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Hopkins RE, Bharat C, Buizen L, Close J, Ivers R, Draper B, Pearson SA, Degenhardt L, Gisev N. Age-Related Risk of Serious Fall Events and Opioid Analgesic Use. JAMA Intern Med 2024; 184:394-401. [PMID: 38373005 PMCID: PMC10877504 DOI: 10.1001/jamainternmed.2023.8154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/10/2023] [Indexed: 02/20/2024]
Abstract
Importance Opioid analgesics may be associated with increased risk of falls, particularly among older adults. Objective To quantify the age-related risk of serious fall events among adults prescribed opioids by opioid exposure, time from initiation, and daily dose. Design, Setting, and Participants This population-based cohort study conducted in New South Wales, Australia, used data linking national pharmaceutical claims to national and state datasets, including information on sociodemographic characteristics, clinical characteristics, medicines use, health services utilization, and mortality (POPPY II study). It included adults (18 years or older) who initiated prescription opioid treatment, which was defined as no prior dispensing during the preceding 365 days, between January 1, 2005, and December 31, 2018. Data were analyzed from February to June 2023. Exposure Time-dependent periods of opioid exposure were evaluated from dispensing records. Main Outcome and Measures Serious fall events identified from emergency department, hospitalization, and mortality records. Negative binomial models were used to assess associations between time-dependent opioid exposure (overall, by time from initiation, and by dose), age, and risk of fall events. Models were adjusted for known fall risk factors, including other fall risk-increasing drugs, frailty risk, and prior serious fall events. Results The cohort comprised 3 212 369 individuals who initiated prescription opioid treatment (1 702 332 women [53%]; median [IQR] age at initiation, 49 [32-65] years). Overall, 506 573 serious fall events were identified, including 5210 fatal falls. During exposure to opioids, the risk of serious fall events was elevated among all age groups; compared with the group aged 18 to 44 years, this risk was highest among those 85 years or older (adjusted incident rate ratio, 6.35; 95% CI, 6.20-6.51). Across all age groups, the first 28 days following opioid initiation was a time of increased serious fall risk; this risk increased with age. Among individuals aged 18 to 84 years, associations were identified between higher daily opioid doses and serious fall events. Conclusions and Relevance The results of this cohort study suggest that prescription opioids were associated with increased risk of serious fall events among adults of all ages, with individuals 85 years or older at greatest risk. These risks should be considered when prescribing opioids, particularly for individuals with preexisting risk factors or when opioids are prescribed at higher doses. Targeted falls prevention efforts may be most effective within the first month following opioid initiation.
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Affiliation(s)
- Ria E. Hopkins
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Luke Buizen
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jacqueline Close
- Neuroscience Research Australia, UNSW Sydney, Sydney, New South Wales, Australia
| | - Rebecca Ivers
- School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Brian Draper
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sallie-Anne Pearson
- School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia
- Menzies Centre for Health Policy, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
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Reily NM, Tang S, Batterham PJ, Aadam B, Draper B, Shand F, Han J, Nicholas A, Christensen H. Help-Seeking and Barriers to Service Use amongst Men with Past-Year Suicidal Ideation and not in Contact with Mental Health Services. Arch Suicide Res 2024; 28:482-498. [PMID: 36987997 DOI: 10.1080/13811118.2023.2190781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
OBJECTIVE Men are less likely than women to engage with formal mental health services for suicidality. We describe the sources of support, barriers to service use, and coping strategies of men with past-year suicidal ideation who are not receiving formal mental health services. METHOD Australian men experiencing past-year suicidal ideation who also did not receive formal mental health services within the past year (n = 176) completed a survey that assessed help-seeking behaviors, coping strategies and styles, use of general services, barriers to service use, and individual-level characteristics. Analyses included descriptive statistics and bivariate analyses. RESULTS The most common type of support was self-help resources, and self-reliance was the most common barrier to formal mental health service use. Most participants had seen a GP for non-mental-health-related reasons in the past year. Men who did not seek any help for their suicidality experienced lower instrumental barriers and perceived need for support, and lower levels of certain coping styles. Limitations included a cross-sectional design and small sample size. CONCLUSION The current study provides insight into the help-seeking experiences of men with past-year suicidality and not receiving formal mental health services. The findings suggest it may be helpful to improve the linkage between online and informal sources of support and evidence-based interventions.
