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Bjelkarøy MT, Simonsen TB, Siddiqui TG, Cheng S, Grambaite R, Benth JŠ, Lundqvist C. Mortality and health-related quality of life in older adults with long-term use of opioids, z-hypnotics or benzodiazepines: a prospective observational study at 5 years follow-up. BMJ Open 2024; 14:e079347. [PMID: 38387984 PMCID: PMC10882342 DOI: 10.1136/bmjopen-2023-079347] [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] [Received: 08/31/2023] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES Disease and medication use in older age is a consequence of age-related declining health. Multimorbidity followed by polypharmacy is common. Central nervous system depressing (CNSD) drugs such as opioids, benzodiazepines and z-hypnotics are not recommended for long-term use in older adults but are in use by many. We aimed to assess mortality and change in health-related quality of life (HRQoL) in older adults with long-term use of CNSDs. METHOD A prospective observational study was conducted at Akershus University Hospital, Norway, 2017-2019, with follow-up in 2021-2022, including 246 participants aged 65-90. At 5-year follow-up, 78 (32%) participants had passed away. Mortality data were collected from patient electronic health records. Of the surviving 168 (68%), we collected further follow-up data from 38 (16%) participants. Follow-up included demographic and clinical data. The EuroQuol Group EQ-5D-5L questionnaire was used to measure HRQoL. Analysis include Cox regression model for survival data and linear mixed model for change in HRQoL over time. RESULTS At follow-up, 78 (31.7%) were deceased. Mean survival time was 3.3 years. Total time for survival data was 4.7 years. Mortality was higher among participants with long-term use of CNSD (HR 1.9 95% CI (1.2 to 3.2), p=0.01). The multivariable analysis found being older (HR 1.1 95% CI (1.0 to 1.1), p=0.020) and male sex (HR 2.1 95% CI (1.2 to 3.5), p=0.008) to be associated with increased risk of mortality. According to the linear mixed model (n=38), there was no significant difference between surviving users and non-users in change in HRQoL EQ-5D-5L index from baseline to follow-up. CONCLUSION Mortality was higher for long-term users of CNSDs at 5-year follow-up. Being older and male sex were associated with mortality. Among survivors, there was no significant difference between the groups in change of HRQoL over time. TRIAL REGISTRATION NUMBER NCT03162081; 22 May 2017.
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Affiliation(s)
| | | | | | - Socheat Cheng
- Akershus University Hospital, Lorenskog, Norway
- University of Oslo, Oslo, Norway
| | - Ramune Grambaite
- Akershus University Hospital, Lorenskog, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Bjelkarøy MT, Simonsen TB, Siddiqui TG, Halset S, Cheng S, Grambaite R, Benth JŠ, Gerwing J, Kristoffersen ES, Lundqvist C. Brief Intervention as a Method to Reduce Z-Hypnotic Use by Older Adults: Feasibility Case Series. JMIR Form Res 2024; 8:e51862. [PMID: 38329779 PMCID: PMC10884901 DOI: 10.2196/51862] [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: 08/15/2023] [Revised: 01/06/2024] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Z-hypnotics or z-drugs are commonly prescribed for insomnia and sleep difficulties in older adults. These drugs are associated with adverse events and dependence and are not recommended for long-term use. Despite evidence of older adults being more sensitive to a wide array of adverse events and clinical guidelines advocating limiting use, inappropriate use in this population is still prevalent. Previous intervention studies have focused mainly on prescriber information. Simple, individually focused intervention designs are less studied. Brief intervention (BI) is a simple, easily transferable method mainly used to treat patients at risk of alcohol overuse. OBJECTIVE Our objective was to design and test the feasibility and acceptability of a BI intervention adapted to address individual, inappropriate use of z-hypnotics among older adults. This preparatory study aimed to optimize the intervention in advance of a quantitative randomized controlled trial investigating the treatment effect in a larger population. METHODS This feasibility case series was conducted at Akershus University Hospital, Norway, in autumn 2021. We included 5 adults aged ≥65 years with long-term (≥4 weeks) use of z-hypnotics and 2 intervening physicians. Additionally, 2 study investigators contributed with process evaluation notes. The BI consists of information on the risk of inappropriate use and individualized advice on how to reduce use. The focus of the intervention is behavioral and aims, in cooperation with the patient and based on shared decision-making, to change patient behavior regarding sleep medication rather than physician-based detoxification and termination of z-hypnotic prescriptions. Qualitative and descriptive quantitative data were collected from intervening physicians, study investigators, and participants at baseline, immediately after the intervention, and at the 6-week follow-up. RESULTS Data were obtained from 2 physicians, 2 study investigators, and 5 participants (4 women) with a median age of 84 years. The average time spent on the BI consultation was 15 minutes. All 5 participants completed the intervention without problems. The participants and 2 intervening physicians reported the intervention as acceptable and were satisfied with the delivery of the intervention. After the intervention, 2 participants stopped their use of z-hypnotics completely and participated in the follow-up interview. Study investigators identified logistical challenges regarding location and time requirements. Identified aspects that may improve the intervention and reduce dropouts included revising the intervention content, focusing on rebound insomnia, adding an information leaflet, and supporting the patient in the period between the intervention and follow-up. The notion that the intervention should best be located and conducted by the patient's own general practitioner was supported by the participants. CONCLUSIONS We identified important aspects to improve the designed intervention and found that the BI is feasible and acceptable for incorporation into a larger randomized trial investigating the treatment effect of BI for reducing z-hypnotic use by older adults. TRIAL REGISTRATION ClinicalTrials.gov NCT03162081; http://tinyurl.com/rmzx6brn.
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Affiliation(s)
- Maria Torheim Bjelkarøy
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Campus Ahus, Lørenskog, Norway
- Health Services Research Unit Helsetjenesteforskning, Akershus University Hosptial, Lørenskog, Norway
| | - Tone Breines Simonsen
- Health Services Research Unit Helsetjenesteforskning, Akershus University Hosptial, Lørenskog, Norway
| | - Tahreem Ghazal Siddiqui
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Campus Ahus, Lørenskog, Norway
- Health Services Research Unit Helsetjenesteforskning, Akershus University Hosptial, Lørenskog, Norway
| | - Sigrid Halset
- Department of Geriatrics, Akershus University Hospital, Lørenskog, Norway
| | - Socheat Cheng
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Campus Ahus, Lørenskog, Norway
- Health Services Research Unit Helsetjenesteforskning, Akershus University Hosptial, Lørenskog, Norway
| | - Ramune Grambaite
- Health Services Research Unit Helsetjenesteforskning, Akershus University Hosptial, Lørenskog, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Campus Ahus, Lørenskog, Norway
- Health Services Research Unit Helsetjenesteforskning, Akershus University Hosptial, Lørenskog, Norway
| | - Jennifer Gerwing
- Health Services Research Unit Helsetjenesteforskning, Akershus University Hosptial, Lørenskog, Norway
| | - Espen Saxhaug Kristoffersen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Christofer Lundqvist
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Campus Ahus, Lørenskog, Norway
- Health Services Research Unit Helsetjenesteforskning, Akershus University Hosptial, Lørenskog, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
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Schultheis M, Grabbe S, Staubach P, Hennig K, Mauch M, Burckhardt M, Langer G, Heise M, Zamsheva M, Schollenberger L, Strobel A. Drivers of disease severity and burden of hidradenitis suppurativa: a cross-sectional analysis on 553 German patients. Int J Dermatol 2024; 63:188-195. [PMID: 37919257 DOI: 10.1111/ijd.16889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/27/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is an inflammatory disease of the inverse skin regions with an age peak at around 40 years and an estimated prevalence of 1%. Nodules and abscesses can develop into fistules and scarring, which cause severe pain. HS is a progressive, life-defining disease that leads to physical limitations, inability to work, and social isolation. There is still little data on the drivers of disease severity and burden. METHOD The cross-sectional study is based on the baseline data of 553 participants of the health care research project "EsmAiL," which was carried out as a multicenter randomized controlled trial. It included adult HS-patients presenting with at least three inflammatory lesions and at least a moderate impact on quality of life. RESULTS Disease activity increases with age. Men are more severely affected than women but feel less burdened. Obesity negatively influences disease activity and disease burden. Affected individuals have a higher level of education than the age adjusted population, but the unemployment rate is significantly higher. Disease activity significantly reduces quality of life and promotes depression and anxiety. CONCLUSIONS HS is a severe and debilitating dermatosis. As a result of the well-established factors involved, HS requires a multi-causal approach to management, in addition to medical and surgical treatment. This must take into account all available therapeutic options, as well as patient education to reduce risk factors and pain, and psychological support. HS requires interdisciplinary and multi-professional care. To prevent disease progression, a structured treatment plan is needed.
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Affiliation(s)
- Michael Schultheis
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Katharina Hennig
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Melanie Mauch
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
| | - Marion Burckhardt
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
- Baden-Wuerttemberg Cooperative State University, School of Business and Health, Stuttgart, Germany
| | - Gero Langer
- Institute for Health- and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Marcus Heise
- Institute for Health- and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of General Practice and Family Medicine, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Marina Zamsheva
- Institute for Health- and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Profile Area Clinical Studies & Biostatistics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Lukas Schollenberger
- Interdisciplinary Center for Clinical Trials, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Alexandra Strobel
- Baden-Wuerttemberg Cooperative State University, School of Business and Health, Stuttgart, Germany
- Profile Centre of Health Sciences Halle, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
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Sivertsen HE, Helvik AS, Gjøra L, Haugan G. Psychometric validation of the Hospital Anxiety and Depression Scale (HADS) in community-dwelling older adults. BMC Psychiatry 2023; 23:903. [PMID: 38053095 PMCID: PMC10696870 DOI: 10.1186/s12888-023-05407-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 11/26/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVES The Hospital Anxiety and Depression Scale (HADS) is commonly used to measure anxiety and depression, but the number of studies validating psychometric properties in older adults are limited. To our knowledge, no previous studies have utilized confirmative factor analyses in community-dwelling older adults, regardless of health conditions. Thus, this study aimed to examine the psychometric properties of HADS in older adults 70 + living at home in a large Norwegian city. METHODS In total, 1190 inhabitants ≥ 70 (range 70 - 96) years completed the HADS inventory in the population-based Trøndelag Health Study (HUNT), termed "HUNT4 70 + " in Trondheim, Norway. Confirmatory factor analyses were performed to test the dimensionality, reliability, and construct validity. RESULTS The original two-factor-solution (Model-1) revealed only partly a good fit to the present data; however, including a cross-loading for item 6D ("I feel cheerful") along with a correlated error term between item 2D ("I still enjoy the things I used to enjoy") and 12D ("I look forward with enjoyment to things") improved the fit substantially. Good to acceptable measurement reliability was demonstrated, and the construct validity was acceptable. CONCLUSIONS The HADS involves some items that are not reliable and valid indicators for the depression construct in this population, especially item 6 is problematic. To improve the reliability and validity of the Norwegian version of HADS, we recommend that essential aspects of depression in older adults should be included.
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Affiliation(s)
- Heidi Emly Sivertsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Anne-Sofie Helvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Linda Gjøra
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Psychiatry, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Gørill Haugan
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
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Saltnes-Lillegård C, Rustøen T, Beitland S, Puntillo K, Hagen M, Lerdal A, Hofsø K. Self-reported symptoms experienced by intensive care unit patients: a prospective observational multicenter study. Intensive Care Med 2023; 49:1370-1382. [PMID: 37812229 PMCID: PMC10622338 DOI: 10.1007/s00134-023-07219-0] [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: 05/30/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE The purpose of this study is to describe the prevalence, intensity and distress of five symptoms in intensive care unit (ICU) patients and to investigate possible predictive factors associated with symptom intensity. METHODS This is a prospective cohort study of ICU patients. A symptom questionnaire (i.e., Patient Symptom Survey) was used to describe the prevalence, intensity and distress of pain, thirst, anxiousness, tiredness, and shortness of breath over seven ICU days. Associations between symptom intensity and possible predictive factors were assessed using the general estimating equation (GEE) model. RESULTS Out of 603 eligible patients, 353 (Sample 2) were included in the present study. On the first ICU day, 195 patients (Sample 1) reported thirst as the most prevalent symptom (66%), with the highest mean intensity score (6.13, 95% confidence interval (CI) [5.7-6.56]). Thirst was the most prevalent (64%) and most intense (mean score 6.05, 95%CI [5.81-6.3]) symptom during seven days in the ICU. Anxiousness was the most distressful (mean score 5.24, 95%CI [4.32-6.15]) symptom on the first day and during seven days (mean score 5.46, 95%CI [4.95-5.98]). During seven days, analgesic administration and sepsis diagnosis were associated with increased thirst intensity. Older age and being mechanically ventilated were associated with decreased pain intensity, and analgesic administration was associated with increased pain intensity. Family visits and female gender were associated with increased intensity of anxiousness and shortness of breath, respectively. CONCLUSIONS Self-reporting ICU patients experienced a high and consistent symptom burden across seven days. Certain variables were associated with the degree of symptom intensity, but further research is required to better understand these associations.
