Objectives: There is concern that there are insufficient old age psychiatrists in an ageing popul... more Objectives: There is concern that there are insufficient old age psychiatrists in an ageing population. We aim to describe the work patterns of old age psychiatrists in Australia and New Zealand in order to identify barriers to training and practice. Methods: Members of the Faculty of Psychiatry of Old Age (FPOA) and other psychiatrists who have completed the Certificate of Psychiatry of Old Age were notified of the online survey by email in October 2008. Results: Two hundred and twenty FPOA members resident in Australia and New Zealand were surveyed and 87 responded (56% male, mean age 49.2 years). While 82% had a public appointment, 34% worked in private practice where barriers included the lack of a multidisciplinary team and remuneration. Only 18% of clinical time was in a rural or regional setting. High levels of job satisfaction (88%) were found, with the main factors being working with older people, working in a multidisciplinary team and the intellectual challenge. Advanced ...
Young onset dementia (YOD) is associated with significant costs and burden, but its cause is poor... more Young onset dementia (YOD) is associated with significant costs and burden, but its cause is poorly understood. The aim of this review was to determine whether environmental and lifestyle factors are associated with risk for non-autosomal dominant degenerative and vascular YOD. Academic databases were searched to March 2015 for studies assessing the impact of modifiable factors (e.g. education, cardiovascular illness, psychiatric illness, alcohol use) in participants under 65 years at symptom onset. Cardiovascular illness, traumatic brain injury, psychiatric illness, heavy alcohol use and estrogen-related factors were identified as potential risk factors for YOD. Evidence for education, childhood development, smoking and heavy metal exposure was inconsistent or of poor quality. A dose-response relationship was found between cumulative and/or increasing severity of exposure and risk for YOD. Environmental and lifestyle risk factors may be relevant to YOD, particularly with severe or ...
To conduct a systematic review of studies that examined associations between physical illness/fun... more To conduct a systematic review of studies that examined associations between physical illness/functional disability and suicidal behaviour (including ideation, nonfatal and fatal suicidal behaviour) among individuals aged 65 and older. Articles published through November 2014 were identified through electronic searches using the ERIC, Google Scholar, PsycINFO, PubMed, and Scopus databases. Search terms used were suicid* or death wishes or deliberate self-harm. Studies about suicidal behaviour in individuals aged 65 and older with physical illness/functional disabilities were included in the review. Sixty-five articles (across 61 independent samples) met inclusion criteria. Results from 59 quantitative studies conducted in four continents suggest that suicidal behaviour is associated with functional disability and numerous specific conditions including malignant diseases, neurological disorders, pain, COPD, liver disease, male genital disorders, and arthritis/arthrosis. Six qualitati...
ABSTRACTBackground:We aimed to determine the rates of alcohol and substance use in geriatric hosp... more ABSTRACTBackground:We aimed to determine the rates of alcohol and substance use in geriatric hospital and community health settings, and to evaluate the performance of screening instruments.Method:A two-phase cross-sectional study was undertaken in geriatric and aged care psychiatry wards and associated community services of a teaching hospital. Participants were screened with the Brief Alcohol Use Disorders Identification Test (AUDIT-C) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for other substances; Geriatric Depression Scale-15 for mood; the Connor–Davidson Resilience Scale; and the Subjective Quality of Life scale. Medical conditions were established. Screen positives for risky substance use continued with the full AUDIT, full ASSIST, CAGE, Addenbrooke's Cognitive Examination-Revised, and the Functional Activities Questionnaire. Medical records were reviewed after three months to ascertain recognition and management of substance use.Results:Of...
Objective cognitive impairment determined by neuropsychological test performance is a core criter... more Objective cognitive impairment determined by neuropsychological test performance is a core criterion for the diagnosis of mild cognitive impairment (MCI), yet no consensus has been reached on how this criterion should be operationalized. The aims of this study were to investigate the effect of varying the criteria used to determine cognitive impairment (CI) on prevalence and case definition and to examine comparability of different criteria. Cross-sectional study. Sydney Memory and Ageing Study, Australia. Nine hundred eighty-seven nondemented community-dwelling adults aged 70-90 years were enrolled in this study. Participants received a comprehensive neuropsychological test battery measuring four cognitive domains. They were classified as normal or cognitively impaired by applying two types of “impairment” rule that varied the statistical threshold for impairment and the criteria used to determine impairment for each cognitive domain. Prevalence of four MCI cognitive subtypes was determined according to nine different criteria and two types of normative data. Rates of CI were compared in persons of English-speaking and non-English-speaking backgrounds (NESB). Prevalence of CI ranged from 4 to 70% depending on the impairment criteria used. Agreement between different criteria was poor to moderate. This lack of consistency had greatest impact on MCI subtype classifications with many being reclassified as “normal” or into a different subtype when stringency of the criteria was increased or decreased. Higher rates of impairment were found in persons of NESB across all cognitive domains. The prevalence of CI was strongly affected by the choice of neuropsychological assessment parameters. Guidelines for operationalizing CI are required.