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Lim ML, Perram A, Radford K, Close J, Draper B, Lord SR, Anstey KJ, O'Dea B, Ambrens M, Hill TY, Brown A, Miles L, Ngo M, Letton M, van Schooten KS, Delbaere K. Protocol of a 12-week eHealth programme designed to reduce concerns about falling in community-living older people: Own Your Balance randomised controlled trial. BMJ Open 2024; 14:e078486. [PMID: 38309754 PMCID: PMC10840028 DOI: 10.1136/bmjopen-2023-078486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/03/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION Concerns about falling (CaF) are common in older people and have been associated with avoidance of activities of daily life. Exercise designed to prevent falls can reduce CaF, but the effects are usually short-lived. Cognitive behavioural therapy (CBT) can reduce CaF for longer but is not readily available in the community and unlikely to prevent falls. A multidomain intervention that combines CBT, motivational interviewing and exercise could be the long-term solution to treat CaF and reduce falls in older people with CaF. This paper describes the design of a randomised controlled trial to test the effectiveness of two different 12 week self-managed eHealth programmes to reduce CaF compared with an active control. METHODS A total of 246 participants (82 per group) aged 65 and over, with substantial concerns about falls or balance will be recruited from the community. They will be randomised into: (1) myCompass-Own Your Balance (OYB) (online CBT programme) intervention or (2) myCompass-OYB plus StandingTall intervention (an eHealth balance exercise programme), both including motivational interviewing and online health education or (3) an active control group (online health education alone). The primary outcome is change in CaF over 12 months from baseline of both intervention groups compared with control. The secondary outcomes at 2, 6 and 12 months include balance confidence, physical activity, habitual daily activity, enjoyment of physical activity, social activity, exercise self-efficacy, rate of falls, falls health literacy, mood, psychological well-being, quality of life, exercise self-efficacy, programme adherence, healthcare use, user experience and attitudes towards the programme. An intention-to-treat analysis will be applied. The healthcare funder's perspective will be adopted for the economic evaluation if appropriate. ETHICS AND DISSEMINATION Ethical approval was obtained from the South Eastern Sydney Local Health District Human Research Ethics Committee (2019/ETH12840). Results will be disseminated via peer-reviewed journals, local and international conferences, community events and media releases. TRIAL REGISTRATION NUMBER ACTRN12621000440820.
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Affiliation(s)
- Mei Ling Lim
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Amy Perram
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Kylie Radford
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Jacqueline Close
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Brian Draper
- Discipline of Psychiatry and Mental Health, University of New South Wales, Randwick, New South Wales, Australia
- Eastern Suburbs Older Persons' Mental Health Service, Randwick, New South Wales, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Kaarin J Anstey
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Bridianne O'Dea
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Meghan Ambrens
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Thi-Yen Hill
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- Prince of Wales Hospital, Randwick, New South Wales, Australia
- Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Alicia Brown
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Lillian Miles
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Michelle Ngo
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Meg Letton
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Kimberley S van Schooten
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Kim Delbaere
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
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Cations M, Lang C, Draper B, Caughey GE, Evans K, Wesselingh S, Crotty M, Whitehead C, Inacio MC. Death by suicide among aged care recipients in Australia 2008-2017. Int Psychogeriatr 2023; 35:724-735. [PMID: 36803904 DOI: 10.1017/s104161022300008x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To characterize the features of aged care users who died by suicide and examine the use of mental health services and psychopharmacotherapy in the year before death. DESIGN Population-based, retrospective exploratory study. SETTING AND PARTICIPANTS Individuals who died while accessing or waiting for permanent residential aged care (PRAC) or home care packages in Australia between 2008 and 2017. MEASUREMENTS Linked datasets describing aged care use, date and cause of death, health care use, medication use, and state-based hospital data collections. RESULTS Of 532,507 people who died, 354 (0.07%) died by suicide, including 81 receiving a home care package (0.17% of all home care package deaths), 129 in PRAC (0.03% of all deaths in PRAC), and 144 approved for but awaiting care (0.23% of all deaths while awaiting care). Factors associated with death by suicide compared to death by another cause were male sex, having a mental health condition, not having dementia, less frailty, and a hospitalization for self-injury in the year before death. Among those who were awaiting care, being born outside Australia, living alone, and not having a carer were associated with death by suicide. Those who died by suicide more often accessed Government-subsidized mental health services in the year before their death than those who died by another cause. CONCLUSIONS Older men, those with diagnosed mental health conditions, those living alone and without an informal carer, and those hospitalized for self-injury are key targets for suicide prevention efforts.
