The psychological consequences of (perceived) ionizing radiation exposure: a review on its role in radiation-induced cognitive dysfunction

PURPOSE

Exposure to ionizing radiation following environmental contamination (e.g., the Chernobyl and Fukushima nuclear accidents), radiotherapy and diagnostics, occupational roles and space travel has been identified as a possible risk-factor for cognitive dysfunction. The deleterious effects of high doses (≥1.0 Gy) on cognitive functioning are fairly well-understood, while the consequences of low (≤0.1 Gy) and moderate doses (0.1-1.0 Gy) have been receiving more research interest over the past decade. In addition to any impact of actual exposure on cognitive functioning, the persistent psychological stress arising from perceived exposure, particularly following nuclear accidents, may itself impact cognitive functioning. In this review we offer a novel interdisciplinary stance on the cognitive impact of radiation exposure, considering psychological and epidemiological observations of different exposure scenarios such as atomic bombings, nuclear accidents, occupational and medical exposures while accounting for differences in dose, rate of exposure and exposure type. The purpose is to address the question that perceived radiation exposure - even where the actual absorbed dose is 0.0 Gy above background dose - can result in psychological stress, which could in turn lead to cognitive dysfunction. In addition, we highlight the interplay between the mechanisms of perceived exposure (i.e., stress) and actual exposure (i.e., radiation-induced cellular damage), in the generation of radiation-induced cognitive dysfunction. In all, we offer a comprehensive and objective review addressing the potential for cognitive defects in the context of low- and moderate-dose IR exposures.

CONCLUSIONS

Overall the evidence shows prenatal exposure to low and moderate doses to be detrimental to brain development and subsequent cognitive functioning, however the evidence for adolescent and adult low- and moderate-dose exposure remains uncertain. The persistent psychological stress following accidental exposure to low-doses in adulthood may pose a greater threat to our cognitive functioning. Indeed, the psychological implications for instructed cohorts (e.g., astronauts and radiotherapy patients) is less clear and warrants further investigation. Nonetheless, the psychosocial consequences of low- and moderate-dose exposure must be carefully considered when evaluating radiation effects on cognitive functioning, and to avoid unnecessary harm when planning public health response strategies.

The simultaneous use of three ventilatory techniques to maintain oxygenation in a patient undergoing tracheal laser resection of tumour

Patients undergoing subglottic airway surgery present a challenge to both anaesthetist and surgeon, and often a balance between surgical access and method of ventilation has to be struck. We report a case in which a 38-year-old female with a large mediastinal mass causing distal tracheal obstruction underwent tracheal laser resection. In order to maintain oxygenation throughout she required simultaneous transnasal humidified rapid-insufflation ventilatory exchange, supraglottic high-frequency jet ventilation and suprastomal manual jet ventilation through her tracheostomy stoma. Where the use of one technique alone failed, the simultaneous use of all three maintained oxygenation and facilitated surgical access for the duration of the procedure.

Health and social care practitioners' understanding of the problems of people with dementia-related visual processing impairment

It has been highlighted that health and social care staff need a greater awareness of the needs and problems of those people with young onset dementia in the UK. Symptoms of Alzheimer's disease are relatively well known (memory loss, disorientation, language difficulties and behavioural problems). However, there is less awareness of dementia-related visual processing impairments in Alzheimer's disease, Dementia with Lewy Bodies or rarer dementia syndromes such as posterior cortical atrophy (PCA), leading to delayed assessment, diagnosis and management. This qualitative study explored health and social care practitioners' opinions of the needs of people with dementia-related visual processing impairment (such as individuals with PCA) and identify any training that these practitioners might need. Social workers, occupational therapists, care home staff, rehabilitation workers (visual impairment), optometrists and admiral nurses participated in focus groups or one-to-one semi-structured interviews. All participants were shown video clips of people with dementia-related visual impairment to facilitate discussion. Sixty-one participants took part in focus groups or interviews between November 2014 and December 2015. Participants' experiences and understanding of dementia were explored and thematic analysis of the data identified two major themes. Theme 1 explores participants' understanding of dementia-related visual impairments. Theme 2 recounts how participants address and support people with dementia-related visual impairment and their families. Participants discussed, reflected and critically analysed the video clips during data collection. Most considered new perspectives of their own clients' difficulties and those participants working with people with rarer dementias consolidated their experiences. However, some participants seemed hesitant to accept the existence of visual processing impairment arising due to dementia, rationalising novel information to existing understanding of memory loss or behavioural problems. This study highlights that health and social care practitioners want more training and better understanding of less well-recognised symptoms of dementia and rarer syndromes (including PCA) to ensure appropriate, evidence-based assessment and intervention.

