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Resnick B, Galik E, McPherson R, Boltz M, Van Haitsma K, Kolanowski A. Gender Differences in Disease, Function, and Behavioral Symptoms in Residents with Dementia. West J Nurs Res 2022; 44:812-821. [PMID: 34044668 PMCID: PMC8627520 DOI: 10.1177/01939459211018822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The purpose of this study was to consider gender differences in depressive symptoms, agitation, resistiveness to care, physical function, and use of psychotropic medications in older adults with moderate to severe dementia in nursing homes. Sixty-seven nursing homes and 889 residents from two states were included. The majority of the participants were female (n = 640, 72%) and White (n = 618, 70%) with a mean age of 86.58 years (SD = 10.31). Differences by gender with regard to age, physical function, depressive symptoms, agitation/aggression, and resistiveness to care were tested using multivariate analysis of variance. Older females with moderate to severe dementia present with more depressive symptoms (anxiety, sadness, and somatic complaints) than males. Males present with more aggressive behavior and are more likely to receive anticonvulsants. Caregivers should focus on preventing and managing depressive symptoms including anxiety, sadness, and somatic complaints among older females and aggressive behavior in older males with dementia.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Rachel McPherson
- Department of Epidemiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marie Boltz
- School of Nursing, Pennsylvania State University, University Park, PA, USA
| | | | - Ann Kolanowski
- School of Nursing, Pennsylvania State University, University Park, PA, USA
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2
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Jyväkorpi SK, Lindström M, Suominen MH, Kautiainen H, Salminen K, Niskanen RT, Pitkälä KH, Roitto HM. Relationship between frailty, nutrition, body composition, quality of life, and gender in institutionalized older people. Aging Clin Exp Res 2022; 34:1357-1363. [PMID: 35146701 PMCID: PMC9151503 DOI: 10.1007/s40520-022-02077-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/10/2022] [Indexed: 11/28/2022]
Abstract
Our aim was to explore the relationship between frailty, nutrition, body composition, and how gender modifies this relationship among long-term care facility residents. We further investigated how body composition correlates with health-related quality of life (HRQoL) in both genders. In all, 549 residents (> 65 years of age) were recruited from 17 long-term care facilities for this cross-sectional study. Demographic information, diagnoses, use of medications, and nutritional supplements were retrieved from medical records. Participants' frailty status, cognition, nutritional status, HRQoL, and body composition were determined. Energy, protein, and fat intakes were retrieved from 1- to 2-day food diaries. The final sample consisted of 300 residents (77% women, mean age 83 years). The majority of participants, 62% of women and 63% of men, were identified as frail. Frail participants in both genders showed lower body mass index (p = 0.0013), muscle mass (MM) (p < 0.001), poorer nutritional status (p = 0.0012), cognition (p = 0.0021), and lower HRQoL (p < 0.001) than did prefrail participants. Women had higher fat mass, whereas men exhibited higher MM. The HRQoL correlated with the MM in both women, r = 0.48 [95% CI 0.38, 0.57] and men r = 0.49 [95% CI 0.38, 0.58]. Interventions aimed at strengthening and retaining MM of long-term residents may also support their HRQoL.
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Affiliation(s)
| | - M Lindström
- City of Helsinki Department of Social Services and Health Care, Geriatric Clinic, Helsinki Hospital, Helsinki, Finland
| | | | | | - K Salminen
- University of Helsinki, Clinicum, Finland
| | | | | | - H-M Roitto
- City of Helsinki Department of Social Services and Health Care, Geriatric Clinic, Helsinki Hospital, Helsinki, Finland
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Context-Enhanced Human-Robot Interaction: Exploring the Role of System Interactivity and Multimodal Stimuli on the Engagement of People with Dementia. Int J Soc Robot 2021. [DOI: 10.1007/s12369-021-00823-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AbstractEngaging people with dementia (PWD) in meaningful activities is the key to promote their quality of life. Design towards a higher level of user engagement has been extensively studied within the human-computer interaction community, however, few extend to PWD. It is generally considered that increased richness of experiences can lead to enhanced engagement. Therefore, this paper explores the effects of rich interaction in terms of the role of system interactivity and multimodal stimuli by engaging participants in context-enhanced human-robot interaction activities. The interaction with a social robot was considered context-enhanced due to the additional responsive sensory feedback from an augmented reality display. A field study was conducted in a Dutch nursing home with 16 residents. The study followed a two by two mixed factorial design with one within-subject variable - multimodal stimuli - and one between-subject variable - system interactivity. A mixed method of video coding analysis and observational rating scales was adopted to assess user engagement comprehensively. Results disclose that when additional auditory modality was included besides the visual-tactile stimuli, participants had significantly higher scores on attitude, more positive behavioral engagement during activity, and a higher percentage of communications displayed. The multimodal stimuli also promoted social interaction between participants and the facilitator. The findings provide sufficient evidence regarding the significant role of multimodal stimuli in promoting PWD’s engagement, which could be potentially used as a motivation strategy in future research to improve emotional aspects of activity-related engagement and social interaction with the human partner.