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Affiliation(s)
- Christin Saltnes-Lillegård
- Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
- Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Tone Rustøen
- Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Sigrid Beitland
- Specialised Health Care Services, Quality and Clinical Pathways, Norwegian Directorate of Health, Oslo, Norway
| | - Kathleen Puntillo
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Milada Hagen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Public Health, Oslo Metropolitan University, Oslo, Norway
| | - Anners Lerdal
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Kristin Hofsø
- Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Lovisenberg Diaconal University College, Oslo, Norway
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Schultheis M, Staubach P, Nikolakis G, Schollenberger L, Mauch M, Burckhardt M, Heise M, Zamsheva M, Strobel A, Langer G, Bechara F, Kirschner U, Hennig K, Kunte C, Goebeler M, Grabbe S. A centre-based ambulatory care concept for hidradenitis suppurativa improves disease activity, disease burden and patient satisfaction: results from the randomized controlled EsmAiL trial. Br J Dermatol 2023; 189:170-179. [PMID: 37132470 DOI: 10.1093/bjd/ljad135] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/20/2023] [Accepted: 04/25/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is an inflammatory disease of the inverse skin regions that occurs in young women, in particular, and affects approximately 1% of the population. Outpatient care is often inadequate and usually cannot prevent progression. OBJECTIVES To evaluate in the EsmAiL ('Evaluation eines strukturierten und leitlinienbasierten multmodalen Versorgungskonzepts für Menschen mit Akne inversa') trial whether an innovative care concept can decrease disease activity and burden, and improve patient satisfaction. METHODS EsmAiL was conducted as a two-arm, multicentre, prospective, randomized controlled trial that included 553 adults with HS. Inclusion criteria were a minimum of three inflammatory lesions and at least a moderate impact of the disease on quality of life. The control group (CG) remained under standard care, while patients in the intervention group (IG) were treated according to a trial-specific, multimodal concept. The primary endpoint was the absolute change in International Hidradenitis Suppurativa Severity Score System (IHS4). RESULTS In total, 274 patients were randomized to the IG and 279 to the CG. Altogether, 377 attended the final assessment after 12 months of intervention. Participants in the IG (n = 203) achieved a mean improvement in IHS4 of 9.3 points, while the average decrease in IHS4 in patients in the CG (n = 174) was 5.7 points (P = 0.003). Patients treated under the new care concept also reported a statistically significantly higher decrease in pain, Dermatology Life Quality Index and Hospital Anxiety and Depression Scale scores compared with those in the CG (P < 0.001). Patient satisfaction was also statistically significantly higher in the IG compared with the CG (P < 0.001). CONCLUSIONS The establishment of standardized treatment algorithms in so-called 'acne inversa centres' in the ambulatory setting has a substantial, positive impact on the course of HS and significantly improves patient satisfaction.
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Affiliation(s)
| | | | - Georgios Nikolakis
- Department of Dermatology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Lukas Schollenberger
- Interdisciplinary Centre for Clinical Trials, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Melanie Mauch
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
| | - Marion Burckhardt
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
- Baden-Wuerttemberg Cooperative State University, School of Business and Health, Stuttgart, Germany
| | - Marcus Heise
- Institute for Health and Nursing Science
- Institute of General Practice and Family Medicine
- Profile Centre of Health Sciences Halle
| | - Marina Zamsheva
- Institute for Health and Nursing Science
- Profile Centre of Health Sciences Halle
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Alexandra Strobel
- Profile Centre of Health Sciences Halle
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Gero Langer
- Institute for Health and Nursing Science
- Profile Centre of Health Sciences Halle
| | - Falk Bechara
- Department of Dermatology, Venereology, and Allergology, St Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
| | | | - Christian Kunte
- Department of Dermatologic Surgery and Dermatology, Artemed Fachklinik München, Munich, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
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Belza C, Avitzur Y, Ungar WJ, Stremler R, Fehlings D, Wales PW. Stress, anxiety, depression, and health-related quality of life in caregivers of children with intestinal failure receiving parenteral nutrition: A cross-sectional survey study. JPEN J Parenter Enteral Nutr 2023; 47:342-353. [PMID: 36336350 DOI: 10.1002/jpen.2461] [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: 06/22/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Improved survival rates for children with intestinal failure (IF) have resulted in an increased population of children receiving long-term parenteral nutrition (PN). Our objective was to determine burden on caregivers of children with IF receiving long-term PN. METHODS We performed a cross-sectional study of caregivers of children with IF receiving long-term PN in our intestinal rehabilitation program. A healthy comparison group matched on age of the child was enrolled. All participants completed standardized questionnaires, including the Parental Stress Index - Short Form (PSI-SF), Hospital Anxiety and Depression Scale (HADS), and PedsQL Family Impact Module (PedsQL FIM). Univariate analysis was completed using a Student t test and chi-square, with an alpha value of <0.05 considered significant. RESULTS Thirty-eight caregivers of children with IF and 29 caregivers of healthy children consented, with response rates of 89% and 96.5%, respectively. Our study demonstrated increased stress for caregivers compared with comparison parents (PSI-SF total score of 83 [SD = 26.8] vs 62.9 [SD = 13.5]; P < 0.01). Caregivers had increased anxiety (HADS anxiety score of 9.3 [SD = 4.8] vs 6.7 [SD = 3.2]; P = 0.02) and higher depression scores (HADS depression score of 6.3 [SD = 4.3] vs 4.1 [SD = 2.6]; P = 0.02) compared with the comparison group. Caregivers of children with IF demonstrated decreased health-related quality of life (HRQoL) (reduced PedsQL FIM total score of 50.6 [SD = 18.2] vs 84.1 [SD = 20.5]; P < 0.01). CONCLUSIONS Our results demonstrated significant burden of care in caregivers of children with IF receiving long-term PN, with elevated stress, anxiety, and depression and decreased HRQoL.
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Affiliation(s)
- Christina Belza
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Yaron Avitzur
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada.,Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Wendy J Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Canada
| | - Robyn Stremler
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Darcy Fehlings
- Holland Bloorview Rehabilitation Hospital, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Paul W Wales
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Canada.,Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA.,Cincinnati Center of Excellence in Intestinal Rehabilitation (CinCEIR), Cincinnati, Ohio, USA
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Säfström E, Årestedt K, Liljeroos M, Nordgren L, Jaarsma T, Strömberg A. Associations between continuity of care, perceived control and self-care and their impact on health-related quality of life and hospital readmission-A structural equation model. J Adv Nurs 2023; 79:2305-2315. [PMID: 36744677 DOI: 10.1111/jan.15581] [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: 06/13/2022] [Revised: 12/13/2022] [Accepted: 01/20/2023] [Indexed: 02/07/2023]
Abstract
AIM The aim of this study is to examine whether a conceptual model including the associations between continuity of care, perceived control and self-care could explain variations in health-related quality of life and hospital readmissions in people with chronic cardiac conditions after hospital discharge. DESIGN Correlational design based on cross-sectional data from a multicentre survey study. METHODS People hospitalized due to angina, atrial fibrillation, heart failure or myocardial infarction were included at four hospitals using consecutive sampling procedures during 2017-2019. Eligible people received questionnaires by regular mail 4-6 weeks after discharge. A tentative conceptual model describing the relationship between continuity of care, self-care, perceived control, health-related quality of life and readmission was developed and evaluated using structural equation modelling. RESULTS In total, 542 people (mean age 75 years, 37% females) were included in the analyses. According to the structural equation model, continuity of care predicted self-care, which in turn predicted health-related quality of life and hospital readmission. The association between continuity of care and self-care was partly mediated by perceived control. The model had an excellent model fit: RMSEA = 0.06, 90% CI, 0.05-0.06; CFI = 0.90; TLI = 0.90. CONCLUSION Interventions aiming to improve health-related quality of life and reduce hospital readmission rates should focus on enhancing continuity of care, perceived control and self-care. IMPACT This study reduces the knowledge gap on how central factors after hospitalization, such as continuity of care, self-care and perceived control, are associated with improved health-related quality of life and hospital readmission in people with cardiac conditions. The results suggest that these factors together predicted the quality of life and readmissions in this sample. This knowledge is relevant to researchers when designing interventions or predicting health-related quality of life and hospital readmission. For clinicians, it emphasizes that enhancing continuity of care, perceived control and self-care positively impacts clinical outcomes. PATIENT OR PUBLIC CONTRIBUTION People and healthcare personnel evaluated content validity and were included in selecting items for the short version.
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Affiliation(s)
- Emma Säfström
- Nyköping Hospital, Sörmland County Council, Nyköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Centre for Clinical Research SörmlandCentre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,Department of Research, Region Kalmar County, Kalmar, Sweden
| | - Maria Liljeroos
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Centre for Clinical Research SörmlandCentre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Lena Nordgren
- Centre for Clinical Research SörmlandCentre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden
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9
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Bjelkarøy MT, Cheng S, Siddiqui TG, Benth JŠ, Grambaite R, Kristoffersen ES, Lundqvist C. The association between pain and central nervous system depressing medication among hospitalised Norwegian older adults. Scand J Pain 2022; 22:483-493. [PMID: 34913326 DOI: 10.1515/sjpain-2021-0120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/23/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Central nervous system depressant medications (CNSD) including benzodiazepines, z-hypnotics and opioids are regularly prescribed for the older patient. These medications are linked to dependence and associated with severe side effects in some older patients. Consensus recommendations for this group suggest limiting their use. We have recently described a high proportion of long-term CNSD use and dependence among older in-hospital patients. In this study, we aim to investigate factors associated with pain intensity and presentation of pain among older adults with long-term use of CNSDs compared to non-users. METHODS Two hundred and forty six elderly hospitalised patients were recruited consecutively in a cross-sectional study. Data was collected from patients and electronic health records (EHR). Independent variables were sex, age, education, emotional symptoms (hospital anxiety and depression scale [HADS]), cognitive function (Mini-mental State Examination test [MMSE]), comorbidity (cumulative illness rating score - geriatrics [CIRS-G]), loneliness (the six-item De Jong Gierveld Loneliness Scale) and prolonged (≥4 weeks) use of any CNSDs or prolonged use of opioids (≥4 weeks). All variables, including pain intensity, were collected at one time point consistent with the cross-sectional study design. Statistical analyses included descriptive statistics and linear regression models using the above mentioned variables and pain intensity (visual analogue scale for pain intensity [VAS] pain 0-100) as outcome. Additional information regarding pain presentation was extracted from the patients' EHR. RESULTS Mean pain intensity VAS (SD) was 35.2 (30.4) and 18.1 (24.2) respectively, for patients with vs. without prolonged use of CNSDs. In the multivariable linear regression analysis, prolonged use of CNSDs and opioids were positively associated with pain intensity (VAS) (regression coefficient (95% CI) 20.7 (11.0; 30.3), p<0.001, and 19.8 (5.7; 33.8), p=0.006, respectively), while sex, age, education, MMSE, HADS, CIRS-G and loneliness scores were not. Pain related to back (23.2%) and lower extremities (23.2%) were most common pain sites, and those with one or more pain sites reported overall higher pain intensity compared to those with no reported pain sites (p<0.006). CONCLUSIONS Prolonged use of CNSD medications as well as prolonged use of opioids are both positively associated with pain intensity. The results may have implications for treatment and long-term pain management for older patients.
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Affiliation(s)
- Maria Torheim Bjelkarøy
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lorenskog, Norway
| | - Socheat Cheng
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lorenskog, Norway
| | - Tahreem Ghazal Siddiqui
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lorenskog, Norway
| | - Jūratė Šaltytė Benth
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lorenskog, Norway
| | - Ramune Grambaite
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Espen Saxhaug Kristoffersen
- Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lorenskog, Norway
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Christofer Lundqvist
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lorenskog, Norway
- Department of Neurology, Akershus Univeristy Hospital, Lorenskog, Norway
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10
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Siddiqui TG, Bjelkarøy MT, Cheng S, Kristoffersen ES, Grambaite R, Lundqvist C. The effect of cognitive function and central nervous system depressant use on mortality-A prospective observational study of previously hospitalised older patients. PLoS One 2022; 17:e0263024. [PMID: 35239678 PMCID: PMC8893618 DOI: 10.1371/journal.pone.0263024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/10/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Older patients are often users of prolonged Central Nervous System Depressants (CNSD) (Z-hypnotics, benzodiazepines and opioids), which may be associated with reduced cognition. The long-term effects of CNSD use and reduced cognitive function in older patients are unclear. The aim of this study was to examine whether cognitive function and CNSD use at baseline hospitalisation were associated with all-cause mortality two years after discharge. METHODS We conducted a prospective observational study, including baseline data (2017-2018) from previously hospitalised older patients (65-90 years), assessing all-cause mortality two years after discharge. We used logistic regression to assess the primary outcome, all-cause mortality two years after baseline hospitalisation. The primary predictors were cognitive function measured by The Mini Mental State Examination (MMSE) and prolonged CNSD use (continuous use ≥ 4 weeks). Adjustment variables: age, gender, education, the Hospital Anxiety and Depression Scale (HADS) and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), using receiver operating characteristics (ROC) to compare the predictive power of the models. In a sub-analysis we used, the Neurobehavioural Cognitive State Examination (Cognistat) and the Clock Drawing Test. RESULTS Two years after discharge, out of 246 baseline patients, 43 were deceased at follow-up, among these 27 (63%) were CNSD users, and 16 (36%) were non-users at baseline, (p = 0.002). In the multivariable models cognitive function (MMSE score) was a predictor of mortality (OR 0.81 (95% CI 0.69; 0.96), p = 0.014). CNSD use was associated with mortality (OR 2.71 (95% CI 1.06; 6.95), p = 0.038), with ROC AUC: 0.74-0.77 for these models. Results using Cognistat supported the findings. The Clock Drawing Test was not significant predictor of mortality. CONCLUSION Two years after discharge from the hospital, older patients with reduced cognitive function and CNSD use during hospital stay had higher mortality. This underlines that inappropriate (prolonged and concurrent) use of CNSDs should be avoided by older patients, particularly in patients with reduced cognitive function. TRIAL REGISTRATION NCT03162081, 22 May 2017.