Understanding help-seeking in older people with urinary incontinence: an interview study

The prevalence of urinary incontinence (UI) increases with age and can negatively affect quality of life. However, relatively few older people with UI seek treatment. The aim of this study was to explore the views of older people with UI on the process of seeking help. Older people with UI were recruited to the study from three continence services in the north of England: a geriatrician-led hospital outpatient clinic (n = 18), a community-based nurse-led service (n = 22) and a consultant gynaecologist-led service specialising in surgical treatment (n = 10). Participants took part in semi-structured interviews, which were transcribed and underwent thematic content analysis. Three main themes emerged: Being brushed aside, in which participants expressed the feeling that general practitioners did not prioritise or recognise their concerns; Putting up with it, in which participants delayed seeking help for their UI due to various reasons including embarrassment, the development of coping mechanisms, perceiving UI as a normal part of the ageing process, or being unaware that help was available; and Something has to be done, in which help-seeking was prompted by the recognition that their UI was a serious problem, whether as a result of experiencing UI in public, the remark of a relative, the belief that they had a serious illness or the detection of UI during comprehensive geriatric assessment. Greater awareness that UI is a treatable condition and not a normal part of ageing is needed in the population and among health professionals. Comprehensive geriatric assessment appeared an important trigger for referral and treatment in our participants. Screening questions by healthcare professionals could be a means to identify, assess and treat older people with UI.

Food activities and identity maintenance in old age: a systematic review and meta-synthesis

OBJECTIVES

Services provided to older people should be developed based on active ageing policies. Nutrition is one aspect of active ageing, but little is known about how food activities contribute to psychological well-being in later life. This is a systematic review of qualitative and quantitative research that answers the question 'What is known about the relationship between food activities and the maintenance of identities in old age?'.

METHODS

We followed the preferred reporting items for systematic reviews and meta-analyses guidelines and used quality assessment parameters to complete a systematic review and narrative synthesis. Academic Search Premier, MEDLINE, CINAHL Plus, and PsycINFO databases were searched.

RESULTS

We initially identified 8016 articles, of which 167 full-text articles were screened for inclusion. Twenty-two articles were included in the review. There was moderate evidence from nine qualitative and two quantitative studies, of variable quality, that food activities contribute to the maintenance of women's gendered identities, the ethnic identities of men and women, and community identities. There was moderate evidence from 10 qualitative studies, of variable quality, that a change in food choice and deteriorating health changed food activity participation. These changes threatened identities. Most studies included both younger adults and older adults.

CONCLUSION

In later life, there are many life experiences leading to change. Further research is needed to develop understanding of how identity and mental well-being are maintained, despite changes in everyday activities like cooking and eating. This may enable health care professionals to meet psychological needs alongside biological needs during nutritional interventions.

Food Activities and Identity Maintenance Among Community-Living Older Adults: A Grounded Theory Study

OBJECTIVE. Engaging in food activities and maintaining identity are each important for productive aging. This study explored the role of food activities in identity maintenance among community-living older adults.

METHOD. We used a grounded theory approach to analyze data collected in semistructured interviews with 39 predominantly White, British older adults living in West London.

RESULTS. Two lifelong food identities—“food lover” and “nonfoodie”—were maintained in the processes of participation and maintenance and threat and compensation. The process change in meaning and identity explained the development of a third food identity—“not bothered”—when participants experienced being alone at the table, deteriorating health, and worry about the cost of food.

CONCLUSION. Food activities that are a pleasurable and important part of daily life contribute to the maintenance of important identities and mental well-being in older adults.