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Montaner X, Tárrega S, Moix J. [Psychological flexibility, burnout and job satisfaction in dementia care workers]. Rev Esp Geriatr Gerontol 2021; 56:144-151. [PMID: 33608164 DOI: 10.1016/j.regg.2020.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/23/2020] [Accepted: 10/28/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The clinical complexity of dementia, its physical burden, and the potential assaults associated with psychological and behavioral symptoms, could put healthcare workers working with dementia at high risk of burnout. Certain attitudes toward dementia and certain coping styles may be a protective factor against the stress experienced by these workers. On the other hand, it has been shown that a coping style based on psychological flexibility can prevent the development of burnout in the workplace. The present study analyzes the relationship between levels of burnout, psychological flexibility, attitudes towards dementia and life satisfaction in a sample of healthcare workers who work with people affected by dementia. METHODS A sample of 105 healthcare workers from the Ricard Fortuny Social Hospital was recruited (day hospital, hospitalization unit, and nursing home), and psychological flexibility (AAQII), burnout levels (MBI), life satisfaction (SWL), anxiety (STAI-R), and attitudes towards dementia (EAD) were assessed. RESULTS Psychological inflexiblility showed a positive relationship with 2 dimensions of burnout (emotional exhaustion [r=.342, P<.01]; depersonalization [r=.328, P<.01]), and with anxiety (r=.723, P<.01), and also showed a negative relation with life satisfaction (r=-.485, P<.01) and affect attitude (r=-.209); p<.05). It was also found a negative relation between rejection attitude with emotional exhaustion (r=-.328, P<.01) and with depersonalization (r=-.328; P<.01). CONCLUSIONS Those participants with greater psychological flexibility, in addition to feel more satisfaction with life, were found to be less likely to feel emotionally exhausted, to depersonalize patients with dementia, and felt more affection for them. On the other hand, no relationship was found between Burnout levels and the cognitive dimension of Attitudes towards dementia (the worker's knowledge of dementia). The results have significant implications regarding the type of training that is given to healthcare workers who work with people affected by dementia. Psychoeducational interventions promoting the psychological flexibility could help to reduce the risk of burnout in healthcare workers who work with dementia.
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Affiliation(s)
- Xavier Montaner
- Departament de Psicologia Bàsica, Evolutiva i de l'Educació, Facultat de Psicologia, Universitat Autònoma de Barcelona, Campus de Bellaterra, Cerdanyola del Vallés, España; Consorci Sociosanitari Ricard Fortuny, Vilafranca del Penedès, España.
| | - Salomé Tárrega
- Facultat de ciències de la Salut de Manresa, Universitat de Vic-Universitat Central de Catalunya, Manresa. España; Estudis de Psicologia i Ciències de l'Educació, Universitat Oberta de Catalunya, Barcelona, España
| | - Jenny Moix
- Departament de Psicologia Bàsica, Evolutiva i de l'Educació, Facultat de Psicologia, Universitat Autònoma de Barcelona, Campus de Bellaterra, Cerdanyola del Vallés, España
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Harris ML, Titler MG, Struble LM. Acupuncture and Acupressure for Dementia Behavioral and Psychological Symptoms: A Scoping Review. West J Nurs Res 2020; 42:867-880. [PMID: 31802723 PMCID: PMC7272277 DOI: 10.1177/0193945919890552] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Due to the dangers associated with psychotropic medications, there is an urgent need for non-pharmacologic therapies to treat behavioral and psychological symptoms of dementia (BPSD). Acupuncture and acupressure are safe and well-tolerated non-pharmacologic therapies for this population, but currently no review has explored acutherapy for management of distressing dementia symptoms. This review synthesizes research on acupuncture and acupressure for BPSD. Upon searching five databases, 15 studies met inclusion/exclusion criteria. Nine examined acupressure, six acupuncture, and eight were randomized controlled trials. The percent of studies demonstrating statistically significant improvements in symptoms were: activities of daily living (ADLs; 75%), agitation (100%), anxiety (67%), depression (100%), mood (100%), neuropsychological disturbances (67%), and sleep disturbances (100%). Variations in study design, intervention procedures, and outcomes limit interpretations about effectiveness. It is recommended that further research be done to examine the efficacy of these therapies and promote generalizability.