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Affiliation(s)
- Tahreem Ghazal Siddiqui
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Maria Torheim Bjelkarøy
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Socheat Cheng
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Espen Saxhaug Kristoffersen
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ramune Grambaite
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Christofer Lundqvist
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
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11
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Schultheis M, Staubach P, Nikolakis G, Grabbe S, Ruckes C, von Stebut E, Kirschner U, Matusiak Ł, Szepietowski JC. LAight® Therapy Significantly Enhances Treatment Efficacy of 16 Weeks of Topical Clindamycin Solution in Hurley I and II Hidradenitis Suppurativa: Results from Period A of RELIEVE, a Multicenter Randomized, Controlled Trial. Dermatology 2021; 238:476-486. [PMID: 34535610 DOI: 10.1159/000518540] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, inflammatory, burdensome skin disease where medical first-line treatment is still limited to long-term, topical and/or systemic antibiotics. The RELIEVE study aimed at evaluating the efficacy of LAight® therapy - a combination of intense pulsed light and radiofrequency - as an adjunct treatment to first-line therapies in Hurley stage I and II HS. METHODS The RELIEVE study was performed as a two-period multicenter randomized controlled trial with blinded assessment. For period A from week 0 to week 16, the 88 participating subjects were randomized into either an intervention group (IG) or a control group (CG). The IG received topical clindamycin 1% solution combined with 8 additional bi-weekly treatments with LAight® therapy. The CG was treated with topical clindamycin 1% solution only. After 16 weeks, patients entered open-label period B and both groups were treated exclusively with LAight® therapy for an additional 16 weeks (8 sessions). The primary efficacy endpoint was the change in International Hidradenitis Suppurativa Score System (∆IHS4) at week 16 to baseline. Secondary endpoints were DLQI, HiSCR, Pain-NRS, and HADS. RESULTS In total, from the 88 patients enrolled in RELIEVE, 81 patients were included in the endpoint analysis after period A. After 16 weeks of treatment, the ∆IHS4 of the group treated with the combination of LAight® therapy and topical clindamycin 1% solution was -7.2 ± 6.7 (-60.0%), which was significantly higher in magnitude than the ∆IHS4 in the group treated with clindamycin 1% solution alone (-1.8 ± 5.6, -17.8%, p < 0.001). Secondary endpoints, including other clinical scores as well as patient-reported outcomes, confirmed that the efficacy of the combined treatment was superior to monotherapy. CONCLUSION The results of the primary endpoint analysis of period A of the RELIEVE study show that the combined therapy with LAight® and topical clindamycin 1% solution, resulted in a significantly higher decrease in disease severity and an improvement of quality of life in comparison to topical clindamycin 1% solution monotherapy. Treatment was well tolerated, and side effects were all mild and transitory. These data speak for the implementation of the combined treatment as a first-line therapy in Hurley stage I and II HS. LAight® therapy as long-term monotherapy (results from period B), will be analyzed in a consecutive paper.
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Affiliation(s)
- Michael Schultheis
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Christian Ruckes
- Interdisciplinary Centre for Clinical Studies, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Esther von Stebut
- Department of Dermatology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
| | - Łukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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12
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Grund S, Kilb M, Breitinger E, Hundsdörfer W, Schäfer HG, Schols JMGA, Gordon AL, Bauer JM, Alpers GW. Evaluation of a new screening instrument for psychological distress in postacute rehabilitation in older person. Eur Geriatr Med 2021; 13:243-251. [PMID: 34510385 DOI: 10.1007/s41999-021-00554-9] [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: 02/03/2021] [Accepted: 08/11/2021] [Indexed: 05/31/2023]
Abstract
PURPOSE Although psychological distress has a negative impact on functional recovery, institutionalisation and mortality rates, there is typically no established procedure to screen for psychological distress in geriatric rehabilitation. The aim of the study was to evaluate a brief single-item Verbal Numerical Rating Scale (VNRS-PD) as a screening tool for psychological distress in multimorbid geriatric rehabilitation patients. METHODS In this cross-sectional study, N = 132 geriatric rehabilitation in-patients (M = 82 years old; 70.5% female) completed a verbal numerical rating scale (VNRS-PD) on satisfaction with their mood as well as the Hospital Anxiety and Depression Scale (HADS) and the short-form of the Geriatric Depression Scale (GDS). Based on the questionnaire data, the rehabilitation patients were classified as high or low in psychopathology. Using receiver-operating characteristic (ROC) curve analysis, optimal cutoff scores of the VNRS-PD were calculated for each questionnaire to detect significant psychological distress. RESULTS Between 28.8% (HADS ≥ 18) and 43.9% (GDS ≥ 6) of the sample had above-cutoff questionnaire scores. The area under the curve (AUC) of the VNRS-PD varied from 0.785 (95%-CI 0.709-0.861) (GDS ≥ 6) and 0.790 (95%-CI 0.716-0.864) (HADS ≥ 18) to 0.807 (95%-CI 0.734-0.880) (GDS ≥ 7). A score of ≤ 5 in the VNRS-PD proved to be the cutoff with an optimal trade-off between sensitivity (0.776-0.867) and specificity (0.638-0.703). CONCLUSION The VNRS-PD may be a suitable screening instrument to detect patients with psychological distress in inpatient geriatric rehabilitation for and to initiate further diagnostics within a graduated psychodiagnostic scheme. This first step may help to identify older patients with psychological distress and mental disorders, to initiate targeted interventions. Further research is needed to replicate these findings in a larger sample.
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Affiliation(s)
- Stefan Grund
- Department of Geriatrics and Geriatric Rehabilitation, Center for Geriatric Medicine, Agaplesion Bethanien Krankenhaus Heidelberg, University of Heidelberg, Heidelberg, Germany.
| | - Michael Kilb
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Eva Breitinger
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Wilfried Hundsdörfer
- Diakonissen Hospital Mannheim Department of Geriatric Rehabilitation, Mannheim, Germany
| | - Hans G Schäfer
- Diakonissen Hospital Mannheim Department of Geriatric Rehabilitation, Mannheim, Germany
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK.,School of Health Sciences, City University of London, London, UK
| | - Jürgen M Bauer
- Department of Geriatrics and Geriatric Rehabilitation, Center for Geriatric Medicine, Agaplesion Bethanien Krankenhaus Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Georg W Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
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13
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Frailty related all-cause mortality or hospital readmission among adults aged 65 and older with stage-B heart failure inpatients. BMC Geriatr 2021; 21:125. [PMID: 33593292 PMCID: PMC7885474 DOI: 10.1186/s12877-021-02072-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frailty increases the adverse outcomes of clinical heart failure; however, the relationship between frailty and stage-B heart failure (SBHF) remains unknown. We aimed to explore the epidemiology and predictive value of frailty in older adults with SBHF. METHODS A prospective cohort of SBHF inpatients aged 65 years or older who were hospitalized between September 2018 and February 2019 and were followed up for 6 months were included. SBHF was defined as systolic abnormality, structural abnormality (left ventricular enlargement, left ventricular hypertrophy, wall motion abnormalities, valvular heart disease), or prior myocardial infarction. Frailty was assessed by the Fried frailty phenotype. Multivariable Cox proportional hazards regression was used to explore the independent risk and prognostic factors. RESULTS Data of 443 participants (age: 76.1 ± 6.79 years, LVEF: 62.8 ± 4.92%, men: 225 [50.8%], frailty: 109 [24.6%]) were analyzed. During the 6-month follow-up, 83 (18.7%) older SBHF inpatients experienced all-cause mortality or readmission, and 29 (6.5%) of them developed clinical HF. Frail individuals had a 1.78-fold (95%CI: 1.02-3.10, P = 0.041) higher risk of 6-month mortality or readmission and a 2.83-fold (95%CI 1.24-6.47, P = 0.014) higher risk of developing clinical HF, independent of age, sex, left ventricular ejection fraction, and N-terminal pro-B-type natriuretic peptide level. CONCLUSIONS Frailty is common in older SBHF inpatients and should be considered to help identify individuals with an increased risk of mortality or readmission, and developing clinical HF. TRIAL REGISTRATION ChiCTR1800017204 .
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14
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Deng Y, He S, Wang J. Validation of the Hospital Anxiety and Depression Scale and the Perceived Stress Scale and psychological features in patients with periodontitis. J Periodontol 2021; 92:1601-1612. [PMID: 33386608 DOI: 10.1002/jper.20-0756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/09/2020] [Accepted: 12/20/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND To investigate the psychometric properties of the Hospital Anxiety and Depression Scale (HADS) and 10-item Perceived Stress Scale (PSS-10) in patients with periodontitis and to evaluate the psychological features of patients with periodontitis. METHODS Overall, 460 individuals with periodontitis were enrolled. The HADS and the PSS-10 were administered to all patients. Methodology testing included the exploratory factor analysis, the confirmatory factor analysis (CFA), test-retest reliability, as well as internal consistency. RESULTS Regarding the CFA results of the HADS, as well as the PSS-10, a bifactor model fitted the data best. The Cronbach alpha value, as well as the intra-class correlation coefficients value of the two measures were all >0.70. The anxiety, depression, distress manifestations, and moderate-to-high perceived stress prevalence were 35.2%, 18.2%, 24.6%, and 43.9%, respectively. Severity of periodontitis, age, smoking, and disease comorbidities were identified as independent prognosticators of the presence of psychological manifestations in periodontitis. CONCLUSION The HADS and the PSS-10 can be used as general measures for psychological assessment in patients with periodontitis.
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Affiliation(s)
- Yongmei Deng
- College of Stomatology, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Songlin He
- College of Stomatology, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jinhua Wang
- College of Stomatology, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
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15
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Yao S, Zheng P, Ji L, Ma Z, Wang L, Qiao L, Wan Y, Sun N, Luo Y, Yang J, Wang H. The effect of comprehensive assessment and multi-disciplinary management for the geriatric and frail patient: A multi-center, randomized, parallel controlled trial. Medicine (Baltimore) 2020; 99:e22873. [PMID: 33181655 PMCID: PMC7668452 DOI: 10.1097/md.0000000000022873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A comprehensive geriatric assessment (CGA) of elderly patients is useful for detecting the patients vulnerabilities. Exercise and early rehabilitation, nutritional intervention, traditional Chinese medicine (TCM), standardized medication guidance, and patient education can, separately, improve and even reverse the physical frailty status. However, the effect of combining a CGA and multi-disciplinary management on frailty in elderly patients remains unclear. The present study assessed the effects of a CGA and multi-disciplinary management on elderly patients with frailty in China. METHODS In this study, 320 in patients with frailty ≥70 years old will be randomly divided into an intervention group and a control group. The intervention group will be given routine management, a CGA and multi-disciplinary management involving rehabilitation exercise, diet adjustment, multi-drug evaluation, acupoint massage in TCM and patient education for 12 months, and the control group will be followed up with routine management for basic diseases. The primary outcomes are the Fried phenotype and short physical performance battery (SPPB). The secondary outcomes are the clinical frailty scale (CFS), non-elective hospital readmission, basic activities of daily living (BADL), 5-level European quality of life 5 dimensions index (EQ-5D), nutrition risk screening-2002 (NRS-2002), medical insurance expenses, fall events, and all-cause mortality. In addition, a cost-effectiveness study will be carried out. DISCUSSION This paper outlines the protocol for a randomized, single-blind, parallel multi-center clinical study. This protocol, if beneficial, will demonstrate the interaction of various intervention strategies, will help improve elderly frailty patients, and will be useful for clinicians, nurses, policymakers, public health authorities, and the general population. TRIAL REGISTRATION Chinese Clinical Trials Register, ChiCTR1900022623. Registered on April 19, 2019, http://www.chictr.org.cn/showproj.aspx?proj=38141.
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Affiliation(s)
- Simin Yao
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
- Peking University Fifth School of Clinical Medicine, Dong Dan, Beijing
| | - Peipei Zheng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
- Peking University Fifth School of Clinical Medicine, Dong Dan, Beijing
| | | | - Zhao Ma
- Department of Rehabilitation
| | | | - Linlin Qiao
- Department of TCM, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China
| | - Yuhao Wan
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
| | - Ning Sun
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
| | - Yao Luo
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
| | - Jiefu Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
| | - Hua Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
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16
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van de Ree CLP, de Munter L, Biesbroeck BHH, Kruithof N, Gosens T, de Jongh MAC. The prevalence and prognostic factors of psychological distress in older patients with a hip fracture: A longitudinal cohort study. Injury 2020; 51:2668-2675. [PMID: 32741607 DOI: 10.1016/j.injury.2020.07.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/01/2020] [Accepted: 07/24/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION A hip fracture can be experienced as a traumatic event that can induce psychological distress. The aim of this study is to give more insight into the prevalence of symptoms of psychological distress in older patients following the first year after a hip fracture. In addition, prognostic factors were determined for psychological distress after hip fracture. MATERIALS AND METHODS This hip fracture cohort data was derived from the Brabant Injury Outcome Surveillance, a multicenter longitudinal prospective cohort study. Hip fracture patients (≥65years) admitted to a hospital between August 2015 and November 2016 were asked to complete a questionnaire at 1 week, and 1, 3, 6 and 12 months. The Hospital Anxiety and Depression Scale (HADS) was used to assess symptoms of anxiety and depression and the Impact of Event Scale (IES) was used to assess symptoms of posttraumatic stress (PTS). Prognostic factors were assessed with multivariable logistic mixed models. RESULTS In total 570 patients (inclusion rate: 69.7%) were included. The prevalence of psychological distress ranged from 36% at 1 week to 31% at 1 year after hip fracture. Frailty at onset of hip fracture was the most important prognostic factor of symptoms of depression (Odds ratio (OR), 2.74; 95% Confidence interval (CI) 1.41 to 5.34) and anxiety (OR, 2.60; 95% CI 1.15 to 5.85) on average in the year following hip fracture. Frailty was not a prognostic factor of symptoms of PTS (OR, 1.97; 95% CI 0.42 to 9.23). CONCLUSIONS The prevalence of psychological distress is high in the first year after a hip fracture. Frailty at onset of a hip fracture is the most important prognostic factor of symptoms of depression and anxiety. These findings have important implications for strategies with early identification of frail patients with a hip fracture at high risk of psychological distress.