Objectives: To examine age-and sex-related differences in risk and protective factors for mild co... more Objectives: To examine age-and sex-related differences in risk and protective factors for mild cognitive impairment (MCI) in community-based elderly individuals. Design: Cross-sectional study. Setting: The population-based Sydney Memory and Ageing Study. Participants: A total of 757 nondemented, community-dwelling elderly individuals from an English-speaking background categorized as younger (70-79 years) or older (80-90 years). Measurements: Risk of MCI was determined for sociodemographic, lifestyle, and cardiac, physical, mental, and general health factors using age-(and sex-) adjusted multiple regressions comprising initially significant univariate factors. Results: The point prevalence of MCI within our sample was 39.1% overall: it was lowest in younger women (32.3%) and similar across men and older women (41.9%-43.6%). The risk of MCI across all participants was increased by the APOE ε4 allele, high homocysteine, and heart disease; and decreased by better odor identification, visual acuity, and mental activity. Risk factors in all younger participants were slow 6-m walk, poor odor identification, and high homocysteine. Risk of MCI was associated in younger women with history of depression, less mental activity, slower 6-m walk, poorer visual acuity, and higher homocysteine; and in younger men with poorer odor identification and higher homocysteine. Older participants showed no significant risk factors for MCI, except for poorer visual acuity in men. Supporting these findings were statistically significant interactions
Describes challenges to conducting CALD dementia research; these include sampling, having valid i... more Describes challenges to conducting CALD dementia research; these include sampling, having valid instruments and costs. Results/Conclusion: Nine key research recommendations in the areas of epidemiology, community knowledge, carers, service delivery, screening and assessment, medical management, residential aged care and minority CALD reached by consensus by an expert group are presented Implications: strategies to encourage CALD research Cultural Group(s): CALD
Alzheimer's & dementia : the journal of the Alzheimer's Association, Jan 28, 2014
This study aimed to determine the prevalence of dementia in collaboration with urban/regional Abo... more This study aimed to determine the prevalence of dementia in collaboration with urban/regional Aboriginal communities. A census of Aboriginal and Torres Strait Islander men and women aged 60 years and above in the target communities identified 546 potential participants, with 336 (61.5%) participating in this cross-sectional study. Participants completed a structured interview and cognitive screening tests. One hundred fifty-three participants also completed a detailed medical assessment. Assessment data were reviewed by a panel of clinicians who determined a diagnosis of dementia or mild cognitive impairment (MCI) according to standard criteria. Crude prevalence of dementia was 13.4%, and age-standardized prevalence was 21.0%. The most common types of dementia were Alzheimer's dementia (44%) and mixed dementia diagnoses (29%). Estimated prevalence of MCI was 17.7%. Consistent with previous findings in a remote population, urban and regional Aboriginal Australians face high rates...
Data concerning 127 persons aged 35 years or above who died by suicide (as determined in consecut... more Data concerning 127 persons aged 35 years or above who died by suicide (as determined in consecutive cases by a Sydney coroner) were analyzed. Psychological autopsy (PA) interviews were conducted in 52 cases, and details were compared with the 75 cases where data were available only from coroner’s files (CF). Most characteristics of the two groups were similar, although more CF suicide victims were of Asian background and unable to speak English fluently. Consensus diagnoses were reached following detailed discussion about PA and CF cases. Logistic regression showed no significant difference between age‐groups in the proportion diagnosed with major depression, which contrasts with the results of an earlier U.S. study.
Mild cognitive impairment (MCI) is a heterogeneous neurocognitive disorder that can be classified... more Mild cognitive impairment (MCI) is a heterogeneous neurocognitive disorder that can be classified into various subtypes. The present study aims to examine the gray matter (GM) atrophy patterns of MCI subtypes in comparison with a cognitively healthy group. Participants, including 135 MCI subjects and 120 cognitively healthy controls, were drawn from the Sydney Memory and Ageing Study. The MCI subjects were first categorized into amnestic (aMCI) and non-amnestic (naMCI) subtypes, which were then divided into single-domain (aMCI-SD and naMCI-SD) and multiple-domain subtypes (aMCI-MD and naMCI-MD). Furthermore, naMCI-SD was divided into three subgroups (language, processing speed, and executive function) according to individual cognitive impairment. Voxel-wise GM volumes were then compared between MCI subtypes and controls. The aMCI group had significantly lower GM volumes in the bilateral hippocampi and temporal cortices than the controls. This was mainly due to GM reduction of aMCI-MD but not aMCI-SD, as the latter did not show any significant GM reduction. GM reduction of naMCI and its two subdivisions was shown in widespread brain regions compared to controls. GM volumes of the multiple-domain subtypes (aMCI-MD and naMCI-MD) were lower than their single-domain counterparts (aMCI-SD and naMCI-SD) in the frontal and temporal lobes, respectively. Moreover, the language subgroup of naMCI-SD showed GM reduction in the frontal and temporal lobes compared to controls. MCI subtypes displayed specific patterns of GM atrophy that appear to be related to their various clinical presentations, which implies that underlying mechanisms of MCI subtypes are different.