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Affiliation(s)
| | - Marita G Titler
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Laura M Struble
- University of Michigan School of Nursing, Ann Arbor, MI, USA
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6
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Maclagan LC, Maxwell CJ, Harris DA, Campitelli MA, Diong C, Lapane KL, Hogan DB, Rochon P, Herrmann N, Bronskill SE. Sex Differences in Antipsychotic and Benzodiazepine Prescribing Patterns: A Cohort Study of Newly Admitted Nursing Home Residents with Dementia in Ontario, Canada. Drugs Aging 2020; 37:817-827. [PMID: 32978758 DOI: 10.1007/s40266-020-00799-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In nursing homes, residents with dementia frequently receive potentially inappropriate medications that are associated with an increased risk of adverse events. Despite known sex differences in clinical presentation and sociodemographic characteristics among persons with dementia, few studies have examined sex differences in patterns and predictors of potentially inappropriate medication use. OBJECTIVES The objectives of this study were to examine sex differences in the patterns of antipsychotic and benzodiazepine use in the 180 days following admission to a nursing home, estimate clinical and sociodemographic predictors of antipsychotic and benzodiazepine use in male and female residents, and explore the effects of modification by sex on the predictors of using these drug therapies. METHODS We conducted a retrospective cohort study of 35,169 adults aged 66 years and older with dementia who were newly admitted to nursing homes in Ontario, Canada between 2011 and 2014. Health administrative databases were linked to detailed clinical assessment data collected using the Resident Assessment Instrument (RAI-MDS 2.0). Cox proportional hazards models were adjusted for clinical and sociodemographic covariates to estimate the rate of antipsychotic and benzodiazepine initiation and discontinuation in the 180 days following nursing home admission in the total sample and stratified by sex. Sex-covariate interaction terms were used to assess whether sex modified the association between covariates and the rate of drug therapy initiation or discontinuation following nursing home entry. RESULTS Across 638 nursing homes, our analytical sample included 22,847 females and 12,322 males. At admission, male residents were more likely to be prevalent antipsychotic users than female residents (33.8% vs 28.3%; p < 0.001), and female residents were more likely to be prevalent benzodiazepine users than male residents (17.2% vs 15.3%, p < 0.001). In adjusted models, female residents were less likely to initiate an antipsychotic after admission (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.73-0.86); however, no sex difference was observed in the rate of benzodiazepine initiation (HR 1.04, 95% CI 0.96-1.12). Female residents were less likely than males to discontinue antipsychotics (HR 0.89, 95% CI 0.81-0.98) and benzodiazepines (HR 0.82, 95% CI 0.75-0.89). Sex modified the association between some covariates and the rate of changes in drug use (e.g., widowed males exhibited an increased rate of antipsychotic discontinuation (p-interaction = 0.03) compared with married males), but these associations were not statistically significant among females. Sex did not modify the effect of frailty on the rates of initiation and discontinuation. CONCLUSIONS Males and females with dementia differed in their exposure to antipsychotics and benzodiazepines at nursing home admission and their patterns of use following admission. A greater understanding of factors driving sex differences in potentially inappropriate medication use may help tailor interventions to reduce exposure in this vulnerable population.
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Affiliation(s)
| | - Colleen J Maxwell
- ICES, Toronto, ON, M4N 3M5, Canada.,School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Daniel A Harris
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | | | - Kate L Lapane
- University of Massachusetts School of Medicine, Worcester, MA, USA
| | - David B Hogan
- Divison of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paula Rochon
- ICES, Toronto, ON, M4N 3M5, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Susan E Bronskill
- ICES, Toronto, ON, M4N 3M5, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. .,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada. .,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.
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7
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Inamura K, Shinagawa S, Tsuneizumi Y, Nagata T, Tagai K, Nukariya K, Shigeta M. Sex differences in the severity of neuropsychiatric symptoms and their relationship with clinico-demographic and psychosocial factors in patients with amnestic mild cognitive impairment and mild Alzheimer's disease. Aging Ment Health 2020; 24:431-438. [PMID: 30588827 DOI: 10.1080/13607863.2018.1539834] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: We examined differences in the severity of neuropsychiatric symptoms (NPS) according to sex and identified NPS-related clinico-demographic and psychosocial factors among community-living patients with amnestic-mild cognitive impairment (a-MCI) or mild Alzheimer's disease (AD).Method: Overall, 111 patients (44 males, 67 females) with mild a-MCI (n = 64) or mild AD (n = 47) were included. We divided the patients according to sex and compared their clinico-demographic and psychosocial factors, explored the severity of NPS using the subscales from the Neuropsychiatric Inventory-Questionnaire (NPI-Q), and further identified variables related to NPS.Results: Significant differences in several clinico-demographic and psychosocial characteristics were observed between the sexes. The severity of delusions was higher among females (mean, 0.48; SD, 1.60) than males (mean, 0.23; SD, 1.07; p = .02), while the severity of irritability was higher among males (mean, 0.97; SD, 1.92) than females (mean, 0.49; SD, 1.40; p = .03). The severity of delusions among females was related to the duration of cognitive decline (B = 0.37, p = .03), while the severity of irritability among males was related to general cognition (B = -0.40, p = .003).Conclusion: The severity of NPS among patients with a-MCI or mild AD differed according to sex. We identified NPS-related clinico-demographic factors among these patients. Sex differences should be considered when determining the need for NPS interventions.