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Affiliation(s)
- C L P van de Ree
- Department Trauma TopCare, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands.
| | - L de Munter
- Department Trauma TopCare, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands
| | - B H H Biesbroeck
- Department Trauma TopCare, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands
| | - N Kruithof
- Department Trauma TopCare, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands
| | - T Gosens
- Department Trauma TopCare, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands; Department of Orthopaedic Surgery, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - M A C de Jongh
- Department Trauma TopCare, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands; Brabant Trauma Registry, Network Emergency Care Brabant, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
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Cheng S, Siddiqui TG, Gossop M, Stavem K, Kristoffersen ES, Lundqvist C. Health-related quality of life in hospitalized older patients with versus without prolonged use of opioid analgesics, benzodiazepines, and z-hypnotics: a cross-sectional study. BMC Geriatr 2020; 20:425. [PMID: 33096993 PMCID: PMC7585301 DOI: 10.1186/s12877-020-01838-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Central nervous system depressant medications (CNSDs) such as opioid analgesics and sedative-hypnotics are commonly prescribed to older patients for the treatment of chronic pain, anxiety and insomnia. Yet, while many studies reported potential harms, it remains unknown whether persistent use of these medications is beneficial for older patients' self-reported health-related quality of life (HRQoL). The present study clarified this knowledge gap through comparing HRQoL of hospitalized older patients with versus without using CNSD drugs for ≥4 weeks. Moreover, we explored the relationship between such use and HRQoL, adjusting for the effects of polypharmacy, comorbidity burden and other clinically relevant covariates. METHODS The study was cross-sectional and included 246 older patients recruited consecutively from somatic departments of a large regional university hospital in Norway. We defined prolonged CNSD use as using opioids, benzodiazepines and/or z-hypnotics for ≥4 weeks. Patients' self-reported HRQoL were measured with scales of the EuroQol EQ-5D-3L instrument. Data analyses were mainly descriptive statistics and regression models. RESULTS Patients with prolonged use of CNSDs reported lower scores on both EQ-5D index and EQ VAS compared with those without such use (p < 0.001). They had higher odds of having more problems performing usual activities (OR = 3.37, 95% CI: 1.40 to 8.13), pain/discomfort (OR = 2.06, 95% CI: 1.05 to 4.04), and anxiety/depression (OR = 3.77, 95% CI: 1.82 to 7.82). In multivariable regression models, there was no significant association between prolonged CNSD use and HRQoL when including pain as a predictor variable. In models not including pain, CNSD use was strongly associated with HRQoL (adjusted for sociodemographic background, polypharmacy, comorbidity, anxiety and depressive symptoms, regression coefficient - 0.19 (95% CI, - 0.31 to - 0.06). CONCLUSIONS Older patients with prolonged CNSD use reported poorer HRQoL. They also had more pain and higher depression scores. Prolonged use of CNSDs was not independently associated with higher HRQoL.
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Affiliation(s)
- Socheat Cheng
- Health Services Research Unit (HØKH), Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway. .,Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lørenskog, Norway.
| | - Tahreem Ghazal Siddiqui
- Health Services Research Unit (HØKH), Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lørenskog, Norway
| | - Michael Gossop
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Knut Stavem
- Health Services Research Unit (HØKH), Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lørenskog, Norway.,Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Espen Saxhaug Kristoffersen
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Christofer Lundqvist
- Health Services Research Unit (HØKH), Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lørenskog, Norway.,Department of Neurology, Akershus University Hospital, Lørenskog, Norway
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18
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Lodhi FS, Elsous AM, Irum S, Khan AA, Rabbani U. Psychometric properties of the Urdu version of the Hospital Anxiety and Depression Scale (HADS) among pregnant women in Abbottabad, Pakistan. Gen Psychiatr 2020; 33:e100276. [PMID: 32914057 PMCID: PMC7449272 DOI: 10.1136/gpsych-2020-100276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/16/2020] [Accepted: 07/02/2020] [Indexed: 12/23/2022] Open
Abstract
Background The Hospital Anxiety and Depression Scale (HADS) is a widely used instrument to measure anxiety and depression symptoms. Aims This study aimed to translate, validate and test the applicability of the Urdu version of the Hospital Anxiety and Depression Scale (HADS/UV) among pregnant women. Methods The original English version of the HADS was translated into Urdu by three bilingual experts and retranslated to English using the forward–backward approach. The questionnaire was administered to a sample of 200 pregnant women availing obstetrics and gynaecology services for routine prenatal check-ups of Ayub Teaching Hospital, Abbottabad, Pakistan. Psychometric properties of the instrument, including reliability (internal consistency, test–retest analysis and interitems correlation), were tested. Face and content validity were also assessed. Content Validity Index (CVI) was determined using the average approach and Item-Level Content Validity Index (I-CVI) and Scale-Level Content Validity Index (S-CVI) were calculated accordingly. Construct validity was examined through exploratory factor analysis. Results Cronbach’s alpha coefficient has been found to be 0.82 for the anxiety subscale and 0.64 for the depression subscale, while overall alpha of the HADS/UV is 0.84. The Urdu version is content valid, and the S-CVI of anxiety subscale, depression subscale and HADS/UV are 0.947, 948 and 0.947, respectively. Test–retest reliability is 0.884 and 0.934 as measured by Pearson correlation and intraclass correlation, respectively. HADS/UV items correlated positively with the whole scale (p<0.001). Factor analysis with varimax rotation revealed that two factors explained 42.75% of the variance. Items’ distribution was quite similar to the original HADS. Conclusion The HADS/UV is a psychometrically sound instrument with satisfactory measurement, including good internal consistency. The instrument shows promise to be a sound tool to assess anxiety and depression in pregnancy.
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Affiliation(s)
- Fahad Saqib Lodhi
- Community Medicine Department, Women Medical College, Abbottabad, Pakistan.,School of public Health, Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Aymen M Elsous
- Unit of Planning and Policy Formulation, Ministry of Health, Gaza Strip, Palestine.,Assistant professor, College of medical sciences, Israa university, Gaza strip, Palestine
| | - Saadia Irum
- Department of Gynecology and Obstetrics, Ayub Medical College, Abbottabad, Pakistan
| | - Adeel Ahmed Khan
- Ministry of Health, Saudi Board Preventive Medicine, Mecca, Saudi Arabia
| | - Unaib Rabbani
- Ministry of Health, Family Medicine Academy, Qassim, Saudi Arabia
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19
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Siddiqui TG, Cheng S, Gossop M, Kristoffersen ES, Grambaite R, Lundqvist C. Association between prescribed central nervous system depressant drugs, comorbidity and cognition among hospitalised older patients: a cross-sectional study. BMJ Open 2020; 10:e038432. [PMID: 32718926 PMCID: PMC7389767 DOI: 10.1136/bmjopen-2020-038432] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Central nervous system depressants (CNSDs) such as opioids, benzodiazepine and Z-hypnotics are commonly used. However, CNSDs may influence cognitive function, especially in older hospitalised patients with comorbidities. The aim was to examine the association between CNSD use and cognitive function in older patients. We assessed global and domain specific cognitive function, among hospitalised older patients, including covariates for comorbidity, anxiety and depression. DESIGN Cross-sectional hospital-based study. SETTINGS Data was collected consecutively from inpatients at somatic wards of a general university hospital. PARTICIPANTS Older patients between 65 and 90 years with/without CNSD use for ≥4 weeks. OUTCOME MEASURES The main outcome was cognitive function assessed by Cognistat. Secondary outcomes were routine clinical tests in the wards (mini-mental state examination (MMSE), trail making test (TMT) A and B, and clock drawing tests). Analyses were bivariate and multiple linear regression, adjusted for age, gender, and education. Covariates were comorbidity, depression and anxiety scores. RESULTS The main result indicated that CNSD users (n=100) had (β=-3.4, 95% CI 6.27 to -0.58, p=0.017) lower Cognistat score than non-users (n=146), adjusted for age, gender, education, anxiety and depression, but not significant when including covariate for comorbidity (β= -2.50 - 5.45; -0.46, p=0.097). Comorbidity was associated with cognitive function (β=-0.77, 95% CI -1.22 to -0.14, p=0.014). Cognistat subdimensions associated with CNSD use were language (p=0.017) and calculation (p=0.003). In clock drawing test, users had lower scores than non-users (β=-0.80, 95% CI 1.24 to -0.36, p=0.004), but no significant difference was found with MMSE and TMT A or B. Z-hypnotics were associated with reduced cognitive function. CONCLUSION Among older hospitalised patients, global cognition and specific cognitive functions were associated with long-term use of CNSD medication as well as with somatic comorbidity. TRIAL REGISTRATION NUMBER NCT03162081, 22 May 2017.
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Affiliation(s)
- Tahreem Ghazal Siddiqui
- Health Services Research Unit (HØKH), Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Socheat Cheng
- Health Services Research Unit (HØKH), Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Michael Gossop
- Centre for Addiction Research, King's College London, London, UK
| | - Espen Saxhaug Kristoffersen
- Health Services Research Unit (HØKH), Akershus University Hospital, Lorenskog, Norway
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ramune Grambaite
- Health Services Research Unit (HØKH), Akershus University Hospital, Lorenskog, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Christofer Lundqvist
- Health Services Research Unit (HØKH), Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurology, Akershus University Hospital, Lorenskog, Norway
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20
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Park J, Tolea M, Besser L, Galvin J. Intention to Be Screened for Alzheimer's Disease in Nondemented Older Adults: Integrated Behavioral Model and Self-Efficacy as Mediation Effect. JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 2020; 30:778-796. [PMID: 33364731 PMCID: PMC7751942 DOI: 10.1080/10911359.2020.1752349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The study explored factors associated with intention to be screened for Alzheimer's disease (AD). The study also examined whether self-efficacy mediates the relationship between knowledge about screening and the intention to be screened for AD. A population-based, random-digit dialing survey was performed and 1,043 responses were collected from a sample of nondemented persons (50 years or older) living in urban, suburban, and rural areas in a Midwestern state. The findings showed that participants who were younger and who had higher levels of (a) perceived benefits and barriers, (b) social support, and (c) self-efficacy reported higher levels of intention to be screened for AD. Older adults with positive life orientation reported greater intention to be screened for AD, whereas depressed participants were more likely to report a plan to be screened for AD. Self-efficacy mediated the relationship between knowledge about screening and intention to be screened. Older adults were more likely to report intention to be screened when they had positive attitudes about the screen and believed that they could receive the screen. The intention to be screened for AD could serve public awareness by defining effective ways to assist older adults to seek a cognitive screen.
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Affiliation(s)
- Juyoung Park
- Phyllis and Harvey Sandler School of Social Work, Florida Atlantic University
| | - Magdalena Tolea
- University of Miami, Miller School of Medicine, Department of Neurology
| | - Lilah Besser
- School of Urban & Regional Planning, Florida Atlantic University
| | - James Galvin
- University of Miami, Miller School of Medicine, Department of Neurology
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21
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Park J, Tolea MI, Sherman D, Rosenfeld A, Arcay V, Lopes Y, Galvin JE. Feasibility of Conducting Nonpharmacological Interventions to Manage Dementia Symptoms in Community-Dwelling Older Adults: A Cluster Randomized Controlled Trial. Am J Alzheimers Dis Other Demen 2020; 35:1533317519872635. [PMID: 31533443 PMCID: PMC10623920 DOI: 10.1177/1533317519872635] [Citation(s) in RCA: 18] [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
This study assessed the feasibility of conducting 3 nonpharmacological interventions with older adults in dementia, exploring the effects of chair yoga (CY), compared to music intervention (MI) and chair-based exercise (CBE) in this population. Using a cluster randomized controlled trial (RCT), 3 community sites were randomly assigned 1:1:1 to CY, MI, or CBE. Participants attended twice-weekly 45-minute sessions for 12 weeks. Thirty-one participants were enrolled; 27 safely completed the interventions and final data collection (retention rate of 87%). Linear mixed modeling was performed to examine baseline and longitudinal group differences. The CY group improved significantly in quality of life compared to the MI group (CY mean = 35.6, standard deviation [SD] = 3.8; MI mean = 29.9, SD = 5.3, P = .010). However, no significant group differences were observed in physical function, behavioral, or psychological symptoms (eg, for mini-PPT: slopetime = 0.01, standard error [SE] = 0.3, P = .984 in the CBE group; slopetime = -0.1, SE = 0.3, P = .869 in the MI group; slopetime = -0.3, SE = 0.3, P = .361 in the CY group) over the 12-week intervention period. Overall, this pilot study is notable as the first cluster RCT of a range of nonpharmacological interventions to examine the feasibility of such interventions in older adults, most with moderate-to-severe dementia. Future clinical trials should be conducted to examine the effects of nonpharmacological interventions for older adults with dementia on health outcomes.