ABSTRACTBackground:Dementia is an emerging health priority in Australian Aboriginal communities, ... more ABSTRACTBackground:Dementia is an emerging health priority in Australian Aboriginal communities, but substantial gaps remain in our understanding of this issue, particularly for the large urban section of the population. In remote Aboriginal communities, high prevalence rates of dementia at relatively young ages have been reported. The current study is investigating aging, cognitive decline, and dementia in older urban/regional Aboriginal Australians.Methods:We partnered with five Aboriginal communities across the eastern Australian state of New South Wales, to undertake a census of all Aboriginal men and women aged 60 years and over residing in these communities. This was followed by a survey of the health, well-being, and life history of all consenting participants. Participants were also screened using three cognitive instruments. Those scoring below designated cut-offs, and a 20% random sample of those scoring above (i.e. “normal” range), completed a contact person interview (wi...
ABSTRACTBackground: This study aimed to determine: (1) the prevalence of depression, anxiety, and... more ABSTRACTBackground: This study aimed to determine: (1) the prevalence of depression, anxiety, and depression associated with anxiety (DA); (2) the risk factor profile of depression, anxiety, and DA; (3) the course of depression, anxiety, and DA over 24 months.Methods: Two-year longitudinal study of 20,036 adults aged 60+ years. We used the Patient Health Questionnaire and the Hospital Anxiety and Depression Scale anxiety subscale to establish the presence of depression and anxiety, and standard procedures to collect demographic, lifestyle, psychosocial, and clinical data.Results: The prevalence of anxiety, depression, and DA was 4.7%, 1.4%, and 1.8%. About 57% of depression cases showed evidence of comorbid anxiety, while only 28% of those with clinically significant anxiety had concurrent depression. There was not only an overlap in the distribution of risk factors in these diagnostic groups but also differences. We found that 31%, 23%, and 35% of older adults with anxiety, depress...
Objective: The aim of this study was to determine whether indirect self-destructive behaviors pre... more Objective: The aim of this study was to determine whether indirect self-destructive behaviors predict mortality in nursing home residents. Method: This cross-sectional study with follow-up after 2 years and 3 months surveyed 593 residents in 10 nursing homes in the eastern suburbs of Sydney, Australia. The following instruments were used: Harmful Behaviors Scale (HBS), Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), Functional Assessment Staging Scale, Resident Classificatin Index, Cumulative Illness Rating Scale, Even Briefer Assessment Scales for Depression, and the suicide item from the Structured Hamilton Depression Rating Scale. Diagnoses of depression, dementia, and psychosis were obtained from nursing home records. Mortality data were obtained in August 1999. Results: At follow-up, 297 (50.1%) residents were still alive with a mean survival time of 565.4 days. Survival analyses found that mortality was predicted by older age, male gender, lower level...
International Journal of Geriatric Psychiatry, 2001
BackgroundThere is wide variation in the rates of behavioural and psychological symptoms of demen... more BackgroundThere is wide variation in the rates of behavioural and psychological symptoms of dementia (BPSD) reported in nursing homes.AimsThis study aimed to investigate: (1) the prevalence of BPSD in nursing home residents using the BEHAVE‐AD; (2) the relationships of BPSD with (a) demographic, (b) dementia, (c) diurnal and (d) nursing home variables; and (3) the inter‐relationships between different types of BPSD, as measured by subscales of the BEHAVE‐AD.ResultsOver 90% of residents exhibited at least one behavioural disturbance. Specifically, there was evidence of psychosis in 60%, depressed mood in 42% and activity disturbances or aggression in 82% of residents. Younger, more functionally impaired residents with a chart diagnosis of psychosis had higher BPSD rates, as did those residing in larger nursing homes. Individual BPSD were significantly intercorrelated.ConclusionsBPSD are ubiquitous in nursing home residents. Behavioural disturbances are frequently associated with psyc...