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Affiliation(s)
- Keisuke Inamura
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Yuri Tsuneizumi
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Tomoyuki Nagata
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenji Tagai
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazutaka Nukariya
- Department of Psychiatry, The Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Masahiro Shigeta
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
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8
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Sex Differences in Care Need and Survival in Patients Admitted to Nursing Home Poststroke. Can J Neurol Sci 2020; 47:153-159. [PMID: 31987059 DOI: 10.1017/cjn.2019.335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Women are more likely to be admitted to nursing home after stroke than men. Differences in patient characteristics and outcomes by sex after institutionalization are less understood. We examined sex differences in the characteristics and care needs of patients admitted to nursing home following stroke and their subsequent survival. METHODS We identified patients with stroke newly admitted to nursing home between April 2011 and March 2016 in Ontario, Canada, with follow-up until March 2018 using linked administrative data. We calculated prevalence ratios and 95% confidence intervals (CIs) for the primary outcomes of dependence for activities of daily living, cognitive impairment, frailty, health instability, and symptoms of depression or pain, comparing women to men. The secondary outcome was all-cause mortality. RESULTS Among 4831 patients, 60.9% were women. Compared to men, women were older (median age [interquartile range, IQR]: 84 [78, 89] vs. 80 [71, 86]), more likely to be frail (prevalence ratio 1.14, 95% CI [1.08, 1.19]), have unstable health (1.45 [1.28, 1.66]), and experience symptoms of depression (1.25 [1.11, 1.40]) or pain (1.21 [1.13, 1.30]), and less likely to have aggressive behaviors (0.87 [0.80, 0.94]). Overall median survival was 2.9 years. In a propensity-score-matched cohort, women had lower mortality than men (hazard ratio 0.85, 95% CI [0.77, 0.94]), but in the age-stratified survival analysis, the survival advantage in women was limited to those aged 75 years and older. CONCLUSIONS Despite lower subsequent mortality, women admitted to nursing home after stroke required more care than men. Pain and depression are two treatable symptoms that disproportionately affect women.
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Tao Y, Peters ME, Drye LT, Devanand DP, Mintzer JE, Pollock BG, Porsteinsson AP, Rosenberg PB, Schneider LS, Shade DM, Weintraub D, Yesavage J, Lyketsos CG, Munro CA. Sex Differences in the Neuropsychiatric Symptoms of Patients With Alzheimer's Disease. Am J Alzheimers Dis Other Demen 2018; 33:450-457. [PMID: 29969907 PMCID: PMC6219457 DOI: 10.1177/1533317518783278] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to describe sex differences in neuropsychiatric symptoms (NPSs) in patients with Alzheimer's disease (AD). Baseline scores on the Cohen-Mansfield Agitation Inventory, Neurobehavioral Rating Scale-Agitation subscale, and the Neuropsychiatric Inventory from patients with AD enrolled in a multicenter trial of citalopram for the treatment of agitation were analyzed. We found not only that patients with AD having agitation were likely to exhibit many other NPSs but also that the women in this study were more likely to exhibit a broader range of NPS than were the men. These results suggest greater heterogeneity in the clinical presentation of women compared to men, and thus in the potential targets for treatment in these patients. Further characterization of sex differences in NPS can inform future efforts aimed at establishing subtypes of patients for whom various treatment approaches will be most appropriate.
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Affiliation(s)
- Ye Tao
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew E. Peters
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lea T. Drye
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Jacobo E. Mintzer
- Medical University of South Carolina, Clinical Biotechnology Research Institute–Roper St Francis Healthcare, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | | | | | - Paul B. Rosenberg
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lon S. Schneider
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - David M. Shade
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Daniel Weintraub
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | | | - Cynthia A. Munro
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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10
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Salech F, Ponce DP, SanMartín CD, Rogers NK, Henríquez M, Behrens MI. Cancer Imprints an Increased PARP-1 and p53-Dependent Resistance to Oxidative Stress on Lymphocytes of Patients That Later Develop Alzheimer's Disease. Front Neurosci 2018; 12:58. [PMID: 29472838 PMCID: PMC5809443 DOI: 10.3389/fnins.2018.00058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/23/2018] [Indexed: 11/13/2022] Open
Abstract
We have proposed that a common biological mechanism deregulated in opposite directions might explain the inverse epidemiological association observed between Alzheimer's disease (AD) and cancer. Accordingly, we showed that lymphocytes from AD patients have an increased susceptibility, whereas those from survivors of a skin cancer, an increased resistance to oxidative death induced by hydrogen peroxide (H2O2), compared to healthy controls (HC). We investigated the susceptibility to H2O2-induced death of lymphocytes in survivors of any type of cancer and in cancer survivors who later developed AD (Ca&AD). We also explored the involvement of Poly [ADP-ribose] polymerase-1 (PARP-1) and p53 pathways in the process, since both are involved in the increased susceptibility to death of AD lymphocytes. Lymphocytes from 11 cancer and 13 Ca&AD patients, and 12 HC were submitted to increasing concentrations of H2O2 for 20 h. Cell death was determined by flow cytometry, in the presence or absence of PARP-1 inhibition (3-aminobenzamide, 3-ABA), or p53 inhibition (pifithrin-α) or stabilization (Nut-3). PARP-1 and p53 mRNA levels were determined by Real-Time PCR. Lymphocytes from cancer and Ca&AD patients showed increased survival compared to HC, without differences between them, opposite to the increased susceptibility to death previously shown in AD. PARP-1 inhibition provided marked protection from H2O2-induced death in the two groups of patients, significantly greater than in HC. Pharmacological inhibition of p53 increased lymphocyte survival in Ca&AD patients, contrary to the effect previously reported in HC and AD. PARP-1 and p53 mRNA levels were elevated in Ca&AD lymphocytes compared with controls. In all, these results show that cancer imprints an increased resistance to H2O2-induced death in lymphocytes that persists after AD development, and is dependent on both PARP-1 and p53. p53 inhibition showed a differential role in cancer and Ca&AD compared to HC and AD lymphocytes, that could explain the inverse susceptibility to oxidative death in cancer and AD. These results are in agreement with the hypothesis of a common biological mechanism in AD and cancer. The similar cell death susceptibility and cell death pattern observed in cancer and Ca&AD lymphocytes suggests that cancer history leaves long term effects on lymphocyte cell death susceptibility.