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Affiliation(s)
- Juyoung Park
- Phyllis and Harvey Sandler School of Social Work, Florida Atlantic University, Boca Raton, FL, USA
| | - Magdalena I. Tolea
- Comprehensive Center for Brain Health, Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Diane Sherman
- Phyllis and Harvey Sandler School of Social Work, Florida Atlantic University, Boca Raton, FL, USA
| | - Amie Rosenfeld
- Comprehensive Center for Brain Health, Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Victoria Arcay
- Phyllis and Harvey Sandler School of Social Work, Florida Atlantic University, Boca Raton, FL, USA
| | - Yve Lopes
- Phyllis and Harvey Sandler School of Social Work, Florida Atlantic University, Boca Raton, FL, USA
| | - James E. Galvin
- Comprehensive Center for Brain Health, Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
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22
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Tedgård E, Tedgård U, Råstam M, Johansson BA. Parenting stress and its correlates in an infant mental health unit: a cross-sectional study. Nord J Psychiatry 2020; 74:30-39. [PMID: 31553257 DOI: 10.1080/08039488.2019.1667428] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: An infant's development is closely linked to the relationship they have with their parents. Parenting stress, affective disorder, and an upbringing with substance-abusing parents can affect parenting quality and increase the risk of children developing behavioral, mental and social problems. The overall aim of the study was to investigate how parents of children attending an outpatient Infant Mental Health (IMH) unit rate their own psychological health and parenting stress, and to explore predictors of parenting stress.Methods: The sample comprised 197 parents, 129 mothers and 68 fathers, referred with their infant/toddler to an outpatient IMH unit for interplay treatment. On admission, the parents completed self-report questionnaires concerning their own mental health problems and parenting stress.Results: The mothers reported significantly more psychiatric symptoms and parenting stress than the fathers. Fathers with substance-abusing parents had often experienced divorce in the family of origin, had a low level of education, and had often experienced trauma. Depression was a predictor for parenting stress for both mothers and fathers.Conclusion: The parents' situation was strained, presenting a variety of psychiatric symptoms and high levels of parenting stress, making assessment of parental health before starting treatment important. The mothers' situations were more serious compared with the fathers', and for both parents depression was a significant predictor for parenting stress. To increase the chances of a positive treatment outcome for the child, both parents should be included in the treatment.
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Affiliation(s)
- Eva Tedgård
- Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden.,Child and Adolescent Psychiatry, Infant and Toddler Unit, Skåne University Hospital, Malmö, Sweden
| | - Ulf Tedgård
- Department of Pediatric Hematology and Oncology, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences Lund, Pediatrics, Lund University, Lund, Sweden
| | - Maria Råstam
- Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden.,Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Björn Axel Johansson
- Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden.,Child and Adolescent Psychiatry, Regional Inpatient Care, Emergency Unit, Skåne University Hospital, Malmö, Sweden
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23
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Cheng S, Siddiqui TG, Gossop M, Kristoffersen ES, Lundqvist C. Sociodemographic, clinical and pharmacological profiles of medication misuse and dependence in hospitalised older patients in Norway: a prospective cross-sectional study. BMJ Open 2019; 9:e031483. [PMID: 31492795 PMCID: PMC6731874 DOI: 10.1136/bmjopen-2019-031483] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/20/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Timely recognition of medication misuse and dependence is crucial to avoid both adverse drug events and increasing health expenditure. Yet the detection of these disorders in older people remains challenging due to the paucity of evidence on characteristics of patients at risk. This study investigates sociodemographic, pharmacological and clinical characteristics and factors associated with prolonged medication use, misuse and dependence in hospitalised older patients, focusing on three commonly prescribed central nervous system depressants (CNSDs): opioid analgesics, benzodiazepines and z-hypnotics. DESIGN A prospective, cross-sectional study complying with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. SETTING Somatic departments of the Akershus University Hospital, Norway. PARTICIPANTS 246 patients aged 65-90 were included. OUTCOME MEASURES Prolonged use was defined as using CNSDs for ≥4 weeks. Misuse and dependence were assessed with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for substance abuse and dependence. We used descriptive statistics to report patients' characteristics and logistic regression to demonstrate factors associated with prolonged use, and misuse or dependence. RESULTS Forty per cent of participants reported using CNSDs for ≥4 weeks. The odds of prolonged use were higher for patients aged 75-84 (OR=2.32, 95% CI 1.16 to 4.65) and ≥85 (OR=3.33, 95% CI 1.25 to 8.87) vs <75 years, for pain intensity (OR=1.02, 95% CI 1.01 to 1.04), and polypharmacy versus no polypharmacy (OR=5.16, 95% CI 2.13 to 12.55). The odds were lower for patients who completed secondary education (OR=0.33, 95% CI 0.13 to 0.83) compared with those with only basic education. Factors associated with misuse or dependence were pain intensity (OR=1.02, 95% CI 1.01 to 1.04) and concurrent use of ≥2 CNSDs (OR=3.99, 95% CI 1.34 to 11.88). CONCLUSION CNSD overuse is prevalent among hospitalised older patients, despite clear guidelines and recommendations. Our findings underline a need for stronger focus on responsible prescribing, timely detection and prevention of this issue, with special attention towards older patients, those with enhanced pain, polypharmacy and/or concurrent use of several CNSDs. TRIAL REGISTRATION NUMBER NCT03162081.
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Affiliation(s)
- Socheat Cheng
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Tahreem Ghazal Siddiqui
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Michael Gossop
- National Addiction Centre, King's College, London, United Kingdom
| | - Espen Saxhaug Kristoffersen
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Christofer Lundqvist
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
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24
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Eriksen S, Bjørkløf GH, Helvik AS, Larsen M, Engedal K. The validity of the hospital anxiety and depression scale and the geriatric depression scale-5 in home-dwelling old adults in Norway ✰. J Affect Disord 2019; 256:380-385. [PMID: 31212233 DOI: 10.1016/j.jad.2019.05.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/20/2019] [Accepted: 05/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the validity of the Norwegian versions of the Geriatric Depression Scale-5 (GDS-5) and the Hospital Anxiety and Depression Scale-D (HADS-D). The aim of this study was therefor to validate the two assessment tools in a population of home-dwelling persons of 60 years of age and above. METHODS A sample of 194 home-dwelling old adults with and without depressive symptoms were recruited. The participants were examined for depressive symptoms (GDS-5, HADS-D) and cognitive impairment. Sociodemographic information was collected. The participants underwent a blinded diagnostic evaluation for a depressive episode according to the diagnostic criteria of ICD-10. RESULTS In all, 56 (28.9%) participants fulfilled criteria for a depressive episode according to ICD-10. The Receiver Operating Characteristics analyses of HAD-D and GDS-5 using the diagnostic criteria of ICD-10 for depression as gold standard was performed. For GDS-5 the Areal under the Curve was 0.81 and for HAD-D 0.75. The cut-off points of the measures that produced the highest accuracies were ≥2 for GDS-5 with a sensitivity of 73.2% and a specificity of 73.2% and ≥4 for HADS-D with a sensitivity of 70.3% and a specificity of 69.6%. LIMITATIONS A larger sample would have given the opportunity for analyzing home dwelling old adults with and without home health care separately. The participants were talked through the self-filling questionnaires. The procedure could have influenced the participants' answers. CONCLUSION GDS-5 and HADS-D are useful screening tools for old adults, but only fairly good to identify depression according to criteria of ICD-10.
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Affiliation(s)
- S Eriksen
- Norwegian National Advisory Unit on Ageing and Health, Postboks 2136, N-3103 Tønsberg, Norway.
| | - G H Bjørkløf
- Norwegian National Advisory Unit on Ageing and Health, Postboks 2136, N-3103 Tønsberg, Norway
| | - A-S Helvik
- Norwegian National Advisory Unit on Ageing and Health, Postboks 2136, N-3103 Tønsberg, Norway; Department of Public Health and General Practice, Norwegian University of Science and Technology, Postboks 8905, N-7491 Trondheim, Norway
| | - M Larsen
- Department of Geriatric Psychiatry, Diakonhjemmet, Oslo, Postboks 23, Vinderen, N-0319 Oslo, Norway
| | - K Engedal
- Norwegian National Advisory Unit on Ageing and Health, Postboks 2136, N-3103 Tønsberg, Norway
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25
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The effect of anxiety on cognition in older adult inpatients with depression: results from a multicenter observational study. Heliyon 2019; 5:e02235. [PMID: 31497664 PMCID: PMC6722253 DOI: 10.1016/j.heliyon.2019.e02235] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/06/2019] [Accepted: 08/01/2019] [Indexed: 11/23/2022] Open
Abstract
Late-life depression is associated with reduced cognitive function beyond normal age-related cognitive deficits. As comorbid anxiety frequently occur in late-life depression, this study aimed to examine the association between anxiety symptoms and cognitive function among older inpatients treated for depression. We hypothesized that there would be an overall additive effect of comorbid anxiety symptoms on dysfunction across cognitive domains. The study included 142 patients treated for late-life depression in hospital, enrolled in the Prognosis of Depression in the Elderly study. Anxiety symptoms were measured at admission using the anxiety subscale of the Hospital Anxiety and Depression Scale. Patients completed cognitive tasks at admission and discharge. Linear mixed and generalized linear mixed models were estimated to investigate the effect of anxiety, on continuous and categorical cognitive scores, respectively, while controlling for depression. Anxiety severity at admission was not associated with performance in any of the cognitive domains. Patients with more symptoms of anxiety at admission demonstrated a significant improvement in immediate recall during the hospital stay. Patients with a score above cutoff indicating clinically significant symptoms on the anxiety subscale performed better on general cognitive function, as measured by the Mini Mental Status Examination at admission, than those below cutoff for anxiety. In conclusion, comorbid anxiety symptoms had no additive effect on cognitive dysfunction in late-life depression in our sample of inpatients.
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26
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Creighton AS, Davison TE, Kissane DW. The psychometric properties, sensitivity and specificity of the geriatric anxiety inventory, hospital anxiety and depression scale, and rating anxiety in dementia scale in aged care residents. Aging Ment Health 2019; 23:633-642. [PMID: 29470096 DOI: 10.1080/13607863.2018.1439882] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Limited research has been conducted into the identification of a valid and reliable screening measure for anxiety in aged care settings, despite it being one of the most common psychological conditions. This study aimed to determine an appropriate anxiety screening tool for aged care by comparing the reliability and validity of three commonly used measures and identifying specific cut-offs for the identification of generalized anxiety disorder (GAD). METHOD One-hundred and eighty nursing home residents (M age = 85.39 years) completed the GAI, HADS-A, and RAID, along with a structured diagnostic interview. RESULTS Twenty participants (11.1%) met DSM-5 criteria for GAD. All measures had good psychometric properties , although reliability estimates for the HADS-A were sub-optimal. Privileging sensitivity , the GAI cut-off score of 9 gave sensitivity of 90.0% and specificity of 86.3%; HADS-A cut-off of 6 gave sensitivity of 90.0% and specificity of 80.6%; and RAID cut-off of 11 gave sensitivity of 85.0% and specificity of 72.5%. CONCLUSION While all three measures had adequate reliability, validity, and cut-scores with high levels of sensitivity and specificity to detect anxiety within aged care, the GAI was the most consistently reliable and valid measure for screening for GAD.
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Affiliation(s)
- Alexandra S Creighton
- a School of Psychological Sciences , Monash University , Clayton , Victoria , Australia.,b Department of Psychiatry , Monash University , Clayton , Victoria , Australia
| | - Tanya E Davison
- b Department of Psychiatry , Monash University , Clayton , Victoria , Australia.,c Institute For Health & Ageing , Australian Catholic University , Melbourne , Victoria , Australia
| | - David W Kissane
- b Department of Psychiatry , Monash University , Clayton , Victoria , Australia
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Tevik K, Selbæk G, Engedal K, Seim A, Krokstad S, Helvik AS. Factors associated with alcohol consumption and prescribed drugs with addiction potential among older women and men - the Nord-Trøndelag health study (HUNT2 and HUNT3), Norway, a population-based longitudinal study. BMC Geriatr 2019; 19:113. [PMID: 30999872 PMCID: PMC6472008 DOI: 10.1186/s12877-019-1114-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/24/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Little is known about factors associated with alcohol consumption and use of drugs with addiction potential in older adults. The aim of this study was to explore the association between socio-demographic variables, physical and mental health and the later (11 years) use of frequent drinking, prescribed drugs with addiction potential and the possible combination of frequent drinking and being prescribed drugs with addiction potential in older adults (≥ 65 years). METHODS In this longitudinal study, we used data from two surveys of the Nord-Trøndelag Health Study (HUNT2 1995-1997 and HUNT3 2006-2008), a population based study in Norway. We totally included 10,656 individuals (5683 women) aged 54 years and older when they participated in HUNT2. Frequent drinking was defined as drinking alcohol 4 days or more per week. Data on prescribed drugs with addiction potential were drawn from the Norwegian Prescription Database. Drugs with addiction potential were defined as at least one prescription of benzodiazepines, z-hypnotics or opioids during one year for a minimum of two consecutive years between 2005 and 2009. RESULTS The typical frequent drinker in HUNT3 was younger, more educated, lived in urban areas, and reported smoking and drinking frequently in HUNT2 compared to the non-frequent drinker in HUNT3. The typical user of prescribed drugs with addiction potential in HUNT3 was an older woman who smoked and was in poor health, suffered from anxiety, had been hospitalized in the last 5 years and used anxiety or sleep medication every week or more often in HUNT2. The typical individual in HUNT3 with the possible combination of frequent drinking and being prescribed drugs with addiction potential had more education, smoked, drank frequently and used anxiety or sleep medication in HUNT2. CONCLUSION Individuals who were identified as frequent drinkers in HUNT2 were more likely to be frequent drinkers in HUNT3, and to have the possible combination of frequent drinking and being prescribed drugs with addiction potential in HUNT3. Health care professionals need to be aware of use of alcohol among older adults using drugs with addiction potential.
