Prevalence and severity of morbidity among Gujarati Asian elders: a controlled comparison

Diagnosis of mental illness in elderly people from ethnic minorities

From the 1991 census (Office of Population Censuses and Surveys, 1993) it is estimated that 5.9% of the total population of England and Wales belong to an ethnic minority, and that 3% of this ethnic minority population are aged 65 years and older. This compares with 17% aged 65 years and older in the indigenous population. Although the numbers of elderly people from ethnic minorities are small in absolute terms, these groups are growing rapidly, and mental health professionals working with elderly patients will increasingly need to be equipped with the necessary services and skills to meet their specific needs. The elderly ethnic minority population of the UK is extremely diverse; the largest groups originate from the Indian subcontinent and the Caribbean, but there are also significant communities of Chinese, Somali, Vietnamese, Eastern European, Mediterranean and Irish origin, all of which require consideration when planning and providing services, whatever their numbers. This diversity is also important when considering the various factors that influence the presentation and diagnosis of mental disorders in these groups.

Charlson comorbidity index is an important prognostic factor for long-term survival outcomes in Korean men with prostate cancer after radical prostatectomy

PURPOSE

To analyze overall survival (OS), prostate cancer (PCa)-specific survival (PCaSS), and non-PCaSS according to the Charlson Comorbidity Index (CCI) after radical prostatectomy (RP) for PCa.

MATERIALS AND METHODS

Data from 336 patients who had RP for PCa between 1992 and 2005 were analyzed. Data included age, preoperative prostate-specific antigen (PSA), prostate volume, clinical stage, and pathologic stage. Pre-existing comorbidities were evaluated by the CCI, and patients were classified into two CCI score categories (0, ≥1).

RESULTS

The mean age of patients was 64.31±6.12 years. The median PSA value (interquartile range, IQR) was 11.30 (7.35 and 21.02) ng/mL with a median follow-up period (IQR) of 96.0 (85.0 and 121.0) months. The mean CCI was 0.28 (0-4). Five-year OS, PCaSS, and non-PCaSS were 91.7%, 96.3%, and 95.2%, respectively. Ten-year OS, PCaSS, and non-PCaSS were 81.9%, 92.1%, and 88.9%, respectively. The CCI had a significant influence on OS (p=0.022) and non-PCaSS (p=0.008), but not on PCaSS (p=0.681), by log-rank test. In multivariate Cox regression analysis, OS was independently associated with the CCI [hazard ratio (HR)=1.907, p=0.025] and Gleason score (HR=2.656, p<0.001). PCaSS was independently associated with pathologic N stage (HR=2.857, p=0.031), pathologic T stage (HR=3.775, p=0.041), and Gleason score (HR=4.308, p=0.001). Non-PCaSS had a significant association only with the CCI (HR=2.540, p=0.009).

CONCLUSION

The CCI was independently associated with both OS and non-PCaSS after RP, but the CCI had no impact on PCaSS. The comorbidities of a patient should be considered before selecting RP as a curative modality for PCa.

Psychiatry of old age and ethnic minority older people in the United Kingdom

This review examines the demographic changes, the epidemiology of mental disorders and suicides, the potential risk and protective factors, access to secondary care old age psychiatry services (OAPSs) and the policy context pertaining to older people from ethnic minority groups in the United Kingdom. The number of older people from ethnic minority groups is increasing. The prevalence of mental disorders in older people from ethnic minority groups is either similar to or higher than that in the indigenous population. Therefore, the number of older people from ethnic minority groups with psychiatric morbidity is also increasing. Ethnic minority older people also have inequity of access to secondary care OAPSs. There is an urgent need to develop and implement practical strategies to improve access by older people from ethnic minority groups to OAPSs.

The Health and Well-being of Jewish People Aged 65 to 85 Years Living at Home in the East End of London

Relatively little is known about what has been termed cultural gerontology, or the experience of ageing among members of particular ethnic minority groups. One of the greatest gaps in current knowledge relates to the subjective health status and use of health services among elderly people in ethnic minorities, particularly those who are Jewish. The research results reported here are from a survey of elderly people in City and Hackney, London, of whom 16% were Jewish. They show that Jewish respondents were more likely than other elderly people to report problems with emotional well-being, with mental and physical health and with functional ability (tasks of daily living). Jewish respondents were also more likely to use services, particularly health services, than other respondents. The associations with service use generally remained after health status had been controlled for.

