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Background: Older adults experience a high rate of falls when they transition to community-living following discharge from hospital. Objectives: To describe the proportion of older adults who could recall having discussed falls and falls prevention strategies with a health professional within 6 months following discharge from hospital. To describe the recalled content of these discussions and the strategies recommended and/or undertaken to prevent falls. Methods: Prospective cohort study of 155 older adults surveyed prior to discharge from hospital, of whom 123 were followed up at month 3 and/or month 6 in the community post-discharge. Participants were recruited from three Australian hospitals. Questionnaires captured predictive factors that may predispose to a fall and data related to the objectives being examined. Results: Of the 123 participants who had at least one follow-up, 54 reported discussing falls with a health professional (49 discussed falls with their general practitioners). Of the 54 participants who recalled having a discussion, 33 commented that they were asked whether they had fallen over. Only six discussed interventions to prevent falls. However, 44 stated that they attempted a total of 53 strategies to prevent falls post-discharge. Of these strategies, 40 had an absence of evidence of effectiveness, 11 had evidence of effectiveness, while two had either evidence of no benefit/harm or evidence of harm for the prevention of falls. In all, 53 participants reported falling post-discharge, but 42% of them did not recall discussing falls with their health professional. Conclusion: There is considerable scope for health professionals, especially general practitioners, to increase the frequency with which they discuss falls and evidence-based interventions to prevent falls in this population.

Introduction As the population ages, by far the greatest increase is in the number of very elderly people, aged 80 years or older. Accurate information on the physical and mental [...]

Abstract Objectives: to compare the domiciliary service receipt of cognitively impaired and equally dependent physically impaired elderly women prior to the passing of the UK Community Care Act. Methods: secondary [...]

In Western populations, the most common cause of dementia is Alzheimer's disease. The second most common cause is vascular disease, in which the brain tissues suffer from the consequences of inadequate and disrupted blood supply. Vascular dementia is the most common cause of dementia among Oriental peoples. The prevalence and risk factors for vascular dementia are not as widely studied as they are in Alzheimer's disease. At least in part, this is due to greater uncertainties in the diagnosis of vascular dementia. Research has been completed in which data from major European studies of dementia have been re-analyzed to provide estimates on the prevalence and risk factors for vascular dementia. The data indicate that the rate of vascular dementia rises sharply with age. The prevalence of the condition is greater among men than women. This is consistent with the sex differences observed in stroke, which is also related to cerebrovascular disease. When only patients from 80 to 89 were considered, the researchers found that a decline in the prevalence of vascular dementia occurred from 1957 to 1972. The age-specific prevalence of vascular dementia was, with one unexplained exception, similar for all women regardless of the European nation of residence. Among men, the prevalence of vascular dementia varied from place to place. The prevalence of vascular dementia was unusually low in Cambridge, England for both sexes; among men, the prevalence was greater in Lund, Sweden and in Finland. In Appignano, Italy, however, vascular dementia among men showed a sharp increase with age that was greater than in other areas. (Consumer Summary produced by Reliance Medical Information, Inc.)