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Affiliation(s)
- Kjerstin Tevik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Arnfinn Seim
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, (NTNU), Levanger, Norway
- Psychiatric Department, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Anne-S Helvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St. Olavs University Hospital, Sluppen, Trondheim, Norway
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Tevik K, Selbæk G, Engedal K, Seim A, Krokstad S, Helvik AS. Mortality in older adults with frequent alcohol consumption and use of drugs with addiction potential - The Nord Trøndelag Health Study 2006-2008 (HUNT3), Norway, a population-based study. PLoS One 2019; 14:e0214813. [PMID: 30990815 PMCID: PMC6467384 DOI: 10.1371/journal.pone.0214813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/20/2019] [Indexed: 12/19/2022] Open
Abstract
Background The aim of this study was to investigate whether frequent drinking, use of drugs with addiction potential and the possible combination of frequent drinking and use of prescribed drugs with addiction potential were associated with all-cause mortality in older adults. Methods We used data from the Nord-Trøndelag Health Study (HUNT3 2006–08), a population-based study in Norway. A total of 11,545 (6,084 women) individuals 65 years and older at baseline participated. We assessed frequent drinking (≥ 4 days a week), occasional drinking (i.e. a few times a year), never drinking and non-drinking in the last year. Drugs with addiction potential were defined as at least one prescription of benzodiazepines, z-hypnotics or opioids during one year for a minimum of two consecutive years between 2005 and 2009. This information was drawn from the Norwegian Prescription Database. The main outcome was all-cause mortality with information drawn from the Norwegian Cause of Death Registry. Follow-up continued until death or latest at 31 December 2013. Logistic regression analyses were used to investigate all-cause mortality since date of study entry and exact age at time of death was unknown. Results The adjusted logistic regression analyses showed that frequent drinking was not associated with all-cause mortality compared to occasional drinking. Men who reported to be never drinkers and non-drinkers in the last year had higher odds of mortality compared to those who drank occasionally. Use of prescribed drugs with addiction potential was associated with increased mortality in men, but not in women. No association was found between the possible combination of frequent drinking and use of prescribed drugs with addiction potential and mortality. Conclusion Neither frequent drinking nor the possible combination of frequent drinking and use of prescribed drugs with addiction potential were associated with all-cause mortality in older women and men. Use of prescribed drugs with addiction potential was associated with higher odds of mortality in men. This finding should lead to more caution in prescribing drugs with addiction potential to this group.
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Affiliation(s)
- Kjerstin Tevik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- * E-mail:
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Arnfinn Seim
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, (NTNU), Levanger, Norway
- Psychiatric Department, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Anne-S Helvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St. Olavs University Hospital, Sluppen, Trondheim, Norway
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Iyasere O, Brown E, Gordon F, Collinson H, Fielding R, Fluck R, Johansson L, Morgan N, Stoves J, Vardhan A, Woodrow G, Davenport A. Longitudinal Trends in Quality of Life and Physical Function in Frail Older Dialysis Patients: A Comparison of Assisted Peritoneal Dialysis and In-Center Hemodialysis. Perit Dial Int 2019; 39:112-118. [DOI: 10.3747/pdi.2018.00086] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 09/17/2018] [Indexed: 11/15/2022] Open
Abstract
Background In-center hemodialysis (HD) has been the standard treatment for older dialysis patients, but reports suggest an associated decline in physical and cognitive function. Cross-sectional data suggest that assisted peritoneal dialysis (aPD), an alternative treatment, is associated with quality of life (QoL) outcomes that are comparable to in-center HD. We compared longitudinal changes in QoL between modalities. Methods We enrolled 106 aPD patients, matched with 100 HD patients from 20 renal centers in England and Northern Ireland. Patients were assessed quarterly for 2 years using the Hospital Anxiety and Depression Scale (HADS), SF-12 physical and mental scores, symptom score, Illness Intrusiveness Rating Scale (IIRS), Barthel's score, and the Renal Treatment Satisfaction Questionnaire (RTSQ). Mixed model analysis was used to assess the impact of dialysis modality on these outcomes during follow-up. P values were adjusted for multiple significance testing. Results Multivariate analysis showed no difference in any of the outcome measures between aPD and HD. Longitudinal trends in outcomes were also not significantly different. Higher age at baseline was associated with lower IIRS and RTSQ scores during follow-up. One-hundred and twenty-five (60.6%) patients dropped out of the study: 59 (28.6%) died, 61 (29.6%) withdrew during follow-up, and 5 (2.5%) were transplanted. Conclusions Quality of life outcomes in frail older aPD patients were equivalent to those receiving in-center HD. Assisted PD is thus a valid alternative to HD for older people with end-stage kidney disease (ESKD) wishing to dialyze at home.
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Affiliation(s)
- Osasuyi Iyasere
- John Walls Renal Unit, Leicester General Hospital, Leicester, UK
| | - Edwina Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Fabiana Gordon
- Statistical Advisory Service, School of Public Health, Imperial College, London, UK
| | | | | | | | - Lina Johansson
- Imperial College London, Department of Nutrition and Dietetics, Hammersmith Hospital, London, UK
| | - Neal Morgan
- Renal Unit, Daisy Hill Hospital, Southern Health and Social Care Trust, Northern Ireland, UK
| | - John Stoves
- Renal Unit, Bradford St Luke's Hospital, Bradford, UK
| | - Anand Vardhan
- Department of Renal Medicine, Manchester Royal Infirmary, Manchester, UK
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Yang Z, Huang X, Liu X, Hou J, Wu W, Song A, Meyers K, Zhang T, Chen H, Wu H. Psychometric Properties and Factor Structure of the Chinese Version of the Hospital Anxiety and Depression Scale in People Living With HIV. Front Psychiatry 2019; 10:346. [PMID: 31156484 PMCID: PMC6531499 DOI: 10.3389/fpsyt.2019.00346] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/01/2019] [Indexed: 01/01/2023] Open
Abstract
The population of people living with HIV (PLWH) is growing in number and usually results in mental health problems that impact their quality of life. Therefore, valid instruments and screening methods for psychological disorders are of great significance. The Hospital Anxiety and Depression Scale (HADS) reveals good psychometric properties, but shows ambiguous results in factor structure. This study aims to evaluate psychometric properties in terms of the internal reliability and structure validity of the Chinese version of the HADS (C-HADS) in a large sample of PLWH in China. The C-HADS was administered to 4,102 HIV-infected adults at an HIV clinic in China. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to examine the factor structure. Measurement invariance was assessed across gender and course of infection. Internal reliability was also assessed. A bifactor model with anomalous loadings of items 7, 8, and 10 fits the data best and holds measurement invariance across gender and course of infection. Internal reliability was good with all Cronbach's alphas > 0.70 and Spearman's ρ between 0.30 and 0.70. The C-HADS has good psychometric properties in terms of internal reliability and structure validity of a bifactor model. The C-HADS is recommended to be used as a total scale that measures general psychological distress, instead of anxiety and depression separately, when applied to PLWH. Further studies are needed to evaluate criterion validity, the cutoff score, and the effect of wording and scoring of the HADS.
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Affiliation(s)
- Zhiyuan Yang
- Peking University People's Hospital, Peking University Health Science Center, Beijing, China.,Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Xiaojie Huang
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Xinchao Liu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Jianhua Hou
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Wenfang Wu
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Aixin Song
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Kathrine Meyers
- The Aaron Diamond AIDS Research Center, New York, NY, United States
| | - Tong Zhang
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Hui Chen
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Hao Wu
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
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31
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Iyasere O, Brown EA, Johansson L, Davenport A, Farrington K, Maxwell AP, Collinson H, Fan S, Habib AM, Stoves J, Woodrow G. Quality of life with conservative care compared with assisted peritoneal dialysis and haemodialysis. Clin Kidney J 2018; 12:262-268. [PMID: 30976407 PMCID: PMC6452183 DOI: 10.1093/ckj/sfy059] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Indexed: 11/21/2022] Open
Abstract
Background There is little information about quality of life (QoL) for patients with end-stage kidney disease (ESKD) choosing conservative kidney management (CKM). The Frail and Elderly Patients on Dialysis (FEPOD) study demonstrated that frailty was associated with poorer QoL outcomes with little difference between dialysis modalities [assisted peritoneal dialysis (aPD) or haemodialysis (HD)]. We therefore extended the FEPOD study to include CKM patients with estimated glomerular filtration rate ≤10 mL/min/1.73 m2 (i.e. individuals with ESKD otherwise likely to be managed with dialysis). Methods CKM patients were propensity matched to HD and aPD patients by age, gender, ethnicity, diabetes status and index of deprivation. QoL outcomes measured were Short Form-12 (SF12), Hospital Anxiety and Depression Scale depression score, symptom score, Illness Intrusiveness Rating Scale (IIRS) and Renal Treatment Satisfaction Questionnaire. Frailty was assessed using the Clinical Frailty Scale. Generalized linear modelling was used to assess the impact of treatment modality on QoL outcomes, adjusting for baseline characteristics. Results In total, 84 (28 CKM, 28 HD and 28 PD) patients were included. Median age for the cohort was 82 (79–88) years. Compared with CKM, aPD was associated with higher SF12 physical component score (PCS) [Exp B (95% confidence interval) = 1.20 (1.00–1.45), P < 0.05] and lower symptom score [Exp B = 0.62 (0.43–0.90), P = 0.01]; depression score was lower in HD compared with CKM [Exp B = 0.70 (0.52–0.92), P = 0.01]. Worsening frailty was associated with higher depression scores [Exp B = 2.59 (1.45–4.62), P < 0.01], IIRS [Exp B = 1.20 (1.12–1.28), P < 0.01] and lower SF12 PCS [Exp B = 0.87 (0.83–0.93), P < 0.01]. Conclusion Treatment by dialysis, both with aPD and HD, improved some QoL measures. Overall, aPD was equal to or slightly better than the other modalities in this elderly population. However, as in the primary FEPOD study, frailty was associated with worse QoL measures irrespective of CKD modality. These findings highlight the need for an individualized approach to the management of ESKD in older people.
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Affiliation(s)
- Osasuyi Iyasere
- John Walls Renal Unit, Leicester General Hospital, Leicester, UK
| | - Edwina A Brown
- Imperial College Renal and Transplant centre, Hammersmith Hospital, London, UK
| | - Lina Johansson
- Imperial College Renal and Transplant centre, Hammersmith Hospital, London, UK
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Sia AD, Williams LJ, Pasco JA, Jacka FN, Brennan-Olsen SL, Veerman JL. The Population Mean Mood Predicts The Prevalence of Depression in an Australian Context. Aust N Z J Psychiatry 2018; 52:461-472. [PMID: 29143531 DOI: 10.1177/0004867417740207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The mean population mood has been demonstrated to strongly correlate with the prevalence of depression in European populations. Mean population mood has, therefore, been proposed as both a metric to measure the impact of population-level interventions to prevent depression and a target for public health policy. AIM To demonstrate the relationship between mean population mood and the prevalence of depression using Australian data in order to broaden the applicability of this finding to the Australian population. METHODS We used data from the Geelong Osteoporosis Study to assess the relationship between population mean mood and depression. Participants reported mood symptoms via questionnaire (the Hospital Anxiety and Depression Scale or General Health Questionnaire-12). Depression was diagnosed by semi-structured clinical interview ( Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Non-patient Edition). Stratification by age and socio-economic status was used to create subpopulation groups. Socio-economic status was measured using Index of Relative Socio-economic Advantage and Disadvantage quintiles, an area-based measure based on Australian census data and published by the Australian Bureau of Statistics. The mean subpopulation questionnaire scores and subpopulation prevalence of depression were then analysed using regression and predictive models. RESULTS Mean subpopulation questionnaire scores correlated well with the prevalence of depression across socio-economic status groups in women but not age groups. Questionnaire scores tended to underestimate the prevalence of depression in the young and overestimate it in the elderly. CONCLUSION The mean population mood was demonstrated to correlate with the population prevalence of depression in Australia for women, but not for men. Due to the issues of questionnaire validity and sample size in the oldest age groups, the age analysis is unlikely to be a representative of population characteristics. Further work to identify population determinants of mean mood could potentially create policy targets to reduce the prevalence of depression.
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Affiliation(s)
- Aaron D Sia
- 1 Department of Medicine, Queen Elizabeth II Jubilee Hospital, Brisbane, QLD, Australia
| | | | - Julie A Pasco
- 2 Deakin University, Geelong, VIC, Australia.,3 Melbourne Medical School-Western Campus, The University of Melbourne, St Albans, VIC, Australia
| | - Felice N Jacka
- 2 Deakin University, Geelong, VIC, Australia.,4 Centre for Adolescent Health, Murdoch Children's Research Institute, VIC, Australia.,5 Black Dog Institute, NSW, Australia
| | - Sharon L Brennan-Olsen
- 2 Deakin University, Geelong, VIC, Australia.,3 Melbourne Medical School-Western Campus, The University of Melbourne, St Albans, VIC, Australia.,6 Australian Institute for Musculoskeletal Science (AIMSS), St Albans, VIC, Australia
| | - J Lennert Veerman
- 7 Cancer Research Division, Cancer Council New South Wales, Sydney, NSW, Australia.,8 School of Public Health, University of Queensland, Brisbane, QLD, Australia
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Validity and Usefulness of the Hospital Anxiety and Depression Scale in Carers of People with Dementia: Evidence from Confirmatory Factor Analysis, Concurrent Validity, and Measurement Invariance in a Large Sample. Am J Geriatr Psychiatry 2017; 25:1270-1280. [PMID: 28709755 DOI: 10.1016/j.jagp.2017.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/30/2017] [Accepted: 05/30/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The Hospital Anxiety and Depression Scale (HADS) is a self-report measure of anxiety and depression. It is recommended for clinical assessment and has been used as the primary outcome in large clinical trials with carers of people with dementia. Its validity and utility have never been examined in this population. The current study addresses this. METHODS In a secondary analysis of baseline data from a recent intervention trial (N = 284) with cross-validation in baseline data from a second trial (N = 230), the authors used confirmatory factor analysis to test whether a one-, two-, or three-factor structure best fit the data and used indices of model misspecification to respecify. Internal consistency, concurrent validity of obtained factors, and measurement invariance across gender, age, kinship, and cohabitation status were assessed. RESULTS A three-factor structure best fit the data. Removal of one item improved model fit. The factors showed good internal consistency and high levels of concurrent validity. Measurement invariance was adequate across gender and kinship but not age or cohabitation status. Results were replicated in the cross-validation sample, enhancing reliability. CONCLUSION In this group the HADS measured three factors; depression, anxiety, and negative affectivity. The depression scale can be used as originally intended, supporting results of large clinical trials. The HADS does not validly measure distress or anxiety. Consequently, clinical practice recommendations could be revisited, and future research trials should not use HADS anxiety or distress as outcomes. Researchers should pay attention to measurement invariance when using HADS to compare carer subgroups.
