International psychogeriatrics
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Comparative Study
Some methodological issues in using aggression rating scales in intervention studies among institutionalized elderly.
Aggressive behavior among geriatric psychiatry inpatients spontaneously declines during serial measurements over time with rating scales. ⋯ A "run in" period of at least 4 weeks may be needed in intervention studies using the SOAS to reduce contamination by spontaneous decline.
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Case Reports Comparative Study
Physicians' decision-making in incompetent elderly patients: a comparative study between Austria, Germany (East, West), and Sweden.
In order to investigate to what extent various determinants in the decision-making process for the treatment of severely ill incompetent patients are influenced by cultural and sociopolitical factors, 540 physicians in Austria, Germany (East and West), and Sweden, countries representing different healthcare systems, were surveyed using a self-administered questionnaire. It provided three case vignettes with different levels of information about the patient's treatment wishes in case of incompetence in a life-threatening situation. We found a general trend to a lower level of treatment in line with the patient's wishes when the information provided was more detailed. ⋯ Ethical concerns and patient's wishes appeared as the most important factors whereas religious beliefs of the physician and hospital costs scored lowest. Because of the variability of treatment decisions and the importance of various factors determining the decision-making, an advance directive may be a feasible way of reducing the number of conflicts in critical situations. We recommend that ethical issues of clinical practice should be emphasized in the medical curriculum and in the training of physicians.
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The aim of the report was to study clinical differences between psychotic late-life depression and psychotic depression in younger patients, to determine if differences were age-related or specific for psychotic late-life depression. Three hundred seventy-six consecutive outpatients, presenting for treatment of unipolar or bipolar depression (with or without psychotic features), were assessed by means of the Structured Clinical Interview for DSM-IV, the Montgomery and Asberg Depression Rating Scale, and the Global Assessment of Functioning Scale. ⋯ Findings were related to psychosis or to age, and not to specific features of psychotic late-life depression. These results support a unitary view of psychotic depression.
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Demographic changes indicating a general aging of the population suggest that the key role of general practitioners (GPs) in the diagnosis and management of dementia becomes more salient. The encouragement of GPs to collaborate with specialists is one chance to support GPs in performing a variety of functions associated with the diagnosis and management of dementia. ⋯ Enhancing the liaison between GPs and specialist physicians by improving the psychogeriatric competence of GPs as well as the connection to nonmedical services is discussed.
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The objective of this study was to assess the psychometric properties of a new instrument, the Delirium Index (DI), to measure changes in the severity of the symptoms of delirium among patients previously diagnosed with delirium. Subjects were medical inpatients aged 65 and over diagnosed with delirium by the Confusion Assessment Method. ⋯ Construct validity was assessed using correlations of the DI with two measures of current function for convergent validity (r = -.60, -.70) and two measures of function before admission for discriminant validity (r = .26,-.42). We conclude that the DI has acceptable levels of interrater reliability, criterion validity, and construct validity.