As the elderly come to constitute a greater proportion of the population, there is a greater need for the tabulation of data on the medical problems of the aged. This is more easily accomplished for severe dementia than for mild dementia. Results of different studies on severe dementia are in general agreement, but reports concerning mild dementia vary wildly in their conclusions. This is due to the fact that most epidemiologists attempting to ascertain the prevalence of dementia in a population rely on the results of brief cognitive tests. Often, this reliance is simply a matter of economics; in a large, population-based study, more elaborate testing may just be too costly. Nevertheless, poor performance on a brief cognitive test is not necessarily indicative of mild dementia. Elderly patients may perform poorly because they are depressed, because they are poorly motivated or inattentive, because they are deaf or have some physical problem, or because they were never very bright even when they were younger. Clearly, accurate statistics on dementia cannot be accumulated if the data are contaminated with unrelated cases. The analysis of data from a recent British study reveals the sorts of problems which may complicate the diagnosis of mild dementia; furthermore, the study shows how adopting an approach which takes a more global view of the condition of the patient may achieve more accurate results. Examples include a woman who appeared to be mildly demented upon testing, but on psychiatric examination was immediately seen to be dyspraxic, having trouble performing coordinated acts, most likely as the result of a stroke. Another patient with a score indicating mild dementia was found to be diabetic upon interview with her daughter; when her diabetes was brought under better control, her mental status improved as well. Researchers recognize that the boundary between mild dementia and other forms of mental impairment are not always clear cut. They also recognize that results obtained from clinical examinations are subject to their own sorts of errors and problems. However, the cases presented illustrate that studies of dementia need to take into account a spectrum of physical, psychiatric, and cognitive problems if they are to yield worthwhile scientific results. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abstract Background Following admission to a nursing home, the feelings of depression and burden that family carers may experience do not necessarily diminish. Additionally, they may experience feelings of guilt and grief for the loss of a previously close relationship. At the same time, individuals with dementia may develop symptoms of depression and agitation (BPSD) that may be related to changes in family relationships, social interaction and stimulation. Until now, interventions to alleviate carer stress and BPSD have treated carers and relatives separately rather than focusing on maintaining or enhancing their relationships. One-to-one structured activities have been shown to reduce BPSD and also improve the caring experience, but barriers such as a lack of resources impede the implementation of activities in aged care facilities. The current study will investigate the effect of individualised activities based on the Montessori methodology administered by family carers in residential care. Methods/Design We will conduct a cluster-randomised trial to train family carers in conducting personalised one-to-one activities based on the Montessori methodology with their relatives. Montessori activities derive from the principles espoused by Maria Montessori and subsequent educational theorists to promote engagement in learning, namely task breakdown, guided repetition, progression in difficulty from simple to complex, and the careful matching of demands to levels of competence. Persons with dementia living in aged care facilities and frequently visiting family carers will be included in the study. Consented, willing participants will be randomly assigned by facility to a treatment condition using the Montessori approach or a control waiting list condition. We hypothesise that family carers conducting Montessori-based activities will experience improvements in quality of visits and overall relationship with the resident as well as higher self-rated mastery, fewer depressive symptoms, and a better quality of life than carers in the waiting list condition. Discussion We hypothesise that training family carers to deliver personalised activities to their relatives in a residential setting will make visits more satisfying and may consequently improve the quality of life for carers and their relatives. These beneficial effects might also reduce nursing staff burden and thus impact positively on residential facilities. Trial Registration Australian New Zealand Clinical Trials Registry - ACTRN12611000998943

Abstract Background The agitated behaviours that accompany dementia (e.g. pacing, aggression, calling out) are stressful to both nursing home residents and their carers and are difficult to treat. Increasingly more attention is being paid to alternative interventions that are associated with fewer risks than pharmacology. Lavandula angustifolia (lavender) has been thought, for centuries, to have soothing properties, but the existing evidence is limited and shows mixed results. The aim of the current study is to test the effectiveness of topically applied pure lavender oil in reducing actual counts of challenging behaviours in nursing home residents. Methods/Design We will use a blinded repeated measures design with random cross-over between lavender oil and placebo oil. Persons with moderate to severe dementia and associated behavioural problems living in aged care facilities will be included in the study. Consented, willing participants will be assigned in random order to lavender or placebo blocks for one week then switched to the other condition for the following week. In each week the oils will be applied on three days with at least a two-day wash out period between conditions. Trained observers will note presence of target behaviours and predominant type of affect displayed during the 30 minutes before and the 60 minutes after application of the oil. Nursing staff will apply 1 ml of 30% high strength essential lavender oil to reduce the risk of missing a true effect through under-dosing. The placebo will comprise of jojoba oil only. The oils will be identical in appearance and texture, but can easily be identified by smell. For blinding purposes, all staff involved in applying the oil or observing the resident will apply a masking cream containing a mixture of lavender and other essential oils to their upper lip. In addition, nursing staff will wear a nose clip during the few minutes it takes to massage the oil to the resident's forearms. Discussion If our results show that the use of lavender oil is effective in reducing challenging behaviours in individuals with dementia, it will potentially provide a safer intervention rather than reliance on pharmacology alone. The study's findings will translate easily to other countries and cultures. Trial Registration Australian New Zealand Clinical Trials Registry - ACTRN 12609000569202

Abstract Background The agitated behaviours that accompany dementia (e.g. pacing, aggression, calling out) are stressful to both nursing home residents and their carers and are difficult to treat. Behaviours stemming from pain, major depression or psychosis benefit from treatment with analgesics, antidepressants or antipsychotics. In other cases, psychotropic medications have limited efficacy but are used very widely. Therefore, increasingly more attention has been paid to nonpharmacological interventions which are associated with fewer risks. The aim of the current study is to test if personalised one-to-one interaction activities based on Montessori principles will reduce the frequency of behavioural symptoms of dementia significantly more than a relevant control condition. Methods/Design We will conduct a controlled trial with randomised cross-over between conditions. Persons with moderate to severe dementia and associated behavioural problems living in aged care facilities will be included in the study. Consented, willing participants will be assigned in random order to Montessori or control blocks for two weeks then switched to the other condition. Montessori activities derive from the principles espoused by Maria Montessori and subsequent educational theorists to promote engagement in learning, namely task breakdown, guided repetition, progression in difficulty from simple to complex, and the careful matching of demands to levels of competence. The control intervention consists of conversation or reading from and looking at pictures in a newspaper to control for non-specific benefits of one-to-one interaction. Presence of target behaviour will be noted as well as level of engagement and type of affect displayed. Secondary measures also include the Cohen-Mansfield Agitation Inventory and information on time and funds spend to prepare the activities. Discussion If our results show that use of Montessori activities is effective in treating challenging behaviours in individuals with dementia, it will potentially provide a safer and more enjoyable intervention rather than reliance on pharmacology alone. Trial Registration Australian New Zealand Clinical Trials Registry - ACTRN12609000564257