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Affiliation(s)
- Monica Cations
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
- College of Education, Psychology and Social Work, Flinders University, AdelaideSA, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
| | - Brian Draper
- Discipline of Psychiatry and Mental Health, Faculty of Medicine, UNSW Sydney, SydneyAustralia
| | - Gillian E Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, AdelaideSA, Australia
| | - Keith Evans
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
| | - Steve Wesselingh
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, AdelaideSA, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, AdelaideSA, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, AdelaideSA, Australia
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Lee W, Sheehan C, Chye R, Chang S, Bayes A, Loo C, Draper B, Agar MR, Currow DC. Subcutaneous ketamine infusion in palliative patients for major depressive disorder (SKIPMDD)-Phase II single-arm open-label feasibility study. PLoS One 2023; 18:e0290876. [PMID: 37963146 PMCID: PMC10645343 DOI: 10.1371/journal.pone.0290876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 08/17/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Ketamine at subanaesthetic dosages (≤0.5mg/kg) exhibits rapid onset (over hours to days) antidepressant effects against major depressive disorder in people who are otherwise well. However, its safety, tolerability and efficacy are not known for major depressive disorder in people with advanced life-limiting illnesses. OBJECTIVE To determine the feasibility, safety, tolerability, acceptability and any antidepressant signal/activity to justify and inform a fully powered study of subcutaneous ketamine infusions for major depressive disorder in the palliative setting. METHODS This was a single arm, open-label, phase II feasibility study (Australian New Zealand Clinical Trial Registry Number-ACTRN12618001586202). We recruited adults (≥ 18-years-old) with advanced life-limiting illnesses referred to four palliative care services in Sydney, Australia, diagnosed with major depressive disorder from any care setting. Participants received weekly subcutaneous ketamine infusion (0.1-0.4mg/kg) over two hours using individual dose-titration design. Outcomes assessed were feasibility, safety, tolerability and antidepressant activity. RESULTS Out of ninety-nine referrals, ten participants received ketamine and were analysed for responses. Accrual rate was 0.54 participants/month across sites with 50% of treated participants achieving ≥ 50% reduction in baseline Montgomery-Åsberg Depression Rating Scale, meeting feasibility criteria set a priori. There were no clinically relevant harms encountered. CONCLUSIONS A future definitive trial exploring the effectiveness of subcutaneous infusion of ketamine for major depressive disorder in the palliative care setting may be feasible by addressing identified study barriers. Individual dose-titration of subcutaneous ketamine infusions over two hours from 0.1mg/kg can be well-tolerated and appears to produce transient antidepressant signals over hours to days.
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Affiliation(s)
- Wei Lee
- University of Technology Sydney, Ultimo, NSW, Australia
- St. Vincent Health Australia, Sydney, NSW, Australia
- HammondCare, Royal North Shore Hospital, St. Leonards, NSW, Australia
- University of Sydney, Northern Clinical School, St. Leonards, NSW, Australia
| | | | - Richard Chye
- University of Technology Sydney, Ultimo, NSW, Australia
- St. Vincent Health Australia, Sydney, NSW, Australia
- University of Notre Dame Australia, Fremantle, NSW, Australia
- University of New South Wales, Randwick, NSW, Australia
| | - Sungwon Chang
- University of Technology Sydney, Ultimo, NSW, Australia
| | - Adam Bayes
- University of New South Wales, Randwick, NSW, Australia
- Blackdog Institute, Hospital Road, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Colleen Loo
- University of New South Wales, Randwick, NSW, Australia
- Blackdog Institute, Hospital Road, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Brian Draper
- University of New South Wales, Randwick, NSW, Australia
| | - Meera R. Agar
- University of Technology Sydney, Ultimo, NSW, Australia
- University of New South Wales, Randwick, NSW, Australia
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Sharwood LN, Waller M, Draper B, Shand F. Exploring community mental health service use following hospital-treated intentional self-harm among older Australians: a survival analysis. Int Psychogeriatr 2023:1-10. [PMID: 37960921 DOI: 10.1017/s1041610223000959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVES This study aimed to examine the impact of community mental health (CMH) care following index hospital-treated intentional self-harm (ISH) on all-cause mortality. A secondary aim was to describe patterns of CMH care surrounding index hospital-treated ISH. DESIGN A longitudinal whole-of-population record linkage study was conducted (2014-2019), with index ISH hospitalization (Emergency Department and/or hospital admissions) linked to all available hospital, deaths/cause of death, and CMH data. SETTING Australia's most populous state, New South Wales (NSW) comprised approximately 7.7 million people during the study period. CMH services are provided statewide, to assess and treat non-admitted patients, including post-discharge review. PARTICIPANTS Individuals with an index hospital presentation in NSW of ISH during the study period, aged 45 years or older. INTERVENTION CMH care within 14 days from index, versus not. MEASUREMENTS Cox-proportionate hazards regression analysis evaluated all-cause mortality risk, adjusted for relevant covariates. RESULTS Totally, 24,544 persons aged 45 years or older experienced a nonfatal hospital-treated ISH diagnosis between 2014 and 2019. CMH care was received by 56% within 14 days from index. Survival analysis demonstrated this was associated with 34% lower risk of death, adjusted for age, sex, marital status, index diagnosis, and 14-day hospital readmission (HR 0.66, 95% CI 0.58, 0.74, p < 0.001). Older males and chronic injury conveyed significantly greater risk of death overall. CONCLUSIONS CMH care within 14 days of index presentation for self-harm may reduce the risk of all-cause mortality. Greater effort is needed to engage older males presenting for self-harm in ongoing community mental health care.