Mental health of migrant elders--the Islington study

BACKGROUND

In the UK, 6% of those aged 65 years and over were born abroad, most of whom now live in inner-city areas. It has been suggested that ethnic elders are particularly vulnerable to mental illness.

AIMS

To compare the prevalence of dementia and depression in older migrants with those born in the UK.

METHOD

A cross-sectional community study of 1085 people aged 65 years or older in an inner-London borough.

RESULTS

Compared with those born in the UK, the prevalence of dementia was raised in African-Caribbeans (17.3%, relative risk=1.72, Cl=1.06-2.81) and lower for the Irish-born (3.6%, relative risk=0.36, Cl=0.17-0.87). All those of African-Caribbean country of birth were significantly younger (P=0.000) but no more likely to be taking antihypertensive drugs. They were no more likely to report having cardiovascular problems but had increased rates of diabetes (P<0.0000). The overall prevalence of depression was 18.3% (95% Cl=16.1-20.7). The highest prevalence rate was found among those born in Greece and Turkey (27.2%, Cl=17.9-39.6). Migration per se does not appear to be a risk for depression and dementia in this population.

CONCLUSIONS

The excess of dementia may be of vascular aetiology. There is the potential for primary or secondary prevention.

The characteristics of Indian subcontinent origin elders newly referred to a psychogeriatric service

BACKGROUND

The ethnic elderly population in the United Kingdom is increasing. Clinical, social and demographic characteristics of ethnic elders referred to and utilizing psychogeriatric services are unknown. Thus, this study was designed to compare these characteristics between Indian subcontinent origin ethnic elders and indigenous elders newly referred to a psychogeriatric service.

METHOD

All new referrals to a psychogeriatric service over a 2-year period were examined. Clinical, social and demographic characteristics of Indian subcontinent origin ethnic elders were compared with those of indigenous elders.

RESULTS

Ethnic elders were younger, had more children, had more people living in their household, were more likely to be married, were less likely to live alone, were more likely to have schizophrenia and less likely to have dementia. There were no differences between the two groups with regard to use of almost all health and social services resources at the time of the referral and after the initial assessment.

CONCLUSIONS

These findings do not support the traditional view that ethnic elders do not adequately access psychogeriatric and social services and that they are primarily cared for by extended families.

Appreciating background and culture: the South Asian elderly and mental health

In the next decade there will be an increase in the number of elderly people from a South Asian background. All too often minority groups are treated as homogeneous, leading to inappropriate generalisations, unmet need, and unsuitable treatment and management. In order to understand and manage a person's illness it is necessary to appreciate the effects of their culture, experiences and environment. The South Asian community is well established in the UK and the attitudes of the growing elderly population towards mental illness, their expressions of distress, and views on management and treatment are only now being canvassed. Awareness of these issues is essential before epidemiological studies of depression and dementia and use of health services by this group will provide beneficial results.

Clinical and public health perspectives and applications of health-related quality of life measurement

Health-related quality of life (HRQL) measures have been developed from the utilitarian ethical perspective of public health medicine which may be contrasted with individual-centered indicators; these emphasise the unique experience of a patient. The impairment-disability-handicap framework provides a more complete description of disease consequences and health outcomes than a generic HRQL indicator. The assessment of reliability and validity of HRQL indicators is often carried out inappropriately: population repeatability is measured when an indicator will be used to examine changes in individuals; between observer variation may be large compared with variation between populations. Content and construct validity are usually measured but the more important predictive validity is neglected. Effect sizes of HRQL indicators are likely to be inflated by use of between subject estimates of variance but the more appropriate within subject variance is seldom reported. HRQL indicators are of very limited value for many clinical and public health tasks: monitoring health of individuals and populations; evaluating the effects of health and social policy; allocating resources; evaluating the effects of treatment. Alternative methods of assessment derived from the impairment-disability-handicap conceptual framework are preferable.