International Journal of Geriatric Psychiatry, 1999
Objective. To describe the treatment of vocally disruptive behaviour (VDB) of multifactorial aeti... more Objective. To describe the treatment of vocally disruptive behaviour (VDB) of multifactorial aetiology. Method. Three case reports were used to illustrate the treatment of multifactorial VDB. Results. A biopsychosocial assessment is required to identify the dierent aetiologies involved and the way they interact. Acute medical and psychiatric factors may demand that interventions are introduced simultaneously rather than in succession. Conclusion. Successful interventions require the combination of biopsychosocial strategies tailored to the individual case with realistic goals that include the acceptance of a residual level of VDB as a reasonable outcome.
Suicide victims frequently have contact with health care professionals in the months before death... more Suicide victims frequently have contact with health care professionals in the months before death. The primary aims of this pilot psychological autopsy study were to determine the feasibility of undertaking a full study and to describe the characteristics of the last health care professional contacts with suicide victims aged > 34 years. We interviewed the informants of 52 suicides. Interviews were obtained from 37 health care professionals who had contact with 28 of the suicides during the 3 months before death. The primary reasons for the last contact with the health care professional were mental health (62%), physical health (22%), and social (14%). 87% of health care professional contacts occurred within 1 month of death. Symptoms of depression were noted in 49% of health care professional contacts. Consensus psychological autopsy diagnoses of depression were made in 64% of suicide victims. Overall suicide risk was assessed by 38% of health care professionals during their las...
Australian and New Zealand Journal of Psychiatry, 2003
Objective: To compare the perceptions of aged care services, adult mental health services and men... more Objective: To compare the perceptions of aged care services, adult mental health services and mental health services for older people regarding aspects of mental health service delivery for older people in New South Wales, Australia. Method: The NSW Branch of the Faculty of Psychiatry of Old Age in association with the NSW Centre for Mental Health, sent a postal survey to all aged care services, adult mental health services and mental health services for older people in NSW. The survey canvassed issues ranging across service profiles, regional variations, availability of resources, processes of care, views on working relationships between services, difficulties and gaps experienced, and ways to improve co-ordination and service delivery. Clinical issues such as the management and practice of psychiatric disorders of old age, educational/training requirements and skill and experience in working with older people were explored. Results: An overall response rate of 86% was achieved, in...
Australian and New Zealand Journal of Psychiatry, 1999
Objective: The aim of this study is to determine the effects of age on the practice, roles, statu... more Objective: The aim of this study is to determine the effects of age on the practice, roles, status and attitudes of psychiatrists within the Royal Australian and New Zealand College of Psychiatrists (RANZCP). Method: A postal survey of Fellows of the RANZCP resident in Australia or New Zealand was conducted. The main outcome measures were: age; location and type of psychiatric practice; hours of work; attitudes towards re-accreditation; changes in work practices over the career; and the perceived benefits and drawbacks of age to psychiatric practice and case selection. Results: Of 1086 eligible subjects, 629 participated. The mean age of the sample was 52.7 years (SD = 13.5). Those psychiatrists favouring re-accreditation were younger. Psychiatrists practising psychotherapy, forensic psychiatry or general psychiatry; working in psychiatric hospitals and private practice were more likely to be older. Older psychiatrists worked shorter hours. There was largely no association between c...
Australian and New Zealand Journal of Psychiatry, 1999
Objective: The aim of this study is to determine the effects of experience on the practice, roles... more Objective: The aim of this study is to determine the effects of experience on the practice, roles, status and attitudes of psychiatrists within the Royal Australian and New Zealand College of Psychiatrists (RANZCP). Method: A postal survey of Fellows of the RANZCP resident in Australia or New Zealand was conducted. The main outcome measures were: years of psychiatric experience; higher medical qualifications; location and type of psychiatric practice; attitudes about senior psychiatrists and mentorship; changes in work practices over the career; and the perceived benefits and drawbacks of experience on psychiatric practice and case selection. Results: Of 1086 eligible subjects, 629 participated. Over 96% of respondents, particularly the younger and less experienced, believed that senior psychiatrists have wisdom to offer to junior colleagues. This wisdom principally related to mentor-ship/supervision. Increased ‘respect and tolerance’ of patients as a benefit of experience was more likely to be reported by respondents who were more experienced. Respondents more confident about treating younger patients and treating functional psychoses were more likely to be less experienced, as were those reluctant to take on psychotherapy cases. Those respondents reluctant to take on ‘dangerous or acting-out patients’ were more experienced. The field of psychiatric practice significantly influenced case selection. Conclusions: Senior psychiatrists have accumulated wisdom through experience that is sought by junior colleagues via mentorship. It is recommended that the RANZCP should specifically address the needs of early career and senior psychiatrists.