Identifying and enhancing risk thresholds in the detection of elder financial abuse: a signal detection analysis of professionals' decision making

BACKGROUND

Financial abuse of elders is an under acknowledged problem and professionals' judgements contribute to both the prevalence of abuse and the ability to prevent and intervene. In the absence of a definitive "gold standard" for the judgement, it is desirable to try and bring novice professionals' judgemental risk thresholds to the level of competent professionals as quickly and effectively as possible. This study aimed to test if a training intervention was able to bring novices' risk thresholds for financial abuse in line with expert opinion.

METHODS

A signal detection analysis, within a randomised controlled trial of an educational intervention, was undertaken to examine the effect on the ability of novices to efficiently detect financial abuse. Novices (n = 154) and experts (n = 33) judged "certainty of risk" across 43 scenarios; whether a scenario constituted a case of financial abuse or not was a function of expert opinion. Novices (n = 154) were randomised to receive either an on-line educational intervention to improve financial abuse detection (n = 78) or a control group (no on-line educational intervention, n = 76). Both groups examined 28 scenarios of abuse (11 "signal" scenarios of risk and 17 "noise" scenarios of no risk). After the intervention group had received the on-line training, both groups then examined 15 further scenarios (5 "signal" and 10 "noise" scenarios).

RESULTS

Experts were more certain than the novices, pre (Mean 70.61 vs. 58.04) and post intervention (Mean 70.84 vs. 63.04); and more consistent. The intervention group (mean 64.64) were more certain of abuse post-intervention than the control group (mean 61.41, p = 0.02). Signal detection analysis of sensitivity (A´) and bias (C) revealed that this was due to the intervention shifting the novices' tendency towards saying "at risk" (C post intervention -.34) and away from their pre intervention levels of bias (C-.12). Receiver operating curves revealed more efficient judgments in the intervention group.

CONCLUSION

An educational intervention can improve judgements of financial abuse amongst novice professionals.

Educating novice practitioners to detect elder financial abuse: a randomised controlled trial

BACKGROUND

Health and social care professionals are well positioned to identify and intervene in cases of elder financial abuse. An evidence-based educational intervention was developed to advance practitioners' decision-making in this domain. The objective was to test the effectiveness of a decision-training educational intervention on novices' ability to detect elder financial abuse. The research was funded by an E.S.R.C. grant reference RES-189-25-0334.

METHODS

A parallel-group, randomised controlled trial was conducted using a judgement analysis approach. Each participant used the World Wide Web to judge case sets at pre-test and post-test. The intervention group was provided with training after pre-test testing, whereas the control group were purely given instructions to continue with the task. 154 pre-registration health and social care practitioners were randomly allocated to intervention (n78) or control (n76). The intervention comprised of written and graphical descriptions of an expert consensus standard explaining how case information should be used to identify elder financial abuse. Participants' ratings of certainty of abuse occurring (detection) were correlated with the experts' ratings of the same cases at both stages of testing.

RESULTS

At pre-test, no differences were found between control and intervention on rating capacity. Comparison of mean scores for the control and intervention group at pre-test compared to immediate post-test, showed a statistically significant result. The intervention was shown to have had a positive moderate effect; at immediate post-test, the intervention group's ratings had become more similar to those of the experts, whereas the control's capacity did not improve. The results of this study indicate that the decision-training intervention had a positive effect on detection ability.

CONCLUSIONS

This freely available, web-based decision-training aid is an effective evidence-based educational resource. Health and social care professionals can use the resource to enhance their ability to detect elder financial abuse. It has been embedded in a web resource at http://www.elderfinancialabuse.co.uk.

The Occupational Performance Measure of Food Activities: Item Pool Development and Measurement Properties

Introduction:

Occupational therapists have the knowledge and skills to improve nutritional risk in community-living older adults by improving performance of food-related occupations. However, few tools are available to evaluate these interventions. We developed the first item pool that measures community-living older adults' occupational performance of food activities.

Method:

In Phase 1 of the research we developed an item pool within a qualitative exploratory study with five older adults. In Phase 2 we designed the Occupational Performance Measure of Food Activities. In Phase 3 we formally assessed the measurement properties of the 15-item measure, using survey responses from 77 community-living older adults. Construct validity, reliability, and utility were evaluated.

