To examine the 1-month prevalence of generalized anxiety disorder (GAD) according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), Diagnostic and Statistical Manual of Mental, Fifth Edition (DSM-V), and International Classification of Diseases, Tenth Revision (ICD-10), and the overlap between these criteria, in a population sample of 75-year-olds. We also aimed to examine comorbidity between GAD and other psychiatric diagnoses, such as depression.
During 2005-2006, a comprehensive semistructured psychiatric interview was conducted by trained nurses in a representative population sample of 75-year-olds without dementia in Gothenburg, Sweden (N = 777; 299 men and 478 women). All psychiatric diagnoses were made according to DSM-IV. GAD was also diagnosed according to ICD-10 and DSM-V.
The 1-month prevalence of GAD was 4.1% (N = 32) according to DSM-IV, 4.5% (N = 35) according to DSM-V, and 3.7% (N = 29) according to ICD-10. Only 46.9% of those with DSM-IV GAD fulfilled ICD-10 criteria, and only 51.7% and 44.8% of those with ICD-10 GAD fulfilled DSM-IV/V criteria. Instead, 84.4% and 74.3% of those with DSM-IV/V GAD and 89.7% of those with ICD-10 GAD had depression. Also other psychiatric diagnoses were common in those with ICD-10 and DSM-IV GAD. Only a small minority with GAD, irrespective of criteria, had no other comorbid psychiatric disorder. ICD-10 GAD was related to an increased mortality rate.
While GAD was common in 75-year-olds, DSM-IV/V and ICD-10 captured different individuals. Current definitions of GAD may comprise two different expressions of the disease. There was greater congruence between GAD in either classification system and depression than between DSM-IV/V GAD and ICD-10 GAD, emphasizing the close link between these entities.
This study will compare the clinical outcomes of 139 elders residing in long-term care (LTC) who received dental treatment with those who did not receive care under a comprehensive dental programme over 5 years.
Numerous studies have documented very poor oral health and limited access to dental care among frail older adults residing in LTC facilities. The University of British Columbia and Providence Healthcare developed a comprehensive dental programme to serve elderly LTC residents within seven Vancouver hospitals. Since 2002, the Geriatric Dentistry Programme has provided annual oral health assessments and access to comprehensive dental care.
A comprehensive oral health assessment was provided using CODE (an index of Clinical Oral Disorders in Elders). A change in oral health status (improvement or worsening) was evaluated by measuring CODE scores including caries and periodontal condition, and other aspects of the dentition.
Eighty-three residents received dental treatment of some form over the 5 years, while 56 did not receive any treatment beyond an annual examination. The percentage of residents initially recommended for treatment in 2002 was 97%, which declined to 70-73% after the 3rd year. The percentage of residents treated increased after the first year and remained at 56-72% thereafter. The comparison between CODE scores from baseline and 5 years later showed an improvement for those receiving care (p = 0.02, chi(2) = 7.9, df = 2).
Within the limitations of this study, residents who did consent and receive care showed an improvement in their oral health status after 5 years.
Before 1981 no representative studies of oral health in an elderly population in northern Sweden had been presented, and longitudinal studies of oral health in the aging person were in general rare. Thus the aim of this study was to investigate longitudinal changes in oral health in a representative sample of an elderly city population in northern Sweden. Reported oral problems and treatment needs were noted, and dental and periodontal status was registered in clinical examinations. The frequency of reported annual dental visits and of being called by the dentist increased in the younger but not in the older cohort during the 9-year period. In 1990 all the 79- and 88-year-olds with annual visits reported that they were recalled by the dentist. The clinical investigation showed an increasing amount of tooth loss, root caries, and periodontal disease with increasing age. Among dentulous persons 1.7 teeth per subject were lost from 1981 to 1990 in the younger cohort, compared with 2.6 teeth per subject in the older cohort. The number of sound teeth decreased very little in the younger cohort (from 3.44 to 3.34) but more evidently in the older cohort (from 3.47 to 2.65) during the 9-year period. The frequency of surfaces with attachment level > 3 mm increased statistically significantly from 1981 to 1990 in the older cohort. Subjects with annual visits had in general fewer oral problems.