Objectives: There is concern that there are insufficient old age psychiatrists in an ageing popul... more Objectives: There is concern that there are insufficient old age psychiatrists in an ageing population. We aim to describe the work patterns of old age psychiatrists in Australia and New Zealand in order to identify barriers to training and practice. Methods: Members of the Faculty of Psychiatry of Old Age (FPOA) and other psychiatrists who have completed the Certificate of Psychiatry of Old Age were notified of the online survey by email in October 2008. Results: Two hundred and twenty FPOA members resident in Australia and New Zealand were surveyed and 87 responded (56% male, mean age 49.2 years). While 82% had a public appointment, 34% worked in private practice where barriers included the lack of a multidisciplinary team and remuneration. Only 18% of clinical time was in a rural or regional setting. High levels of job satisfaction (88%) were found, with the main factors being working with older people, working in a multidisciplinary team and the intellectual challenge. Advanced ...
Young onset dementia (YOD) is associated with significant costs and burden, but its cause is poor... more Young onset dementia (YOD) is associated with significant costs and burden, but its cause is poorly understood. The aim of this review was to determine whether environmental and lifestyle factors are associated with risk for non-autosomal dominant degenerative and vascular YOD. Academic databases were searched to March 2015 for studies assessing the impact of modifiable factors (e.g. education, cardiovascular illness, psychiatric illness, alcohol use) in participants under 65 years at symptom onset. Cardiovascular illness, traumatic brain injury, psychiatric illness, heavy alcohol use and estrogen-related factors were identified as potential risk factors for YOD. Evidence for education, childhood development, smoking and heavy metal exposure was inconsistent or of poor quality. A dose-response relationship was found between cumulative and/or increasing severity of exposure and risk for YOD. Environmental and lifestyle risk factors may be relevant to YOD, particularly with severe or ...
To conduct a systematic review of studies that examined associations between physical illness/fun... more To conduct a systematic review of studies that examined associations between physical illness/functional disability and suicidal behaviour (including ideation, nonfatal and fatal suicidal behaviour) among individuals aged 65 and older. Articles published through November 2014 were identified through electronic searches using the ERIC, Google Scholar, PsycINFO, PubMed, and Scopus databases. Search terms used were suicid* or death wishes or deliberate self-harm. Studies about suicidal behaviour in individuals aged 65 and older with physical illness/functional disabilities were included in the review. Sixty-five articles (across 61 independent samples) met inclusion criteria. Results from 59 quantitative studies conducted in four continents suggest that suicidal behaviour is associated with functional disability and numerous specific conditions including malignant diseases, neurological disorders, pain, COPD, liver disease, male genital disorders, and arthritis/arthrosis. Six qualitati...
ABSTRACTBackground:We aimed to determine the rates of alcohol and substance use in geriatric hosp... more ABSTRACTBackground:We aimed to determine the rates of alcohol and substance use in geriatric hospital and community health settings, and to evaluate the performance of screening instruments.Method:A two-phase cross-sectional study was undertaken in geriatric and aged care psychiatry wards and associated community services of a teaching hospital. Participants were screened with the Brief Alcohol Use Disorders Identification Test (AUDIT-C) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for other substances; Geriatric Depression Scale-15 for mood; the Connor–Davidson Resilience Scale; and the Subjective Quality of Life scale. Medical conditions were established. Screen positives for risky substance use continued with the full AUDIT, full ASSIST, CAGE, Addenbrooke's Cognitive Examination-Revised, and the Functional Activities Questionnaire. Medical records were reviewed after three months to ascertain recognition and management of substance use.Results:Of...
Objective cognitive impairment determined by neuropsychological test performance is a core criter... more Objective cognitive impairment determined by neuropsychological test performance is a core criterion for the diagnosis of mild cognitive impairment (MCI), yet no consensus has been reached on how this criterion should be operationalized. The aims of this study were to investigate the effect of varying the criteria used to determine cognitive impairment (CI) on prevalence and case definition and to examine comparability of different criteria. Cross-sectional study. Sydney Memory and Ageing Study, Australia. Nine hundred eighty-seven nondemented community-dwelling adults aged 70-90 years were enrolled in this study. Participants received a comprehensive neuropsychological test battery measuring four cognitive domains. They were classified as normal or cognitively impaired by applying two types of “impairment” rule that varied the statistical threshold for impairment and the criteria used to determine impairment for each cognitive domain. Prevalence of four MCI cognitive subtypes was determined according to nine different criteria and two types of normative data. Rates of CI were compared in persons of English-speaking and non-English-speaking backgrounds (NESB). Prevalence of CI ranged from 4 to 70% depending on the impairment criteria used. Agreement between different criteria was poor to moderate. This lack of consistency had greatest impact on MCI subtype classifications with many being reclassified as “normal” or into a different subtype when stringency of the criteria was increased or decreased. Higher rates of impairment were found in persons of NESB across all cognitive domains. The prevalence of CI was strongly affected by the choice of neuropsychological assessment parameters. Guidelines for operationalizing CI are required.