Findings:

A 13-item measure of the occupational performance of food activities showed acceptable validity and reliability in three subscales (Cronbach's α ranged from .70 to .75). The item pool demonstrated good utility. We had comparable results for administration via self-completion survey (n = 38) and interview (n = 39).

Conclusion:

This unique item pool showed promising validity and reliability for the measurement of the occupational performance of food activities. Occupational therapists are cautioned against modifying existing measurement tools without thorough testing of the resulting new measure of occupational performance.

Improving continence services for older people from the service-providers' perspective: a qualitative interview study

OBJECTIVE

To examine in depth the views and experiences of continence service leads in England on key service and continence management characteristics in order to identify and to improve our understanding of barriers to a good-quality service and potential facilitators to develop and to improve services for older people with urinary incontinence (UI).

DESIGN

Qualitative semistructured interviews using a purposive sample recruited across 16 continence services.

SETTING

3 acute and 13 primary care National Health Service Trusts in England.

PARTICIPANTS

16 continence service leads in England actively treating and managing older people with UI.

RESULTS

In terms of barriers to a good-quality service, participants highlighted a failure on the part of commissioners, managers and other health professionals in recognising the problem of UI and in acknowledging the importance of continence for older people and prevalent negative attitudes towards continence and older people. Patient assessment and continence promotion regardless of age, rather than pad provision, were identified as important steps for a good-quality service for older people with UI. More rapid and appropriate patient referral pathways, investment in service capacity, for example, more trained staff and strengthened interservice collaborations and a higher profile within medical and nurse training were specified as being important facilitators for delivering an equitable and high-quality continence service. There is a need, however, to consider the accounts given by our participants as perhaps serving the interests of their professional group within the context of interprofessional work.

CONCLUSIONS

Our data point to important barriers and facilitators of a good-quality service for older people with UI, from the perspective of continence service leads. Further research should address the views of other stakeholders, and explore options for the empirical evaluation of the effectiveness of identified service facilitators.

Successful ageing in an area of deprivation: part 1--a qualitative exploration of the role of life experiences in good health in old age

OBJECTIVES

To determine the life histories and current circumstances of healthy and unhealthy older people who share an ecology marked by relative deprivation and generally poor health.

STUDY DESIGN

In-depth interview study with a qualitative analysis.

METHODS

Matched pairs of healthy and unhealthy 'agers' were interviewed face-to-face. Healthy ageing was assessed in terms of hospital morbidity and self-reported health. Study participants consisted of 22 pairs (44 individuals), aged 72-89 years, matched for sex, age and deprivation category, and currently resident in the West of Scotland. All study participants were survivors of the Paisley/Renfrew (MIDSPAN) survey, a longitudinal study commenced in 1972 with continuous recording of morbidity and mortality since. Detailed life histories were obtained which focused on family, residence, employment, leisure and health. This information was supplemented by more focused data on 'critical incidents', financial situation and position in social hierarchies.

RESULTS

Data provided rich insights into life histories and current circumstances but no differences were found between healthy and unhealthy agers.

CONCLUSIONS

It is important to understand what differentiates individuals who have lived in circumstances characterized by relative deprivation and poor health, yet have aged healthy. This study collected rich and detailed qualitative data. Yet, no important differences were detected between healthy and unhealthy agers. This is an important negative result as it suggests that the phenomenon of healthy ageing and the factors that promote healthy ageing over a lifetime are so complex that they will require even more detailed studies to disentangle.

Successful ageing in an area of deprivation: part 2--a quantitative exploration of the role of personality and beliefs in good health in old age

OBJECTIVES

This paper presents further analysis of a study aimed at examining the determinants of good health and successful ageing in an area of deprivation. In this paper we report findings from the quantitative data related to two of the original eight research questions: (1) To what extent can health in old age be attributed to psychological/personality variables? and (2) What is the role of religious beliefs and 'spirituality' in healthy ageing?

STUDY DESIGN

In-depth interview study in which standardized measures of personality and beliefs were administered, along with measures of beliefs devised for the study.

