the analgesic drug use has been reported to increase in general in nursing home patients. However, there is insufficient evidence in terms of what agents are used, variations of use over time and to whom these drugs are prescribed.
we investigated the prescribing patterns of scheduled analgesic drugs in Norwegian nursing home patients from 2000 to 2011, with the association to age, gender, cognitive function and type of nursing home unit.
secondary analyses of four study samples (three observational studies and one randomised controlled trial).
nursing home patients included in study samples from 2000 (n = 1,926), 2004 (n = 1,163), 2009 (n = 850) and 2011 (n = 1,858) located in 14 Norwegian counties.
trend analyses of analgesic drug prescriptions. Percentages were described using t-test, ?(2) and Mann-Whitney U test and multivariate logistic regression.
the odds ratio for receiving any pain medication in 2011 compared with 2000 was 2.6 (95% CI 2.23-2.91), this is corresponding to a 65% increase from 34.9 to 57.6%. The paracetamol prescription increased by 113%, from 22.7% in 2000 to 48.4% in 2011. Strong opioids (fentanyl, buprenorphine, morphine, oxycodone) increased from 1.9% in 2000 to 17.9% in 2011 (P
Comment In: Age Ageing. 2016 Jan;45(1):7-826764389
Erratum In: Age Ageing. 2016 Mar;45(2):32326941355
Anxiety symptoms are highly prevalent in elders with mild cognitive disorders, but little is known about the associations of specific anxiety disorders to mild cognitive disorders.
To identify the clinical and subclinical anxiety disorders associated with cognitive impairment no dementia (CIND) and to determine whether these associations differ depending on sex and concomitant depressive episodes.
Participants constituted a random sample (n?=?2414) of community-dwelling adults aged 65-96 years. The following clinical and subclinical DSM-IV anxiety disorders were identified with a semi-structured interview: specific phobia, social phobia, agoraphobia, panic disorder, obsessive-compulsive, and generalized anxiety disorder (GAD). Major depressive episodes or minor depression (MDE/MD) were also determined based on the DSM-IV criteria. CIND cases were defined based on Mini-Mental State Examination (MMSE) cut-offs (15th percentile) stratified for age, education, and sex. Potentially confounding variables (age, education, MDE/MD, chronic diseases, and psychotropic drug use) were statistically controlled.
In men, after adjusting for confounding variables, CIND was associated with subclinical GAD (odds ratio (OR): 4.93, 95% confidence interval: 1.84-13.23). Further analyses showed that in men, CIND was related to clinical/subclinical GAD whether MDE/MD was present (7.05, 1.88-26.43) or absent (9.33, 3.24-26.83). In women, CIND was not linked to any clinical or subclinical anxiety disorder.
These results suggest that in community-dwelling elders, GAD is the main anxiety disorder associated with poor global cognitive functioning. Moreover, this association is modified by sex, but not by the presence of depressive episodes.
The association between medical diagnosis and caregiver burden: a cross-sectional study of recipients of informal support and caregivers from the general population study 'Good Aging in Skåne', Sweden.
Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, CRC, Skåne University Hospital, Lund University, Jan Waldenströms gata 35, Build. 28 Fl.13, 205 02, Malmo, Sweden. email@example.com.
Different kinds of chronic diseases might imply different dimensions of caregiver burden, not previously described among the caregivers to recipients from the general elder population.
The main objective was to examine differences in burden between the 343 caregivers to persons with different diagnoses.
A group of elderly recipients of informal care (n?=?343) from the general population study 'Good Aging in Skåne' (GÅS) Sweden, were divided into five diagnostic groups: dementia (n?=?90), heart and lung diseases (n?=?48), stroke (n?=?62), fractures (n?=?66), depression (n?=?40) and the group "other", consisting of different diagnoses (n?=?37) according to ICD-10. Differences in burden were analyzed using the Caregiver Burden Scale (CBS), a 22-item scale consisting of five dimensions: general strain, isolation, disappointment, emotional involvement and environmental burden. A total burden index comprises the mean of all the 22 items and a higher score indicates a higher burden.
The most common diagnosis associated to caregiving was dementia and fracture and the median hours weekly for informal support with instrumental ADL for the five diagnostic groups ranged from 7 to 45 h for spouses and from 4 to 7 h for parents. The highest proportion of caregivers scoring high total burden was seen among recipients with dementia (50%) and depression (38%); the OR for high total burden for the dementia group was 4.26 (2.29-7.92) and depression group 2.38 (1.08-5.24) adjusted for covariates like age, gender and ADL and these two groups had higher self-perception of burden in all the dimensions, especially the dimension's emotional burden and strain.
Informal support constitutes a substantial time for instrumental ADL for the diseased elders. Caregivers to persons with dementia and depression experience high burden.
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The semantic differential (SeD) technique was applied to 158 caregivers from a nursing home in the northern part of Sweden. The questionnaire contained fifty-eight bipolar scales of adjective pairs and the interviewees indicated their reactions to a described picture of a severely demented person: A factor analysis revealed three dimensions; an ethical one, an esthetical one, and one about the person's own feelings. The fifty-eight scales were mostly rated toward the negative poles. The severely demented person was rated as painful, apathetic, suffering, weak, afraid, sad, cold, dark, rough, and ugly. Four years later a comparable group of caregivers (n = 93) answered a revised questionnaire containing the 26 SeD scales with factor loadings > .50 for the picture of the severely demented person. The result was nearly identical and alternative interpretations are discussed.