Objectives: To examine age-and sex-related differences in risk and protective factors for mild co... more Objectives: To examine age-and sex-related differences in risk and protective factors for mild cognitive impairment (MCI) in community-based elderly individuals. Design: Cross-sectional study. Setting: The population-based Sydney Memory and Ageing Study. Participants: A total of 757 nondemented, community-dwelling elderly individuals from an English-speaking background categorized as younger (70-79 years) or older (80-90 years). Measurements: Risk of MCI was determined for sociodemographic, lifestyle, and cardiac, physical, mental, and general health factors using age-(and sex-) adjusted multiple regressions comprising initially significant univariate factors. Results: The point prevalence of MCI within our sample was 39.1% overall: it was lowest in younger women (32.3%) and similar across men and older women (41.9%-43.6%). The risk of MCI across all participants was increased by the APOE ε4 allele, high homocysteine, and heart disease; and decreased by better odor identification, visual acuity, and mental activity. Risk factors in all younger participants were slow 6-m walk, poor odor identification, and high homocysteine. Risk of MCI was associated in younger women with history of depression, less mental activity, slower 6-m walk, poorer visual acuity, and higher homocysteine; and in younger men with poorer odor identification and higher homocysteine. Older participants showed no significant risk factors for MCI, except for poorer visual acuity in men. Supporting these findings were statistically significant interactions
Describes challenges to conducting CALD dementia research; these include sampling, having valid i... more Describes challenges to conducting CALD dementia research; these include sampling, having valid instruments and costs. Results/Conclusion: Nine key research recommendations in the areas of epidemiology, community knowledge, carers, service delivery, screening and assessment, medical management, residential aged care and minority CALD reached by consensus by an expert group are presented Implications: strategies to encourage CALD research Cultural Group(s): CALD
Alzheimer's & dementia : the journal of the Alzheimer's Association, Jan 28, 2014
This study aimed to determine the prevalence of dementia in collaboration with urban/regional Abo... more This study aimed to determine the prevalence of dementia in collaboration with urban/regional Aboriginal communities. A census of Aboriginal and Torres Strait Islander men and women aged 60 years and above in the target communities identified 546 potential participants, with 336 (61.5%) participating in this cross-sectional study. Participants completed a structured interview and cognitive screening tests. One hundred fifty-three participants also completed a detailed medical assessment. Assessment data were reviewed by a panel of clinicians who determined a diagnosis of dementia or mild cognitive impairment (MCI) according to standard criteria. Crude prevalence of dementia was 13.4%, and age-standardized prevalence was 21.0%. The most common types of dementia were Alzheimer's dementia (44%) and mixed dementia diagnoses (29%). Estimated prevalence of MCI was 17.7%. Consistent with previous findings in a remote population, urban and regional Aboriginal Australians face high rates...
Data concerning 127 persons aged 35 years or above who died by suicide (as determined in consecut... more Data concerning 127 persons aged 35 years or above who died by suicide (as determined in consecutive cases by a Sydney coroner) were analyzed. Psychological autopsy (PA) interviews were conducted in 52 cases, and details were compared with the 75 cases where data were available only from coroner’s files (CF). Most characteristics of the two groups were similar, although more CF suicide victims were of Asian background and unable to speak English fluently. Consensus diagnoses were reached following detailed discussion about PA and CF cases. Logistic regression showed no significant difference between age‐groups in the proportion diagnosed with major depression, which contrasts with the results of an earlier U.S. study.
Mild cognitive impairment (MCI) is a heterogeneous neurocognitive disorder that can be classified... more Mild cognitive impairment (MCI) is a heterogeneous neurocognitive disorder that can be classified into various subtypes. The present study aims to examine the gray matter (GM) atrophy patterns of MCI subtypes in comparison with a cognitively healthy group. Participants, including 135 MCI subjects and 120 cognitively healthy controls, were drawn from the Sydney Memory and Ageing Study. The MCI subjects were first categorized into amnestic (aMCI) and non-amnestic (naMCI) subtypes, which were then divided into single-domain (aMCI-SD and naMCI-SD) and multiple-domain subtypes (aMCI-MD and naMCI-MD). Furthermore, naMCI-SD was divided into three subgroups (language, processing speed, and executive function) according to individual cognitive impairment. Voxel-wise GM volumes were then compared between MCI subtypes and controls. The aMCI group had significantly lower GM volumes in the bilateral hippocampi and temporal cortices than the controls. This was mainly due to GM reduction of aMCI-MD but not aMCI-SD, as the latter did not show any significant GM reduction. GM reduction of naMCI and its two subdivisions was shown in widespread brain regions compared to controls. GM volumes of the multiple-domain subtypes (aMCI-MD and naMCI-MD) were lower than their single-domain counterparts (aMCI-SD and naMCI-SD) in the frontal and temporal lobes, respectively. Moreover, the language subgroup of naMCI-SD showed GM reduction in the frontal and temporal lobes compared to controls. MCI subtypes displayed specific patterns of GM atrophy that appear to be related to their various clinical presentations, which implies that underlying mechanisms of MCI subtypes are different.