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Djukanovic I, Carlsson J, Årestedt K. Is the Hospital Anxiety and Depression Scale (HADS) a valid measure in a general population 65-80 years old? A psychometric evaluation study. Health Qual Life Outcomes 2017; 15:193. [PMID: 28978356 PMCID: PMC5628437 DOI: 10.1186/s12955-017-0759-9] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 09/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The HADS (Hospital Anxiety and Depression Scale) aims to measure symptoms of anxiety (HADS Anxiety) and depression (HADS Depression). The HADS is widely used but has shown ambiguous results both regarding the factor structure and sex differences in the prevalence of depressive symptoms. There is also a lack of psychometric evaluations of the HADS in non-clinical samples of older people. The aim of the study was to evaluate the factor structure of the HADS in a general population 65-80 years old and to exam possible presence of differential item functioning (DIF) with respect to sex. METHODS This study was based on data from a Swedish sample, randomized from the total population in the age group 65-80 years (n = 6659). Confirmatory factor analyses (CFA) were performed to examine the factor structure. Ordinal regression analyses were conducted to detect DIF for sex. Reliability was examined by both ordinal as well as traditional Cronbach's alpha. RESULTS The CFA showed a two-factor model with cross-loadings for two items (7 and 8) had excellent model fit. Internal consistency was good in both subscales, measured with ordinal and traditional alpha. Floor effects were presented for all items. No indication for meaningful DIF regarding sex was found for any of the subscales. CONCLUSIONS HADS Anxiety and HADS Depression are unidimensional measures with acceptable internal consistency and are invariant with regard to sex. Despite pronounced ceiling effects and cross-loadings for item 7 and 8, the hypothesized two-factor model of HADS can be recommended to assess psychological distress among a general population 65-80 years old.
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Affiliation(s)
- Ingrid Djukanovic
- Faculty of Health and Life Sciences, Linnaeus University, 391 82, Kalmar, SE, Sweden.
| | - Jörg Carlsson
- Faculty of Health and Life Sciences, Linnaeus University, 391 82, Kalmar, SE, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, 391 82, Kalmar, SE, Sweden.,Department of Research, Kalmar County Hospital, Kalmar, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Stott J, Spector A, Orrell M, Scior K, Sweeney J, Charlesworth G. Limited validity of the Hospital Anxiety and Depression Scale (HADS) in dementia: evidence from a confirmatory factor analysis. Int J Geriatr Psychiatry 2017; 32:805-813. [PMID: 27352820 DOI: 10.1002/gps.4530] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/16/2016] [Accepted: 05/27/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The Hospital Anxiety and Depression Scale (HADS) is a well-validated, self-report measure of both anxiety and depression. It is frequently used with people with dementia. However, its structural validity has never been examined in this population. The current study used confirmatory factor analysis (CFA) to assess this. METHODS Baseline data from two intervention studies for people with mild to moderate dementia were combined (N = 268). CFA was used to test whether a one, two or three factor structure best fit the data. Indices of model misspecification were examined to test for poor quality items, and models re-specified accordingly. Finally, measurement invariance across gender and different levels of cognitive impairment was assessed. RESULTS A one-factor structure did not fit the data. Two and three factor structures fitted the data equally well. Model fit was improved by removal of two items. Measurement invariance was adequate across gender, but poor across groups with differing levels of cognitive impairment. CONCLUSION The HADS is acceptable and feasible but difficult to interpret in a dementia population. We suggest that it should be interpreted as measuring two separate factors of anxiety and depression and not one 'distress' factor. However, two items may need to be removed, affecting cut-off scores. Poor measurement invariance means the HADS may not be a good tool for measuring differences in anxiety and depression between those with mild and those with moderate cognitive impairment. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Joshua Stott
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Aimee Spector
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Katrina Scior
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Joanne Sweeney
- Division of Psychology and Language Science, University College London, London, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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36
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Steinke S, Bruland P, Blome C, Osada N, Dugas M, Fritz F, Augustin M, Ständer S. Chronic pruritus: evaluation of patient needs and treatment goals with a special regard to differences according to pruritus classification and sex. Br J Dermatol 2017; 176:363-370. [DOI: 10.1111/bjd.14910] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2016] [Indexed: 02/06/2023]
Affiliation(s)
- S. Steinke
- Center for Chronic Pruritus Department of Dermatology University Hospital Münster Von‐Esmarch‐Straße 58 48149 Münster Germany
- German Center for Health Services Research in Dermatology (CVderm) Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - P. Bruland
- Institute of Medical Informatics University of Münster Münster Germany
| | - C. Blome
- German Center for Health Services Research in Dermatology (CVderm) Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - N. Osada
- Institute of Medical Informatics University of Münster Münster Germany
| | - M. Dugas
- Institute of Medical Informatics University of Münster Münster Germany
| | - F. Fritz
- Institute of Medical Informatics University of Münster Münster Germany
| | - M. Augustin
- German Center for Health Services Research in Dermatology (CVderm) Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - S. Ständer
- Center for Chronic Pruritus Department of Dermatology University Hospital Münster Von‐Esmarch‐Straße 58 48149 Münster Germany
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Alawi EM, Mathiak KA, Panse J, Mathiak K. Health-related quality of life in patients with indolent and aggressive non-Hodgkin lymphoma. COGENT PSYCHOLOGY 2016. [DOI: 10.1080/23311908.2016.1169582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Eliza M. Alawi
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital Aachen, RWTH Aachen University, Pauwelsstr. 30, Aachen 52074, Germany
- Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany
| | - Krystyna A. Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital Aachen, RWTH Aachen University, Pauwelsstr. 30, Aachen 52074, Germany
- Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Jens Panse
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation Medical, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital Aachen, RWTH Aachen University, Pauwelsstr. 30, Aachen 52074, Germany
- Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany
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Vulnerable parenting among mothers with substance abuse in their family of origin: a cross-sectional comparative study of mothers in an infant and toddler program. SPRINGERPLUS 2016; 5:1540. [PMID: 27652113 PMCID: PMC5020034 DOI: 10.1186/s40064-016-3045-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/11/2016] [Indexed: 12/27/2022]
Abstract
Objective To investigate whether women raised in a family with substance abuse constitute a particularly vulnerable group of patients in an infant psychiatry setting and to identify the risk factors of suspected parental malfunctioning in women referred to treatment in an infant and toddler intervention program. Background A history of family substance abuse can severely disrupt the caretaking abilities of parents in ways that can have far-reaching consequences, and children growing up with insufficient parental care may incorporate this deficiency into their own parental behavior. Methods In total, 126 mothers completed self-report questionnaires assessing their substance abuse and health problems as well as problems in their family of origin. The index group was defined as women who reported substance abuse in their family of origin (n = 35). The comparison group was defined as women who denied substance abuse in their family of origin (n = 91). Results Symptoms of depression and anxiety were overrepresented in the total group of mothers compared with the Swedish norm. The index group had experienced parental divorce and traumatic life events more often and reported earlier substance abuse of their own. They had significantly more depression and ADHD symptoms and were more often single parents. All these factors can have a negative influence, separately or in combination, on the ability to practice sensitive parenting. Conclusions Female offspring of substance-abusing parents are an especially vulnerable group of patients. To prevent the intergenerational transmission of alcohol and drug abuse, it is important to identify parents with specific needs and to administer targeted treatment and support at primary health care centers and child psychiatric clinics.
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Bjørkløf GH, Engedal K, Selbæk G, Maia DB, Coutinho ESF, Helvik AS. Locus of control and coping strategies in older persons with and without depression. Aging Ment Health 2016; 20:831-9. [PMID: 25955293 DOI: 10.1080/13607863.2015.1040722] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare locus of control and coping strategies in older persons with and without depression. METHOD This cross-sectional study included 144 depressed in-patients from seven psychogeriatric hospital units, and 106 community-dwelling older persons without depression. All participants were 60 years and older. Locus of control was assessed by a 17-items self-report questionnaire with six response categories. Coping strategies were assessed by a 26-items self-report questionnaire with five response categories. For analytical purposes, age (<75 years vs. ≥75 years), level of education (<10 years vs. ≥10 years) and general medical health (poor vs. not poor) were categorized. RESULTS In linear regression analysis, controlling for demographics, health, and social variables, the depressed in-patients showed a higher external locus of control orientation and a less frequent use of problem-focused coping strategies compared with the non-depressed group. No differences in use of emotion-focused strategies were found between the two groups. CONCLUSION Compared with the non-depressed old persons, the depressed hospitalized older persons were characterized by perceptions of less personal control, and less use of problem-focused strategies, what also might have brought positive alterations into their situation.
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Affiliation(s)
- Guro Hanevold Bjørkløf
- a Ageing and Health, Norwegian Centre for Research, Education and Service Development , Vestfold Hospital Trust , Tønsberg , Norway.,b Department for Mental Health Research and Development, Division for Mental health and Addiction , Vestre Viken Hospital Trust , Lier , Norway.,c Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Knut Engedal
- a Ageing and Health, Norwegian Centre for Research, Education and Service Development , Vestfold Hospital Trust , Tønsberg , Norway
| | - Geir Selbæk
- a Ageing and Health, Norwegian Centre for Research, Education and Service Development , Vestfold Hospital Trust , Tønsberg , Norway.,d Research Center of Old Age Psychiatry , Innlandet Hospital Trust , Ottestad , Norway.,e Akershus University Hospital , Lørenskog , Norway
| | - Deborah Bezerra Maia
- f National School of Public Health, Fundação Oswaldo Cruz (ENSP-FIOCRUZ) , Rio , Brazil
| | | | - Anne-Sofie Helvik
- a Ageing and Health, Norwegian Centre for Research, Education and Service Development , Vestfold Hospital Trust , Tønsberg , Norway.,g Department of Public Health and General Practice, Faculty of Medicine , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway.,h St Olav's University Hospital , Trondheim , Norway
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Depressionen im höheren Lebensalter, Teil 1. Z Gerontol Geriatr 2016; 49:335-48. [DOI: 10.1007/s00391-015-1019-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/11/2015] [Accepted: 12/22/2015] [Indexed: 12/29/2022]
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Aune I, Dahlberg U, Haugan G. Sense of coherence among healthy Norwegian women in postnatal care: Dimensionality reliability and construct validity of the Orientation to Life Questionnaire. SEXUAL & REPRODUCTIVE HEALTHCARE 2015; 8:6-12. [PMID: 27179371 DOI: 10.1016/j.srhc.2015.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 11/24/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Salutogenesis focuses on identifying the causes of health rather than the causes of illness, and in this way offers a health promotion framework for maternity services. The application of salutogenesis theory in empirical studies of healthy women in maternity care appears to be rare, and mostly incomplete. The objective of this study is to examine the psychometric properties of the Orientation to Life Questionnaire (OLQ) assessing sense of coherence (SOC) in a population of healthy Norwegian women during the postnatal period. METHODS Self-reported cross-sectional data were collected from 183 women six weeks into the postnatal period. The data were analysed by descriptive statistics and confirmative factor analysis. RESULTS Discriminant validity was supported by significant negative correlations between SOC, meaningfulness, comprehensibility, manageability, anxiety and depression. Inter-item consistency with Cronbach's alpha (0.62-0.87) and composite reliability (0.60-0.92) revealed acceptable to good values approving the reliability. The original one-dimensional concept of sense of coherence was confirmed in this study. However, in accordance with previous research, some misspecifications in reference to correlated error variances between the items OLQ2 and OLQ3 were discovered. CONCLUSION This study lends support to the original one-dimensional construct of sense of coherence, and sheds more light upon the troublesome pair of items OLQ2-OLQ3. Further studies are required. However, based on our results, a rewording or deletion of one of these two items seems necessary in order to achieve a reliable and valid instrument measuring SOC among healthy postnatal women.
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Affiliation(s)
- Ingvild Aune
- Department of Nursing Science, Midwifery Education, Faculty of Health and Social Science, Norwegian University of Science and Technology, Mauritz Hansens gate 2, 7004 Trondheim, Norway.
| | - Unn Dahlberg
- Department of Women's Health, St. Olavs University Hospital, Olav Kyrres gt. 17, 7006 Trondheim, Norway
| | - Gørill Haugan
- Department of Nursing Science and Center for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway
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Djukanović I, Sorjonen K, Peterson U. Association between depressive symptoms and age, sex, loneliness and treatment among older people in Sweden. Aging Ment Health 2015; 19:560-8. [PMID: 25266255 DOI: 10.1080/13607863.2014.962001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The objective of this study was to examine the prevalence of and the association between depressive symptoms and loneliness in relation to age and sex among older people (65-80 years) and to investigate to what extent those who report depressive symptoms had visited a health care professional and/or used antidepressant medication. METHOD A cross-sectional study was conducted in a Swedish sample randomized from the total population in the age group 65-80 years (n = 6659). Chi square tests and logistic regression analyses were conducted. RESULTS The data showed that 9.8% (n = 653) reported depressive symptoms and 27.5% reported feelings of loneliness. More men than women reported depressive symptoms, and the largest proportion was found among men in the age group 75-80 years. An association between the odds to have a depressive disorder and loneliness was found which, however, decreased with increasing age. Of those with depressive symptoms a low proportion had visited a psychologist (2.9%) or a welfare officer (4.2%), and one in four reported that they use antidepressant medication. Of those who reported depressive symptoms, 29% considered that they had needed medical care during the last three months but had refrained from seeking, and the most common reason for that was negative experience from previous visits. CONCLUSION Contrary to findings in most of the studies, depressive symptoms were not more prevalent among women. The result highlights the importance of detecting depressive symptoms and loneliness in older people and to offer adequate treatment in order to increase their well-being.