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Affiliation(s)
- Felipe Salech
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Centro de Investigación Clínica Avanzada (CICA), Hospital Clínico Universidad de Chile, Santiago, Chile.,Departamento de Neurociencias Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Unidad de Geriatría, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Daniela P Ponce
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Centro de Investigación Clínica Avanzada (CICA), Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Carol D SanMartín
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Nicole K Rogers
- Departamento de Neurociencias Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Mauricio Henríquez
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Maria I Behrens
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Centro de Investigación Clínica Avanzada (CICA), Hospital Clínico Universidad de Chile, Santiago, Chile.,Departamento de Neurociencias Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago, Chile.,Clínica Alemana, Santiago, Chile
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11
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Prevalence estimates of mild behavioral impairment in a population-based sample of pre-dementia states and cognitively healthy older adults. Int Psychogeriatr 2018; 30:221-232. [PMID: 28931446 DOI: 10.1017/s1041610217001909] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A dearth of population-based epidemiological research examines neuropsychiatric symptom (NPS) in sub-clinical populations across the spectrum from normal aging to mild cognitive impairment (MCI). The construct of mild behavioral impairment (MBI) describes the emergence of sustained and impactful NPS in advance of or in combination with MCI. This is the first epidemiological study to operationalize the recently published diagnostic criteria for MBI and determine prevalence estimates across the spectrum from cognitively normal to MCI. METHODS MBI was assessed in 1,377 older (age range 72-79 years; 52% male; MCI ;= 133; cognitively normal, but-at-risk = 397; cognitively healthy = 847). MBI was assessed in accordance with the ISTAART-AA diagnostic criteria for MBI using the neuropsychiatric inventory. RESULTS 34.1% of participants met the criteria for MBI. High prevalence of MBI across the cognitive spectrum was reported (48.9% vs. 43.1% vs. 27.6%). Irrespective of level of cognitive impairment, impulse dyscontrol (33.8% vs. 28.7% vs. 17.2%) and decreased motivation (32.3% vs. 26.2% vs. 16.3%) were the most frequently met MBI domains. MBI was more prevalent in men (χ2 = 4.98, p = 0.026), especially the domains of decreased motivation and impulse dyscontrol. CONCLUSIONS This study presents the first population-based prevalence estimates for MBI using the recently published ISTAART-AA diagnostic criteria. Findings indicate relatively high prevalence of MBI in pre-dementia clinical states and amongst cognitively healthy older adults. Findings were gender-specific, with MBI affecting more men than women. Knowing the estimates of these symptoms in the population is essential for understanding and differentiating the very early development of clinical disorders.
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12
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Myers DR, Rogers RK, LeCrone HH, Kelley K. The Behavioral Health Role in Nursing Facility Social Work. J Appl Gerontol 2017; 38:1063-1095. [DOI: 10.1177/0733464817733103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Types of compromised resident behaviors licensed nursing facility social workers encounter, the behavioral health role they enact, and effective practices they apply have not been the subject of systematic investigation. Analyses of 20 in-depth interviews with Bachelor of Social Work (BSW)/Master of Social Work (MSW) social workers averaging 8.8 years of experience identified frequently occurring resident behaviors: physical and verbal aggression/disruption, passive disruption, socially and sexually inappropriateness. Six functions of the behavioral health role were care management, educating, investigating, preventing, mediating, and advocating. Skills most frequently applied were attention/affirmation/active listening, assessment, behavior management, building relationship, teamwork, and redirection. Narratives revealed role rewards as well as knowledge deficits, organizational barriers, personal maltreatment, and frustrations. Respondents offered perspectives and prescriptions for behavioral health practice in this setting. The findings expand understanding of the behavioral health role and provide an empirical basis for more research in this area. Recommendations, including educational competencies, are offered.
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Gender differences in clusters of NPS in Dutch nursing homes - a factor analysis. Int Psychogeriatr 2016; 28:1989-1999. [PMID: 27572478 DOI: 10.1017/s1041610216001216] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) have a high prevalence among patients with dementia, up to 80%. NPS can be grouped by type and stage of dementia. However, NPS have not previously been grouped by gender. Our objective was to investigate whether NPS cluster differently in men or women in the nursing home patients. METHODS Factor analysis to assess the clustering of items in the Cohen-Mansfield Agitation Inventory (CMAI) and Neuropsychiatric Inventory-Nursing home version (NPI-NH) into components, for both scales and for gender. Differences in symptom clustering between male and female patients were assessed using a three-step procedure: (1) identifying a gender specific distinctive item, (2) describe the correlation between the distinctive item with any other item in this cluster, (3) testing whether the correlation between a distinctive item and any other item in the cluster (which is present in both sexes) is different for males and females using a general linear model. RESULTS Our database consisted of 1,609 patients. There were five male and three female clusters for NPI-NH and eight male and seven female clusters for CMAI. There were three distinctive items in the NPI-NH and ten in the CMAI. CONCLUSIONS There are other clusters of NPS in males and females. Our analysis revealed more significant relations in female than male patients. This might have an implication on the clinical course.