ABSTRACTBackground:Dementia is an emerging health priority in Australian Aboriginal communities, ... more ABSTRACTBackground:Dementia is an emerging health priority in Australian Aboriginal communities, but substantial gaps remain in our understanding of this issue, particularly for the large urban section of the population. In remote Aboriginal communities, high prevalence rates of dementia at relatively young ages have been reported. The current study is investigating aging, cognitive decline, and dementia in older urban/regional Aboriginal Australians.Methods:We partnered with five Aboriginal communities across the eastern Australian state of New South Wales, to undertake a census of all Aboriginal men and women aged 60 years and over residing in these communities. This was followed by a survey of the health, well-being, and life history of all consenting participants. Participants were also screened using three cognitive instruments. Those scoring below designated cut-offs, and a 20% random sample of those scoring above (i.e. “normal” range), completed a contact person interview (wi...
ABSTRACTBackground: This study aimed to determine: (1) the prevalence of depression, anxiety, and... more ABSTRACTBackground: This study aimed to determine: (1) the prevalence of depression, anxiety, and depression associated with anxiety (DA); (2) the risk factor profile of depression, anxiety, and DA; (3) the course of depression, anxiety, and DA over 24 months.Methods: Two-year longitudinal study of 20,036 adults aged 60+ years. We used the Patient Health Questionnaire and the Hospital Anxiety and Depression Scale anxiety subscale to establish the presence of depression and anxiety, and standard procedures to collect demographic, lifestyle, psychosocial, and clinical data.Results: The prevalence of anxiety, depression, and DA was 4.7%, 1.4%, and 1.8%. About 57% of depression cases showed evidence of comorbid anxiety, while only 28% of those with clinically significant anxiety had concurrent depression. There was not only an overlap in the distribution of risk factors in these diagnostic groups but also differences. We found that 31%, 23%, and 35% of older adults with anxiety, depress...
Objective: The aim of this study was to determine whether indirect self-destructive behaviors pre... more Objective: The aim of this study was to determine whether indirect self-destructive behaviors predict mortality in nursing home residents. Method: This cross-sectional study with follow-up after 2 years and 3 months surveyed 593 residents in 10 nursing homes in the eastern suburbs of Sydney, Australia. The following instruments were used: Harmful Behaviors Scale (HBS), Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), Functional Assessment Staging Scale, Resident Classificatin Index, Cumulative Illness Rating Scale, Even Briefer Assessment Scales for Depression, and the suicide item from the Structured Hamilton Depression Rating Scale. Diagnoses of depression, dementia, and psychosis were obtained from nursing home records. Mortality data were obtained in August 1999. Results: At follow-up, 297 (50.1%) residents were still alive with a mean survival time of 565.4 days. Survival analyses found that mortality was predicted by older age, male gender, lower level...
International Journal of Geriatric Psychiatry, 2001
BackgroundThere is wide variation in the rates of behavioural and psychological symptoms of demen... more BackgroundThere is wide variation in the rates of behavioural and psychological symptoms of dementia (BPSD) reported in nursing homes.AimsThis study aimed to investigate: (1) the prevalence of BPSD in nursing home residents using the BEHAVE‐AD; (2) the relationships of BPSD with (a) demographic, (b) dementia, (c) diurnal and (d) nursing home variables; and (3) the inter‐relationships between different types of BPSD, as measured by subscales of the BEHAVE‐AD.ResultsOver 90% of residents exhibited at least one behavioural disturbance. Specifically, there was evidence of psychosis in 60%, depressed mood in 42% and activity disturbances or aggression in 82% of residents. Younger, more functionally impaired residents with a chart diagnosis of psychosis had higher BPSD rates, as did those residing in larger nursing homes. Individual BPSD were significantly intercorrelated.ConclusionsBPSD are ubiquitous in nursing home residents. Behavioural disturbances are frequently associated with psyc...
