The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
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Am J Geriatr Psychiatry · May 2007
Neither atypical nor conventional antipsychotics increase mortality or hospital admissions among elderly patients with dementia: a two-year prospective study.
Antipsychotics are widely used to manage behavioral disorders in patients with dementia. Recently, serious concerns have been raised about the stroke and mortality risk of atypical antipsychotics when administered to patients with dementia. ⋯ Among these frail and very old patients with dementia, neither the use of atypical antipsychotics nor the use of conventional neuroleptics increased mortality or hospital admissions. The use of restraints, however, doubled the risk of mortality.
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Am J Geriatr Psychiatry · Apr 2007
Religious beliefs and practices are associated with better mental health in family caregivers of patients with dementia: findings from the REACH study.
Providing care to a loved one with dementia and the death of that loved one are generally considered two of the most stressful human experiences. Each puts family caregivers at risk of psychologic morbidity. Although research has suggested that religious beliefs and practices are associated with better mental health, little is known about whether religion is associated with better mental health in family caregivers. Our objective, then, is to explore the relationship between religion and mental health in active and bereaved dementia caregivers. ⋯ Religious beliefs and practices, and religious attendance in particular, are associated with better mental health in family caregivers of persons with dementia.
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Am J Geriatr Psychiatry · Mar 2007
The clinical significance of subsyndromal depression in older primary care patients.
Many seniors experience depressive symptoms not meeting standard diagnostic criteria. The authors sought to examine the clinical correlates of older primary care patients with "subsyndromal depression" (SSD), hypothesizing that SSD subjects have greater symptoms and functional impairment than nondepressed patients, but not as severe as those with major or minor depression, and to explore the characteristics of subjects captured by three different definitions of SSD used in prior published work. ⋯ Subsyndromal depression is common and associated with symptoms or impairments of clinical importance. Sole reliance on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition definitions of major or minor depression omit a substantial proportion of seniors with clinically significant depressive symptoms. Longitudinal study is needed to help clinicians identify those at greatest risk for poor outcomes, while researchers testing mechanistic models should include patients with SSD to determine whether they share pathogenetic underpinnings with more severe mood disorders.
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Am J Geriatr Psychiatry · Feb 2007
Randomized Controlled TrialEarly symptoms in the prodromal phase of delirium: a prospective cohort study in elderly patients undergoing hip surgery.
The authors investigated prodromal delirium symptoms in elderly patients undergoing hip surgery. ⋯ Most elderly patients undergoing hip surgery with postoperative delirium already have early symptoms in the prodromal phase of delirium. These findings are potentially useful for screening purposes and for optimizing prevention strategies targeted at reducing the incidence of postoperative delirium.
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Am J Geriatr Psychiatry · Jan 2007
The effects of postoperative pain and its management on postoperative cognitive dysfunction.
To determine risks for postoperative cognitive dysfunction (POCD), the authors conducted a prospective cohort study of 225 patients > or = 65 years of age undergoing noncardiac surgery. Cognitive testing using the Word List, Verbal Fluency, and Digit Symbol tests was conducted for each patient preoperatively and 1 and 2 days postoperatively in patients without postoperative delirium. POCD was defined as meeting statistical criteria for decline from the patient's preoperative performance levels on at least two of the three cognitive tests. ⋯ Compared with those receiving postoperative analgesia through a patient-controlled analgesia device that administered opioids intravenously, those who received postoperative analgesia orally were at significantly lower risk for the development of POCD (odds ratio: 0.22; 95% confidence interval: 0.06-0.80; Wald chi-square = 5.36, df = 1, p = 0.02). Older patients undergoing noncardiac surgery who are not delirious can experience significant declines in cognitive functioning postoperatively. Those at least risk of experiencing POCD were those who received postoperative analgesia orally.