Fifty-two family caregivers for demented elderly people were investigated for burden and burnout experiences. A structured burden questionnaire and the Burnout Measure were used. Burnout is described in relation to the caregiver's gender, age, family relationship and the demented person's living place. Older wives and daughters were the most likely to report burnout in their lives. Some siblings and daughters-in-law also risked developing burnout. Regression analysis showed that limitation in social life, poor health and a lack of positive outlook on caring were the most important independent variables explaining variance in burnout among caregivers. There was no difference in burnout experiences between caregivers having their demented elderly person living at home and those having them in an institution.
INTRODUCTION: The aim of this paper is to describe elderly people living in different care settings in Sweden according to prevalence of dementia, ADL functions, psychiatric symptoms, behavioural symptoms and workload imposed on the staff. MATERIAL & METHODS: In total 842 persons living in different settings (nursing homes, homes for the aged, service houses and group-livings) has been investigated. The MDDAS scale has been used to measure motor functions, vision, hearing, speech, ADL functions, behavioural disturbances, psychiatric symptoms and workload imposed on the staff. RESULTS: Probands cared for in different settings differ considerably as to prevalence of dementia, ADL functions, behaviour and psychiatric symptoms. Those living in nursing homes were most impaired and imposed the heaviest workload on the staff. The study has also shown that the nursing load is increasing rapidly in the homes for the aged.
The overall aim of the study was to investigate if and how persons with dementia were able to take part in negotiations for formal support, as cases of citizenship as practice The transcripts used for analysis were from 11 assessment meetings conducted in Sweden, in which the formal applicant was a person with dementia. The findings suggest that the actual participation of persons with dementia in assessment meetings varies. Communication problems were found in the meetings to different degrees and were dealt with differently and with various consequences. For those persons with dementia contributing at the same levels as the other participants, there was an attempt at mutual understanding. For those making fewer contributions, the other interlocutors took over the initiative and thus affected the practice of citizenship by persons with dementia in a negative way. The practice of citizenship is situation based and varies depending on all participants. When the person with dementia is able to participate in the conversation, social workers can facilitate for them to overcome communication problems by giving them more time and signaling acceptance. If the person with dementia has great problems in participating, the other participants can find different strategies to at least involve her or him in the conversation.
OBJECTIVE: To examine the prevalence, psychiatric and behavior symptoms, differing symptom profiles, and diurnal variations of delirium in older patients. DESIGN: A descriptive, point prevalence study with a cross-sectional design. SETTING: One ordinary county hospital (n = 148), three nursing homes (n = 202), five old people's homes (n = 196), and home medical care patients (n = 171) in parts of a hospital catchment area in Mid-Sweden. PARTICIPANTS: A total of 717 patients 75 years of age and older were observed and assessed for the prevalence of delirium. Women accounted for 66.4% of the studied population, and the mean age for both sexes was 83.7 years. MEASUREMENTS: All patients were examined using the OBS (Organic Brain Syndrome) scale, and delirium was diagnosed according to DSM-III-R. RESULTS: Delirium was diagnosed in 315 of 717 (43.9%) patients, and 135 of 315 (42.9%) of the delirious patients had dementia. Thirty-seven percent of the patients with delirium were delirious in the afternoon, evening, or at night, and 47% of the delirious patients had morning delirium. The delirious patients presented a wide variety of psychiatric symptoms. More than half the patients exhibiting anxiety, psychomotor slowing, depressed mood, and irritability. Nearly 26% were classified as having hypoactive, 22% as having hyperactive, and 42% as having mixed delirium, whereas 11% had neither hypo- nor hyperactive delirium. Seventy-seven percent were classified as having delirium with pronounced emotional and 43% with pronounced psychotic symptoms. CONCLUSIONS: This study shows that patients with delirium have very different clinical profiles. This might indicate a need for different treatment strategies for patients with different types of delirium.
Comment In: J Am Geriatr Soc. 1999 Nov;47(11):138210573453
Nursing homes are important alternatives to large hospitals when psychiatrically ill patients are relocated in the community, but their suitability for this type of patient is being questioned. This study compared patients in two traditional Swedish nursing homes (n = 66) and patients in long-term care at a large psychiatric hospital (n = 106). The results showed that both types of institutions housed patients with organic dementia and psychiatric symptoms. The hospitalized demented patients, however, displayed significantly more cognitive impairment, more confusion, and more behavioral disturbances than the nursing home patients. Significant differences were also found between the nursing home patients and hospitalized psychiatrically ill patients without dementia. The latter were younger, had better activities of daily living capacity, but displayed more psychiatric symptoms and behavioral disturbances than the nursing home patients. We concluded that all the patients in long-term psychiatric care will require sheltered accommodation. The demented patients could possibly be integrated into nursing homes, but successful integration would require special arrangements. Psychogeriatric units with staff qualified to care for patients with severe behavioral disturbances would be preferable. It would not be possible to meet the psychiatrically ill patients' special need of care in existing nursing homes. Alternative living arrangements, with care given by staff trained in psychiatry, are recommended.