: new understanding of suicide ideation by dementia subtypes. Int Psychogeriatr 2022; 34:319-321. [PMID: 35538873 DOI: 10.1017/s1041610222000333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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26
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Suicidal Ideation and Suicide-Attempt-Related Hospitalizations among People with Alzheimer’s Disease (AD) and AD-Related Dementias in the United States during 2016–2018. J Clin Med 2022; 11:jcm11040943. [PMID: 35207214 PMCID: PMC8878214 DOI: 10.3390/jcm11040943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023] Open
Abstract
People living with Alzheimer’s disease (AD) and AD-related dementias (ADRDs) are at a higher risk of suicidal behaviors given intersecting risk factors. Previous studies generally only focused on AD, small clinical samples, or grouped all dementia subtypes together, limiting insights for other ADRD subtypes. The objective of this study was to generate evidence related to the relative burden of suicidal behaviors (suicidal ideation and suicide attempt) among people with AD and ADRDs. This retrospective cross-sectional study identified hospitalizations related to suicidal behaviors (suicidal ideation and suicide attempt) for patients with Alzheimer’s disease (AD) and AD-related dementias using ICD-10-CM codes from the Nationwide Readmissions Database (NRD). A logistic regression model was estimated to assess associations between AD/ADRD subtype and patient characteristics, and the risk for a suicidal-behavior-related hospitalization and modes of harm were reported. During 2016–2018, there were 12,538 hospitalizations related to suicidal behaviors for people with AD/ADRDs. The overall prevalence of suicidal-behavior-related hospitalizations was lowest for AD (0.8%) and highest for frontotemporal dementia (2.6%). Among hospitalizations for suicide attempts, the most common mode of harm was medications or drugs (89.2% of all attempts), followed by weapons (17.7%). We found that there was a difference in the frequency of suicidal-behavior-related hospitalizations among AD/ADRD hospitalized patients across dementia subtypes.
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Armstrong MJ, Moore K, Jacobson CE, Bedenfield N, Patel B, Sullivan JL. Frequency of suicidal ideation and associated clinical features in Lewy body dementia. Parkinsonism Relat Disord 2021; 90:33-37. [PMID: 34352608 DOI: 10.1016/j.parkreldis.2021.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Neuropsychiatric disturbance is common in individuals with Lewy body dementia (LBD). Despite this, there is minimal research regarding suicide risks in this population. METHODS This study was a retrospective review of a prospectively-collected database at a tertiary movement disorders clinic. Database participants with an LBD diagnosis at their most recent visit and at least one complete Beck Depression Inventory-II (BDI-II) were included. Additional measures included demographics and measures of cognition, psychiatric symptoms, motor function, and the Parkinson Disease Questionnaire-39. The frequency of suicidal ideation was assessed using question 9 of the BDI-II. Features associated with a BDI-II score greater than zero were assessed using logistic regression. RESULTS The database included 95 individuals with LBD and at least one BDI-II (visit years 2010-2020). Most participants were older men who identified as white. Eighteen individuals (18.9%; 95% CI 12.3%-28.0%) reported thoughts of killing themselves without an intent to carry them out (BDI-II = 1). No participants reported a desire or plan to kill themselves. The presence of SI was associated with measures of depression, anxiety, and emotional well-being, but not with demographics, measures of disease severity, or other psychiatric concerns. CONCLUSION These findings emphasize the importance of routine screening for psychiatric symptoms in LBD and intervention when such concerns are identified. Interventions could include pharmacologic (e.g. depression treatment) and non-pharmacologic (e.g. firearm screening) approaches. More research is needed to assess suicidal ideation and suicide risks in large and more diverse LBD populations. Prospective studies should include measures of additional potential contributors to suicidality.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, P.O. Box 100268, Gainesville, FL, 32611, USA.
| | - Kathryn Moore
- Department of Neurology, University of Florida College of Medicine, P.O. Box 100268, Gainesville, FL, 32611, USA.
| | - Charles E Jacobson
- Department of Neurology, University of Florida College of Medicine, P.O. Box 100268, Gainesville, FL, 32611, USA.
| | - Noheli Bedenfield
- Department of Neurology, University of Florida College of Medicine, P.O. Box 100268, Gainesville, FL, 32611, USA.
| | - Bhavana Patel
- Department of Neurology, University of Florida College of Medicine, P.O. Box 100268, Gainesville, FL, 32611, USA.
| | - Jennifer L Sullivan
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152M), Boston, MA, 02131, USA; Boston University School of Public Health, Department of Health Law, Policy and Management, 715 Albany St, Talbot Building, Boston, MA, 02118, USA.
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Suicide among Older Adults with Dementia: Effects of Korea's Long-Term Care Insurance System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126582. [PMID: 34207323 PMCID: PMC8296317 DOI: 10.3390/ijerph18126582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
South Korea recently expanded its coverage rate of long-term care insurance (LTCI) by adding a “dementia special grade” in 2014 to improve care service accessibility and extend health life for older adults with dementia. In this study, we propose a multifaceted policy to reduce the suicide risk among older adults with dementia by evaluating the effectiveness of using the long-term care services (LTCS). A sample of 62,282 older adults was selected from the “Older Adults Cohort DB” of the National Health Insurance Service. We conducted Kaplan–Meier and Cox regression to represent the yearly survival curve from 2002 to 2015 according to the individual characteristics. Difference-in-difference estimation was conducted to identify the effect of LTCS on suicide rates by using LTCS before and after 2014. The suicide risk of older adults using LTCS was about 0.256-times lower than those who did not use it (OR = 0.296, 95% CI = 0.183–0.478), whereas it increased after the expansion of the dementia grading (OR = 2.131, 95% CI = 1.061–4.280). To prevent the risk of suicide among older adults with dementia, not only did the mortality rate vary depending on the sex, activities of daily living (ADL), and type of caregiver at the individual level but appropriate national intervention and management, such as improving the accessibility of LTCS, are also needed.
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