International Journal of Geriatric Psychiatry, 1999
Objective. To describe the treatment of vocally disruptive behaviour (VDB) of multifactorial aeti... more Objective. To describe the treatment of vocally disruptive behaviour (VDB) of multifactorial aetiology. Method. Three case reports were used to illustrate the treatment of multifactorial VDB. Results. A biopsychosocial assessment is required to identify the dierent aetiologies involved and the way they interact. Acute medical and psychiatric factors may demand that interventions are introduced simultaneously rather than in succession. Conclusion. Successful interventions require the combination of biopsychosocial strategies tailored to the individual case with realistic goals that include the acceptance of a residual level of VDB as a reasonable outcome.
Suicide victims frequently have contact with health care professionals in the months before death... more Suicide victims frequently have contact with health care professionals in the months before death. The primary aims of this pilot psychological autopsy study were to determine the feasibility of undertaking a full study and to describe the characteristics of the last health care professional contacts with suicide victims aged > 34 years. We interviewed the informants of 52 suicides. Interviews were obtained from 37 health care professionals who had contact with 28 of the suicides during the 3 months before death. The primary reasons for the last contact with the health care professional were mental health (62%), physical health (22%), and social (14%). 87% of health care professional contacts occurred within 1 month of death. Symptoms of depression were noted in 49% of health care professional contacts. Consensus psychological autopsy diagnoses of depression were made in 64% of suicide victims. Overall suicide risk was assessed by 38% of health care professionals during their las...
Australian and New Zealand Journal of Psychiatry, 2003
Objective: To compare the perceptions of aged care services, adult mental health services and men... more Objective: To compare the perceptions of aged care services, adult mental health services and mental health services for older people regarding aspects of mental health service delivery for older people in New South Wales, Australia. Method: The NSW Branch of the Faculty of Psychiatry of Old Age in association with the NSW Centre for Mental Health, sent a postal survey to all aged care services, adult mental health services and mental health services for older people in NSW. The survey canvassed issues ranging across service profiles, regional variations, availability of resources, processes of care, views on working relationships between services, difficulties and gaps experienced, and ways to improve co-ordination and service delivery. Clinical issues such as the management and practice of psychiatric disorders of old age, educational/training requirements and skill and experience in working with older people were explored. Results: An overall response rate of 86% was achieved, in...
Australian and New Zealand Journal of Psychiatry, 1999
Objective: The aim of this study is to determine the effects of age on the practice, roles, statu... more Objective: The aim of this study is to determine the effects of age on the practice, roles, status and attitudes of psychiatrists within the Royal Australian and New Zealand College of Psychiatrists (RANZCP). Method: A postal survey of Fellows of the RANZCP resident in Australia or New Zealand was conducted. The main outcome measures were: age; location and type of psychiatric practice; hours of work; attitudes towards re-accreditation; changes in work practices over the career; and the perceived benefits and drawbacks of age to psychiatric practice and case selection. Results: Of 1086 eligible subjects, 629 participated. The mean age of the sample was 52.7 years (SD = 13.5). Those psychiatrists favouring re-accreditation were younger. Psychiatrists practising psychotherapy, forensic psychiatry or general psychiatry; working in psychiatric hospitals and private practice were more likely to be older. Older psychiatrists worked shorter hours. There was largely no association between c...
Australian and New Zealand Journal of Psychiatry, 1999
Objective: The aim of this study is to determine the effects of experience on the practice, roles... more Objective: The aim of this study is to determine the effects of experience on the practice, roles, status and attitudes of psychiatrists within the Royal Australian and New Zealand College of Psychiatrists (RANZCP). Method: A postal survey of Fellows of the RANZCP resident in Australia or New Zealand was conducted. The main outcome measures were: years of psychiatric experience; higher medical qualifications; location and type of psychiatric practice; attitudes about senior psychiatrists and mentorship; changes in work practices over the career; and the perceived benefits and drawbacks of experience on psychiatric practice and case selection. Results: Of 1086 eligible subjects, 629 participated. Over 96% of respondents, particularly the younger and less experienced, believed that senior psychiatrists have wisdom to offer to junior colleagues. This wisdom principally related to mentor-ship/supervision. Increased ‘respect and tolerance’ of patients as a benefit of experience was more likely to be reported by respondents who were more experienced. Respondents more confident about treating younger patients and treating functional psychoses were more likely to be less experienced, as were those reluctant to take on psychotherapy cases. Those respondents reluctant to take on ‘dangerous or acting-out patients’ were more experienced. The field of psychiatric practice significantly influenced case selection. Conclusions: Senior psychiatrists have accumulated wisdom through experience that is sought by junior colleagues via mentorship. It is recommended that the RANZCP should specifically address the needs of early career and senior psychiatrists.
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Papers by Brian Draper