METHODS

One hundred matched pairs of healthy and unhealthy 'agers' were interviewed face-to-face. Healthy ageing was assessed in terms of hospital morbidity and self-reported health. The sample comprised 106 males and 94 females (53 male matched pairs and 47 female matched pairs) ranging in age from 70 to 90 years of age with the majority (n=165) falling into the 71-80 age group and the remaining 35 in the 81-90 age group. All study participants were survivors of the Paisley/Renfrew (MIDSPAN) survey, a longitudinal study commenced in 1972 with continuous recording of morbidity and mortality since. Questionnaires assessing extraversion, neuroticism, psychoticism, health locus of control, sense of coherence, optimism, and religiosity were filled in by participants during the interviews.

RESULTS

Compared to the unhealthy group, the healthy participants were less neurotic, more likely to endorse an internal locus of control belief and less likely to endorse a powerful others locus of control belief, and to report a greater sense of coherence. The unhealthy group scored higher on the religiosity/spirituality measure devised for this study.

CONCLUSIONS

The findings are interesting in that, although they cannot address the issue of cause and effect, the very fact that the personality traits measured in this study were linked to health status in old age, further strengthens the argument that in general practice and hospital settings, an understanding of personality aids practitioners in dealing with patients. Finally, with the growing body of evidence that personality traits have a high degree of heritability, the routine gathering of information on personality traits would aid epidemiologists in their understanding of the determinants of healthy and successful ageing.

Speculations on the future of taught masters courses in gerontology: lessons from a comparison of England, Scotland, Finland, and Spain

Postgraduate education in gerontology is now widespread within European universities, but, even so, such developments remain very uneven. This paper outlines the variety of provision by describing Master's programmes in a sample of countries: England, Scotland, Finland, and Spain. These programmes illustrate some of the common problems: lack of funding for students, limited availability of academic staff, and reliance on a small core of dedicated teachers. They exhibit many strengths, including the breadth of curricula, high academic standards, high calibre and varied backgrounds of the students, the value of the qualification in employment, and meeting the demands of an ageing Europe. At the same time, these courses are faced with important issues about their sustainability. This paper argues that the demand for generalist courses such as gerontology taught Master's may fall in the coming years due to a combination of factors, such as employers' unwillingness to allow day release and demands by older people themselves for treatment and care by specialists. Generalist courses, this paper argues, may only survive in the biggest and best universities serving large populations and in cities able to attract overseas students.

Stabilisation of the unstable fractured zygomatic arch with a Kirschner wire

Although relatively uncommon, isolated fractures of the zygomatic arch can sometimes be difficult to stabilise following reduction. We present a simple method of stabilisation using a Kirschner wire.

The Chief Scientist reports. ... Mental health hearings for elderly people with dementia

The aim of the study reported here was to examine the feasibility of mental health hearings, modelled along the lines of the Children's Hearings, for handling legal and ethical problems that arise in managing the personal and financial affairs of elderly people with dementia. The study involved interviews with professionals, as well as a postal survey. The findings indicated that technically irregular solutions to problems were commonplace. Over half of the professionals surveyed thought that mental health hearings would help solve disputes.

The management of zygomatic complex fractures--results of a survey

A study was undertaken to investigate the current practices in the UK in the management of zygomatic complex fractures. The results are presented and discussed with reference to recent literature on the subject.

Reconstruction of the infraorbital margin with a composite microvascular free flap

A technique for reconstruction of the infraorbital bony rim and overlying soft tissues following ablative surgery is described using an osseofasciocutaneous radial forearm free flap. The advantages of this type of reconstruction are outlined.

Frontal sinus carcinoma presenting as acute sinusitis

Primary carcinoma of the frontal sinus is extremely rare. The aetiology of the tumour remains obscure, and even with rapid diagnosis and radical surgery the prognosis remains very poor.

Actinomycosis of the tongue. A diagnostic dilemma

Actinomycosis of the tongue is an uncommon form of this well known but little seen bacterial disease. A review of the literature is presented and a report of a case which is believed to be the first from the British Isles in recent years. The clinical appearance mimicked a deep seated malignant tumour with induration, limitation of tongue movement and pain. A Tru-Cut biopsy was obtained which revealed a diagnosis of actinomycosis. Treatment was with oral phenoxymethylpenicillin for 3 months.