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Björk S, Juthberg C, Lindkvist M, Wimo A, Sandman PO, Winblad B, Edvardsson D. Exploring the prevalence and variance of cognitive impairment, pain, neuropsychiatric symptoms and ADL dependency among persons living in nursing homes; a cross-sectional study. BMC Geriatr 2016; 16:154. [PMID: 27549203 PMCID: PMC4994232 DOI: 10.1186/s12877-016-0328-9] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Earlier studies in nursing homes show a high prevalence of cognitive impairment, dependency in activities of daily living (ADL), pain, and neuropsychiatric symptoms among residents. The aim of this study was to explore the prevalence of the above among residents in a nationally representative sample of Swedish nursing homes, and to investigate whether pain and neuropsychiatric symptoms differ in relation to gender, cognitive function, ADL-capacity, type of nursing-home unit and length of stay. METHODS Cross-sectional data from 188 randomly selected nursing homes were collected. A total of 4831 residents were assessed for cognitive and ADL function, pain and neuropsychiatric symptoms. Data were analysed using descriptive statistics and the chi-square test. RESULTS The results show the following: the prevalence of cognitive impairment was 67 %, 56 % of residents were ADL-dependent, 48 % exhibited pain and 92 % exhibited neuropsychiatric symptoms. The prevalence of pain did not differ significantly between male and female residents, but pain was more prevalent among cognitively impaired and ADL-dependent residents. Pain prevalence was not significantly different between residents in special care units for people with dementia (SCU) and general units, or between shorter-and longer-stay residents. Furthermore, the prevalence of neuropsychiatric symptoms did not differ significantly between male and female residents, between ADL capacities or in relation to length of stay. However, residents with cognitive impairment and residents in SCUs had a significantly higher prevalence of neuropsychiatric symptoms than residents without cognitive impairment and residents in general units. CONCLUSIONS The prevalence rates ascertained in this study could contribute to a greater understanding of the needs of nursing-home residents, and may provide nursing home staff and managers with trustworthy assessment scales and benchmark values for further quality assessment purposes, clinical development work and initiating future nursing assessments.
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Affiliation(s)
- Sabine Björk
- Department of Nursing, Umeå University, Umeå, Sweden.
| | | | - Marie Lindkvist
- Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anders Wimo
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Per-Olof Sandman
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.,Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Bengt Winblad
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - David Edvardsson
- Department of Nursing, Umeå University, Umeå, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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Baron S, Ulstein I, Werheid K. Psychosocial interventions in Alzheimer's disease and amnestic mild cognitive impairment: evidence for gender bias in clinical trials. Aging Ment Health 2015; 19:290-305. [PMID: 25048626 DOI: 10.1080/13607863.2014.938601] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) affects twice as many women as men. Gender differences in symptom profile, living conditions, coping style and response might affect the outcome of psychosocial interventions (PSIs). OBJECTIVES Our aim was to review gender differences in the available high-quality phase III trials on PSI in AD and amnestic mild cognitive impairment (aMCI) by considering the gender ratio in the investigated samples. DESIGN Randomized controlled trials published in 2000-2012 were stepwise analyzed by statistically testing the representativeness of the gender ratio and examining reported gender differences. RESULTS Forty-five studies (62% of 73 studies) reported gender ratios for each subsample and were included. In these studies, females were underrepresented in the control groups. In the 14 studies (19%) reporting analyses of gender differences, women were underrepresented in both intervention and control groups. However, in the six studies (8%) reporting significant gender differences in outcome, gender distribution was in accordance with prevalence rates. CONCLUSION Current evidence is insufficient for reliable conclusions on gender differences in PSI outcome in AD and aMCI, as 81% of the available clinical trials either not reported the gender ratio of their samples, or underrepresent females. Further research is needed addressing gender differences, and clinical trials should routinely control for gender bias.
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Affiliation(s)
- Stefanie Baron
- a Department of Psychology , Humboldt University Berlin , Berlin , Germany
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16
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Kolanowski AM, Hill NL, Kurum E, Fick DM, Yevchak AM, Mulhall P, Clare L, Valenzuela M. Gender differences in factors associated with delirium severity in older adults with dementia. Arch Psychiatr Nurs 2014; 28:187-92. [PMID: 24856271 PMCID: PMC4033832 DOI: 10.1016/j.apnu.2014.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 01/15/2014] [Accepted: 01/22/2014] [Indexed: 11/29/2022]
Abstract
The purpose of this descriptive correlational study was to explore potential gender differences in the relationship of dementia severity, age, APOE status, cognitive reserve and co-morbidity (two potentially modifiable factors), to delirium severity in older adults. Baseline data from an ongoing clinical trial and a Poisson regression procedure were used in the analyses. Participants were 148 elderly individuals with dementia and delirium admitted to post-acute care. In women, delirium severity was related to dementia severity (p=0.002) and co-morbidity moderated that effect (p=0.03). In men, education was marginally associated with delirium severity (p=0.06). Implications for research are discussed.