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Affiliation(s)
- Ingrid Djukanović
- a Department of Health and Caring Sciences , Linnaeus University , Kalmar , Sweden
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Greenberg BR, Grossman EF, Bolwell G, Reynard AK, Pennell NA, Moravec CS, McKee MG. Biofeedback Assisted Stress Management in Patients with Lung Cancer: A Feasibility Study. Appl Psychophysiol Biofeedback 2015; 40:201-8. [DOI: 10.1007/s10484-015-9277-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Stumpf A, Ständer S, Warlich B, Fritz F, Bruland P, Pfleiderer B, Heuft G, Schneider G. Relations between the characteristics and psychological comorbidities of chronic pruritus differ between men and women: women are more anxious than men. Br J Dermatol 2015; 172:1323-8. [PMID: 25350351 DOI: 10.1111/bjd.13492] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although sex and gender are becoming more important in diagnostics and therapy, there is still little knowledge about sex-specific differences in chronic pruritus (CP). OBJECTIVES To compare, taking into consideration the characteristics of pruritus, sex-specific differences in psychological symptoms in patients with CP. METHODS Sociodemographic data, data on the clinical characteristics of the skin and CP were documented over a 1-year period in all patients attending the Competence Center Chronic Pruritus of the University Hospital Münster for the first time. All patients completed the Hospital Anxiety and Depression Scale. Student's t-tests for independent study groups and linear regression analyses were applied. RESULTS A total of 619 patients (278 men, 341 women) were included in the analysis. Women were more anxious than men, but were not more depressed. A linear regression analysis indicated that depression and anxiety scores in women were related to the average intensity of pruritus during the previous 4 weeks and to a more generalized pruritus at the beginning of CP; older age in women also correlated with the scores on the depression subscale. Interestingly, the associations were different in men: scores on the depression scale were associated with the diagnosis of CP pruritus with multiple scratch lesions. CONCLUSIONS There are sex-specific differences in the relationship between the psychological symptoms and clinical characteristics of CP; higher anxiety scores were achieved by women. Whether psychological symptoms can be reversed when CP and scratch lesions improve is an issue that needs further exploration.
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Affiliation(s)
- A Stumpf
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany.,Competence Center Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - S Ständer
- Competence Center Chronic Pruritus, University Hospital Münster, Münster, Germany.,Department of Dermatology, University Hospital Münster, Münster, Germany
| | - B Warlich
- Competence Center Chronic Pruritus, University Hospital Münster, Münster, Germany.,Department of Dermatology, University Hospital Münster, Münster, Germany
| | - F Fritz
- Department of Medical Informatics, University Hospital Münster, Münster, Germany
| | - P Bruland
- Department of Medical Informatics, University Hospital Münster, Münster, Germany
| | - B Pfleiderer
- Competence Center Chronic Pruritus, University Hospital Münster, Münster, Germany.,Department of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - G Heuft
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany.,Competence Center Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - G Schneider
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany.,Competence Center Chronic Pruritus, University Hospital Münster, Münster, Germany
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Haugan G, Drageset J. The hospital anxiety and depression scale--dimensionality, reliability and construct validity among cognitively intact nursing home patients. J Affect Disord 2014; 165:8-15. [PMID: 24882171 DOI: 10.1016/j.jad.2014.04.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Depression and anxiety are particularly common among individuals living in long-term care facilities. Therefore, access to a valid and reliable measure of anxiety and depression among nursing home patients is highly warranted. AIM To investigate the dimensionality, reliability and construct validity of the Hospital Anxiety and Depression scale (HADS) in a cognitively intact nursing home population. METHODS Cross-sectional data were collected from two samples; 429 cognitively intact nursing home patients participated, representing 74 different Norwegian nursing homes. Confirmative factor analyses and correlations with selected constructs were used. RESULTS The two-factor model provided a good fit in Sample1, revealing a poorer fit in Sample2. Good-acceptable measurement reliability was demonstrated, and construct validity was supported. LIMITATIONS Using listwise deletion the sample sizes were 227 and 187, for Sample1 and Sample2, respectively. Greater sample sizes would have strengthen the statistical power in the tests. The researchers visited the participants to help fill in the questionnaires; this might have introduced some bias into the respondents׳ reporting. The 14 HADS items were part of greater questionnaires. Thus, frail, older NH patients might have tired during the interview causing a possible bias. CONCLUSION Low reliability for depression was disclosed, mainly resulting from three items appearing to be inappropriate indicators for depression in this population. Further research is needed exploring which items might perform as more reliably indicators for depression among nursing home patients.
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Affiliation(s)
- Gørill Haugan
- Sør-Trøndelag University College, Faculty of Nursing and Research Centre for Health Promotion and Resources, HIST, Norway.
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Kaur S, Zainal NZ, Low WY, Ramasamy R, Sidhu JS. Factor Structure of Hospital Anxiety and Depression Scale in Malaysian Patients With Coronary Artery Disease. Asia Pac J Public Health 2014; 27:450-60. [DOI: 10.1177/1010539514533719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Hospital Anxiety and Depression Scale (HADS) is a common screening instrument used to determine the levels of anxiety and depression experienced by a patient and has been extensively used in patients with coronary artery disease (CAD). This study aimed to establish the factor structure of HADS in a Malaysian sample of 189 patients with CAD. Factor analysis of HADS using principal component analysis with varimax rotation yielded 3 factors. Confirmatory factor analysis supported the use of HADS in assessing 3 distinct dimensions of psychological distress—namely, anxiety, anhedonia, and psychomotor retardation. The HADS showed good internal consistency and was found to be a valid measure of psychological distress among Malaysian patients with CAD. However, low mean scores on the original 2 factors—that is, anxiety and depression—and also on the 2 depression subscales—anhedonia and psychomotor retardation—suggests that the recommended cutoff score to screen for psychological distress among CAD patients be reevaluated. Further research to determine the generalizability and consistency for the tridimensional structure of the HADS in Malaysia is recommended.
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Affiliation(s)
- Satpal Kaur
- University of Malaya, Kuala Lumpur, Malaysia
| | | | - Wah Yun Low
- University of Malaya, Kuala Lumpur, Malaysia
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Helvik AS, Engedal K, Selbæk G. Sense of coherence and quality of life in older in-hospital patients without cognitive impairment--a 12 month follow-up study. BMC Psychiatry 2014; 14:82. [PMID: 24645676 PMCID: PMC3995424 DOI: 10.1186/1471-244x-14-82] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relation between sense of coherence (SOC) and quality of life (QoL) among older persons has been found in some, but not all, studies and mostly in studies with cross-sectional design. We wanted to study if SOC was associated with domains of QoL at hospitalization and one year later among persons 65 years and above without cognitive impairment. METHOD At hospitalization (T1) and 12 month follow-up (T2) QoL and cognitive status were assessed using the WHOQOL-BREF and the Mini-Mental State Examination. At baseline, the 13-item version of the SOC scale was used to assess coping, the Hospital Anxiety and Depression Scale (HADS) was used to assess depressive and anxiety symptoms. Level of functioning was rated using Lawton and Brody's scales for physical self-maintenance and instrumental activities of daily living (personal and instrumental ADL). RESULTS In total, 165 (80 men) persons with a mean age of 77.7 (SD 6.9) years were included. The proportion of people rating their overall QoL as high had decreased from T1 to T2. The mean score on QoL- physical domain had increased, while the mean score of QoL-environmental domain had decreased. In adjusted regression analyses at T1, a high level of SOC was positively associated with QoL in three of four domains, i.e. physical, psychological and environmental, but level of SOC assessed at T1 was not associated with any domain of QoL at T2. Personal ADL was associated with some domains of QOL at T1 and T2. CONCLUSION The SOC level was associated with older adult's QoL during hospitalization but not their QoL one year after the hospital stay.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Institutt for samfunns medisin, Norwegian University of Science and Technology (NTNU), Postboks 8905, Trondheim NO-7491, Norway.
| | - Knut Engedal
- National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Geir Selbæk
- National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway,Akershus University Hospital, Lørenskog, Norway
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The validity and clinical utility of the hospital anxiety and depression scale (HADS) with older adult New Zealanders. Int Psychogeriatr 2014; 26:325-33. [PMID: 24267511 DOI: 10.1017/s104161021300197x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The Hospital Anxiety and Depression Scale (HADS) has established use with older adult populations in New Zealand but few studies have evaluated its psychometric properties. Research with the psychometric properties of the HADS in elderly populations has primarily used correlational methods that do not allow for the effects of measurement error to be observed. The hypothesized tripartite model of anxiety and depression within the HADS was evaluated using confirmatory factor analysis (CFA) methods. METHODS Overall, 203 community-dwelling older adults who were recruited from older adult community groups completed the HADS. Competing two- and three-factor structures were trialled using CFA. RESULTS A three-factor model indicated a lack of differentiation between factors and poor clinical utility and was rejected in favor of a two-factor model. Significant correlations were observed between the anxiety and depression factors on the two-factor model, but it was considered to have validity for older adult samples. Good internal consistency was found for the HADS. CONCLUSIONS A two-factor model of the HADS was favored due to the lack of differentiation between factors on the three-factor model, and the higher clinical utility of a two-factor solution. The validity of the HADS may be limited by over-diagnosing anxiety in non-clinical populations. It is recommended that the HADS be used to measure change over time through treatment and not be used as a diagnostic tool until future research establishes appropriate norms and cut-offs.
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Helvik AS, Skancke RH, Selbæk G, Engedal K. Nursing home admission during the first year after hospitalization - the contribution of cognitive impairment. PLoS One 2014; 9:e86116. [PMID: 24497936 PMCID: PMC3908879 DOI: 10.1371/journal.pone.0086116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 12/04/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The importance of cognitive and physical functioning for nursing home admission among medically hospitalized older patients is rarely studied in a one-year follow-up perspective. This study aims to explore the association between patient characteristics and nursing home admission within one year after hospitalization in persons 65 years or more. DESIGN A one-year longitudinal study. METHODS We included 463 (234 women) persons aged 65 years or more from internal medical wards in a rural area of Norway. Cognitive function was assessed using the Mini Mental State Examination; physical and instrumental functional status was assessed using the physical self-maintenance scale and instrumental activities of daily living scale of Lawton and Brody. Comorbidity was measured with the Charlson index. Admission to nursing home within one year (yes versus no) was analyzed using logistic regression analysis and Cox proportional hazard regression analysis. RESULTS The mean age of the sample was 80.5 (SD 7.4) years, mean Mini Mental State Examination score was 24.1 (SD 3.8) (maximum score is 30). In adjusted analysis participants with cognitive impairment (a Mini Mental State Examination score <25) or impaired physical functioning at baseline had higher risk of admission to nursing home within one year (OR 3.0, 95%CI 1.5-6.2 and OR 3.5, 95%CI 1.8-9.6, respectively). The time before admission was also associated with cognitive impairment and impaired physical functioning in the adjusted analysis (HR 2.6 95%CI 1.4-4.8 and HR 3.7, 95%CI 1.5-8.9, respectively). CONCLUSION Impaired cognitive and physical functioning increased the risk for nursing home admission within one year after hospitalization. However, putative regressors, such as education and social network were not included in the analysis.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St Olav's University Hospital, Trondheim, Norway
- Innlandet Hospital Trust, Division Tynset, Tynset, Norway
- * E-mail:
| | - Randi Helene Skancke
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Innlandet Hospital Trust, Division Tynset, Tynset, Norway
| | - Geir Selbæk
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
- Akershus University Hospital, Lørenskog, Norway
- The Norwegian Centre for Dementia Research, Oslo University Hospital, Ullevaal, Norway
| | - Knut Engedal
- The Norwegian Centre for Dementia Research, Oslo University Hospital, Ullevaal, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Carlozzi NE, Miciura A, Migliore N, Dayalu P. Understanding the Outcomes Measures used in Huntington Disease Pharmacological Trials: A Systematic Review. J Huntingtons Dis 2014; 3:233-52. [PMID: 25300328 PMCID: PMC4217648 DOI: 10.3233/jhd-140115] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The identification of the gene mutation causing Huntington disease has raised hopes for new treatments to ease symptoms and slow functional decline. As such, there has been a push towards designing efficient pharmacological trials (i.e., drug trials), especially with regard to selecting outcomes measures that are both brief and sensitive to changes across the course of the disease, from subtle prodromal changes, to more severe end-stage changes. OBJECTIVES Recently, to aid in efficient development of new HD research studies, the National Institute of Neurological Disorders and Stroke (NINDS) published recommendations for measurement selection in HD. While these recommendations are helpful, many of the recommended measures have little published data in HD. As such, we conducted a systematic review of the literature to identify the most common outcomes measures used in HD clinical trials. METHODS Major medical databases, including PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials, were used to identify peer-reviewed journal articles in English from 2001 through April 2013; 151 pharmacological trials were identified. RESULTS The majority of HD clinical trials employed clinician-reported outcomes measures (93%); patient reported outcome measures (11%) and observer reported outcome measures (3%) were used with much less frequency. CONCLUSIONS We provide a review of the most commonly used measures across these trials, compare these measures to the clinical recommendations made by the NINDS working groups, and provide recommendations for selecting measures for future clinical trials that meet the Food and Drug Administration standards.
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Angela Miciura
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Migliore
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Praveen Dayalu
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
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