Objectives: One-on-one structured Montessori-based activities conducted with people with dementia can improve agitation and enhance engagement. These activities may however not always be implemented by nursing home staff. Family members may present an untapped resource for enabling these activities. This study aimed to evaluate the impact of the Montessori activities implemented by family members on visitation experiences with people who have dementia.Design: Cluster-randomized crossover design.Setting: General and psychogeriatric nursing homes in the state of Victoria, Australia.Participants: Forty participants (20 residents and 20 carers) were recruited.Intervention: During visits, family members interacted with their relative either through engaging in Montessori-based activities or reading a newspaper (the control condition) for four 30-minute sessions over 2 weeks.Measurements: Residents' predominant affect and engagement were rated for each 30-second interval using the Philadelphia Geriatric Center Affect Rating Scale and the Menorah Park Engagement Scale. The Pearlin Mastery Scale was used to rate carers satisfaction with visits. The 15-item Mutuality Scale measured the carers quality of their relationship with the resident. Carers' mood and overall quality of life were measured using the Center for Epidemiological Studies Depression Scale and Carer-QoL questionnaires, respectively.Results: Linear regressions within the generalized estimating equations approach assessed residents' and carers' outcomes. Relative to the control condition, the Montessori condition resulted in more positive engagement (b = 13.0, 95%CI 6.3-19.7, p < 0.001) and affect (b = 0.4, 95%CI 0.2-0.6, p < 0.001) for the residents and higher satisfaction with visits for carers (b = 1.7, 95%CI 0.45-3.00, p = 0.008). No correction was applied to p-values for multiple comparisons.Conclusion: This study strengthens the evidence base for the use of the Montessori programs in increasing well-being in nursing home residents. The findings also provide evidence that family members are an additional valuable resource in implementing structured activities such as the Montessori program with residents. [ABSTRACT FROM AUTHOR]

Objectives: To develop indicators of safe psychotropic prescribing practices for people with dementia and to test them in a convenience sample of six aged mental health services in Victoria, Australia. Method: The clinical records of 115 acute inpatients were checked by four trained auditors against indicators derived from three Australian health care quality and safety standards or guidelines. Indicators addressed psychotropic medication history taking; the prescribing of regular and 'as needed' psychotropics; the documentation of psychotropic adverse reactions, and discharge medication plans. Results: The most problematic areas concerned the gathering of information about patients' psychotropic prescribing histories at the point of entry to the ward and, later, the handing over on discharge of information concerning newly prescribed treatments and the reasons for ceasing medications, including adverse reactions. There were wide variations between services. Conclusion: The indicators, while drawn from current Australian guidelines, were entirely consistent with current prescribing frameworks and provide useful measures of prescribing practice for use in benchmarking and other quality improvement activities. [ABSTRACT FROM AUTHOR]

Objectives:The aim of this study was to evaluate the efficacy and acceptability of a psychological intervention based on acceptance and commitment therapy (ACT) to improve symptoms of depression and anxiety among older adults living in long-term care. Method:Forty one residents aged between 63 and 97 years (M= 85.3 years) participated in this study. Residents were allocated to receive either a 12 session ACT intervention implemented by trainee psychology therapists or a wait-list control group. Measures of depression and anxiety were collected at baseline and 8 week post-intervention, and residents who received the intervention were tracked for three months. A treatment satisfaction questionnaire was administered to residents who received the intervention and a sample of 10 facility staff members. Results:Using an intention to treat approach and controlling for baseline scores, scores on depression measures were significantly lower after the ACT intervention than after the wait-list control. These outcomes were maintained at three-month follow-up. Treatment satisfaction was rated highly by both residents and their care staff. Conclusion:This preliminary trial suggests that ACT shows promise as a therapeutic approach to address symptoms of depression in long-term care. [ABSTRACT FROM AUTHOR]