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Affiliation(s)
- Ann M Kolanowski
- The Pennsylvania State University, College of Nursing, University Park, PA.
| | - Nikki L Hill
- The Pennsylvania State University, College of Nursing, University Park, PA.
| | - Esra Kurum
- Istanbul Medeniyet University, Istanbul, Turkey.
| | - Donna M Fick
- The Pennsylvania State University, College of Nursing, University Park, PA.
| | | | - Paula Mulhall
- The Pennsylvania State University, College of Nursing, University Park, PA.
| | - Linda Clare
- Bangor University, School of Psychology, Gwynedd, UK.
| | - Michael Valenzuela
- Regenerative Neuroscience Group, Brain and Mind Research Institute, University of Sydney, Sydney, Australia.
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Enmarker I, Olsen R, Hellzen O. Management of person with dementia with aggressive and violent behaviour: a systematic literature review. Int J Older People Nurs 2011; 6:153-62. [PMID: 21539720 DOI: 10.1111/j.1748-3743.2010.00235.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Studies indicate that physical and pharmacological restraints are still often in the frontline of aggression management in a large number of nursing homes. In the present literature review the aim was to describe, from a nursing perspective, aggressive and violent behaviour in people with dementia living in nursing home units and to find alternative approaches to the management of dementia related aggression as a substitute to physical and chemical restraints. METHODS A systematic literature review in three phases, including a content analysis of 21 articles published between 1999 and August 2009 has been conducted. RESULTS The results could be summarised in two themes: 'origins that may trigger violence' and 'activities that decrease the amount of violent behaviour'. Together, the themes showed that violence was a phenomenon that could be described as being connected to a premorbid personality and often related to the residents' personal care. It was found that if the origin of violent actions was the residents' pain, it was possible to minimise it through nursing activities. This review also indicated that an organisation in special care units for residents who exhibit aggressive and violent behaviour led to the lesser use of mechanical restraints, but also an increased use of non-mechanical techniques. CONCLUSION The optimal management of aggressive and violent actions from residents with dementia living in nursing homes was a person-centred approach to the resident. Qualitative studies focusing on violence were sparsely found, and this underlines the importance of further research in this area to elucidate how violence and aggressiveness is experienced and understood by both staff and patients. RELEVANCE TO CLINICAL PRACTICE To communicate with people with dementia provides a challenge for nurses and other health caregivers. To satisfy the needs of good nursing care, an important aspect is therefore to get knowledge and understanding about aggressive and violent behaviour and its management.
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Affiliation(s)
- Ingela Enmarker
- Faculty of Health Science, Nord-Trondelag University College, Namsos, Norway.
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Isaksson U, Graneheim UH, Åström S, Karlsson S. Physically violent behaviour in dementia care: Characteristics of residents and management of violent situations. Aging Ment Health 2011; 15:573-9. [PMID: 21815849 DOI: 10.1080/13607863.2011.556600] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Physically violent behaviour (PVB) is common among residents with dementia and often complicates nursing care. This study aims to explore types of caring situations, resident characteristics related to PVB and professional caregivers' management of PVB. METHODS The study included 40 group homes for 309 residents with dementia. Data was gathered by means of structured interviews, the Multi-Dimensional Dementia Assessment Scale and the Geriatric Rating Scale. RESULTS Ninety-eight of the residents (31.7%) were assessed as showing PVB during the preceding week. Three factors were independently associated with PVB: male gender, antipsychotic treatment and decline in orientation. Violent residents were more likely to have impaired speech, difficulties understanding verbal communication and prescribed analgesics and antipsychotics than were non-violent residents. PVB occurred mainly in intimate helping situations and was managed by symptom-oriented approaches, such as distraction, medication and isolation. The working team also held frequent discussions about the residents with PVB. CONCLUSION This study shows that PVB is frequently displayed among residents in group homes for persons with dementia and the caregivers mainly manage PVB in a symptom-oriented way. To enhance the quality of care for patients with dementia, there is a need for interventions that aim to understand and manage the residents' physical violent behaviour.
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Affiliation(s)
- Ulf Isaksson
- Department of Nursing, Umeå University, The Caring Science Building, Umeå, Sweden.
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Annandale E, Hammarström A. Constructing the 'gender-specific body': A critical discourse analysis of publications in the field of gender-specific medicine. Health (London) 2010; 15:571-87. [PMID: 21177718 DOI: 10.1177/1363459310364157] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Gender-specific medicine, a new and increasingly influential ethos within medical research and practice, has received little critical attention to date. The objective of this article is to critically examine the attributes of gender-specific medicine as imparted by its advocates. Through a critical discourse analysis of its two leading academic journals, we identify five interrelated discourses: of male/female difference; of hegemonic biology; of men's disadvantages; of biological and social reductionism; and of the fragmented body. Together these comprise a master discourse of the 'gender-specific body'. The discourse of the 'gender-specific body' is discussed in relation to the current neoliberal political agenda which frames healthcare as a market good and locates health and illness in individual bodies rather than in the wider social arrangements of society. We argue that the 'gender-specific body' threatens not only to turn back the clock to a vision of the biological body as fixed and determinate, but to extend this ever deeper into the social imagination. Lost in the process is any meaningful sense of the human body as a relatively open system which develops in interaction with its social world. We propose that, as it gains momentum, the 'gender-specific body' is likely progressively to circumscribe our thinking about the health of women and men in potentially problematic ways.