The 39 item Parkinson's disease questionnaire (PDQ-39) is the most widely used patient reported rating scale in Parkinson's disease. However, several fundamental measurement assumptions necessary for confident use and interpretation of the eight PDQ-39 scales have not been fully addressed.
Postal survey PDQ-39 data from 202 people with Parkinson's disease (54% men; mean age 70 years) were analysed regarding psychometric properties using traditional and Rasch measurement methods.
Data quality was good (mean missing item responses, 2%) and there was general support for the legitimacy of summing items within scales without weighting or standardisation. Score reliabilities were adequate (Cronbach's alpha 0.72-0.95; test-retest 0.76-0.93). The validity of the current grouping of items into scales was not supported by scaling success rates (mean 56.2%), or factor and Rasch analyses. All scales represented more health problems than that experienced by the sample (mean floor effect 15%) and showed compromised score precision towards the less severe end.
Our results provide general support for the acceptability and reliability of the PDQ-39. However, they also demonstrate limitations that have implications for the use of the PDQ-39 in clinical research. The grouping of items into scales appears overly complex and the meaning of scale scores is unclear, which hampers their interpretation. Suboptimal targeting limits measurement precision and, therefore, probably also responsiveness. These observations have implications for the role of the PDQ-39 in clinical trials and evidence based medicine. PDQ-39 derived endpoints should be interpreted and selected cautiously, particularly regarding small but clinically important effects among people with less severe problems.
The proportion of individuals with dementia is increasing in all kinds of institutions. Specialised day hospitals are now being developed as an alternative to long term care for the demented. Twelve day hospital wards, with 312 individuals suffering from dementia, were included in a study aiming to assess functional abilities and frequencies of participation in different activities. Eighty-nine per cent of the day hospital patients could be classified as having a dementia disease. Seventy-eight per cent of the population were dependent on some kind of help from a caregiver in the performance of ADL activities. The most common occupations that could be seen in the programmes were physical activities, entertainment, and personal care activities. The activities were often undertaken as large group activities, often including more than ten patients. The functional abilities that characterise the population are comparable with those of the population living in pensioners' service blocks with full board.
BACKGROUND: Dementia is a chronic illness associated with a progressive loss of cognitive and intellectual abilities, such as memory, judgment and abstract thinking.The objective of this study was to assess the health utilities of patients with dementia in Europe and identify the key factors influencing their Health-Related Quality of Life (HRQol). METHODS: This study used cross-sectional data from the Odense study; a Danish cohort of patients aged 65-84 living in Odense, Denmark. A total of 244 patients with mild to severe dementia were interviewed together with a caregiver about their health status and activities of daily living (ADL). Alzheimer's disease was diagnosed according to the NINCDS-ADRDA criteria for probable dementia. Vascular dementia and other types of dementia were diagnosed according to the DSM-IIIR criteria. Severity of dementia was defined by score intervals on the Mini Mental State Examination score: mild (MMSE 20-30), moderate (MMSE 10-19), and severe (MMSE 0-9). Based on the ADL information, the patients' dependency level was defined as either dependent or independent. Questions from the Odense Study were mapped into each of the five dimensions of the EQ-5D in order to assess patients' HRQol. Danish EQ-5D social tariffs were used to value patients' HRQol.A regression analysis of EQ-5D values was conducted with backward selection on gender, age, severity, ADL level and setting in order to determine the main factor influencing HRQoL. RESULTS: The EQ-5D weight in patients independent upon others in ADL was 0.641 (95% CI: [0.612-0.669]), and in those dependent upon others was 0.343 (95% CI: [0.251-0.436]). CONCLUSION: Dependency upon others to perform ADL was the main factor affecting HRQoL.