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Kamble P, Chen H, Sherer JT, Aparasu RR. Use of Antipsychotics among Elderly Nursing Home Residents with Dementia in the US. Drugs Aging 2009; 26:483-92. [DOI: 10.2165/00002512-200926060-00005] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
BACKGROUND When a person has dementia, non-cognitive behaviors and symptoms might constitute a greater problem than the cognitive decline itself. Male or female sex might be a predisposing factor for certain types of behavior disturbances and symptoms. The aim of the present analysis was to explore the correlation between sex and the prevalence of behavioral and psychological symptoms of dementia. METHOD A total of 3395 people with cognitive impairment (1056 men and 2339 women) were selected from two large cross-sectional surveys of those in geriatric care settings, conducted in 1982 and 2000 in the county of Västerbotten, Sweden. Symptoms were assessed using the Multi-Dimensional Dementia Assessment Scale (MDDAS), and prevalence was compared using multivariate logistic regression. Drug data were obtained from prescription records. RESULTS For 17 out of 39 behaviors and symptoms, the prevalence differed significantly between men and women. Men more often exhibited aggressive behavior and regressive behaviors, and women more often exhibited depressive symptoms. There were no sex differences for passiveness and hallucinations. The prevalence of antipsychotic drug use was higher among men (35.5% compared to 28.9%, p < 0.001) and antidepressant drug use higher among women (30.1% compared to 25.6%, p = 0.006). The prevalence of use of anxiolytics, hypnotics and sedatives did not differ. CONCLUSION There are some differences in the prevalence of behavioral and psychological symptoms of dementia between men and women. These different symptom profiles might possibly explain some of the differences found in the pharmacological treatment of men and women with a dementia disorder.
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Isaksson U, Åström S, Sandman PO, Karlsson S. Factors associated with the prevalence of violent behaviour among residents living in nursing homes. J Clin Nurs 2009; 18:972-80. [DOI: 10.1111/j.1365-2702.2008.02440.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bellantonio S, Kenny AM, Fortinsky RH, Kleppinger A, Robison J, Gruman C, Kulldorff M, Trella PM. Efficacy of a geriatrics team intervention for residents in dementia-specific assisted living facilities: effect on unanticipated transitions. J Am Geriatr Soc 2008; 56:523-8. [PMID: 18179497 DOI: 10.1111/j.1532-5415.2007.01591.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine whether a multidisciplinary team intervention minimizes unanticipated transitions from assisted living for persons with dementia. DESIGN Randomized trial. SETTING Two dementia-specific assisted living facilities in Connecticut owned and managed by the same corporation. PARTICIPANTS One hundred older adults with dementia who relocated to assisted living. INTERVENTION Four systematic multidisciplinary assessments by a geriatrician, geriatrics advanced practice nurse, physical therapist, dietitian, and social worker during the first 9 months of relocation to assisted living. MEASUREMENTS Permanent relocation to a nursing facility, emergency department (ED) visits, hospitalization, and death. RESULTS Fifty-five residents experienced any unanticipated transition out of assisted living, on average 84 +/- 74 days after relocation; falls were the primary reason for transition. The intervention reduced the risk of any unanticipated transitions (13%), permanent relocation to a nursing facility (11%), ED visits (12%), hospitalization (45%), and death (63%), but the results did not meet statistical significance. In secondary analysis, more men experienced any unanticipated transition (P<.001), hospitalization (P<.001), or death (P<.001) than women. CONCLUSION Although an untargeted multidisciplinary intervention did not significantly reduce the risk of transitions for individuals with dementia relocating to assisted living in this small sample, trends for decreasing hospitalization and death were found. The data further suggest that those at risk for falls and men may benefit from targeted clinical interventions to prevent unanticipated transitions, especially during the first 3 months after relocation.
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Affiliation(s)
- Sandra Bellantonio
- Baystate Medical Center/Tufts University School of Medicine, Springfield, Massachusetts, USA
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Kolanowski A, Fick D, Waller JL, Ahern F. Outcomes of antipsychotic drug use in community-dwelling elders with dementia. Arch Psychiatr Nurs 2006; 20:217-25. [PMID: 17010825 DOI: 10.1016/j.apnu.2006.04.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Revised: 03/23/2006] [Accepted: 04/15/2006] [Indexed: 11/15/2022]
Abstract
This study used administrative data from a large health care insurer in the southeast United States to describe the utilization pattern and health care outcomes of antipsychotic drug use in community-dwelling elders with dementia. Claims data from 959 unique cases were analyzed to address research aims. Overall, 27% of the sample was dispensed antipsychotic drugs, with the most prevalent type being atypical antipsychotic drugs. Individuals on any type of antipsychotic drug experienced more delirium, depression, hip fracture, falls, and syncope than those not on these drugs, even after controlling for age, sex, comorbidity, and number of other drugs prescribed. Implications for practice are discussed.
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Affiliation(s)
- Ann Kolanowski
- School of Nursing, The Pennsylvania State University, 201 Health and Human Development Bldg., University Park, PA 16802, USA.
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