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Affiliation(s)
- Lisa N Sharwood
- Black Dog Institute, University of New South Wales, Sydney, Kensington, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- School of Engineering, University of Technology Sydney, Sydney, NSW, Australia
- School of Population Health, University of NSW, Sydney
| | | | - Brian Draper
- Eastern Suburbs Older Persons' Mental Health Service, Randwick, NSW, 2031, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales,Sydney, NSW, Australia
| | - Fiona Shand
- Black Dog Institute, University of New South Wales, Sydney, Kensington, NSW, Australia
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Walker AR, Srasuebkul P, Trollor JN, Wand APF, Draper B, Cvejic RC, Moxey A, Reppermund S. Risk factors for dementia and self-harm: A linkage study. Alzheimers Dement 2023; 19:5138-5150. [PMID: 37126409 DOI: 10.1002/alz.13080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/22/2023] [Accepted: 03/11/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION People living with dementia experience poor mental health and high rates of self-harm. We investigated risk factors for self-harm in people aged > 40 years living with dementia and risk factors for dementia after self-harm. METHODS Using linked hospital data from New South Wales, Australia, we defined a dementia cohort (n = 154,811) and a self-harm cohort (n = 28,972). Using survival analyses, we investigated predictors of self-harm for the dementia cohort, and predictors of dementia for the self-harm cohort. RESULTS We found self-harm or dementia diagnoses occurred most often within 24 months of a dementia diagnosis or initial self-harm presentation, respectively. Men living with dementia, and people with complex psychiatric profiles, had the greatest risk of self-harm. Men who had self-harmed had the greatest risk of dementia diagnoses. DISCUSSION Men and people with complex psychiatric profiles and dementia may particularly benefit from post-diagnosis mental and behavioral support to reduce risk of self-harm.
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Affiliation(s)
- Adrian R Walker
- The Department of Developmental Disability Neuropsychiatry, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Preeyaporn Srasuebkul
- The Department of Developmental Disability Neuropsychiatry, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Julian N Trollor
- The Department of Developmental Disability Neuropsychiatry, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Centre for Healthy Brain Ageing, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Anne P F Wand
- Speciality of Psychiatry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Brian Draper
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Eastern Suburbs Older Persons Mental Health Service, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Rachael C Cvejic
- The Department of Developmental Disability Neuropsychiatry, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Annette Moxey
- Dementia Australia, Griffith, Australian Capital Territory, Australia
| | - Simone Reppermund
- The Department of Developmental Disability Neuropsychiatry, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Centre for Healthy Brain Ageing, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
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Draper B. Attempted suicide in older people in New South Wales, Australia, 1870-1908. Hist Psychiatry 2023; 34:305-319. [PMID: 37119262 PMCID: PMC10443651 DOI: 10.1177/0957154x231168956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
This study examines attempted suicide in older people between 1870 and 1908 in (NSW), Australia. Statistical Registers of NSW indicate persons aged 60+ had disproportionately high rates of apprehension (10.9%) and conviction (13.0%) for attempted suicide. Newspaper reports of 110 suicide attempts in older people indicate that alcohol misuse, poor health, depression, being tired of living, financial problems, relationship difficulties, loss events and insanity were the main issues. Most were treated compassionately with medical care and support, albeit sometimes in a gaol setting. Medical casebooks of persons aged 60+ years with suicide attempts (n = 49) or suicidal ideation (n = 43) admitted to hospitals for the insane indicated that over 75% were psychotic and 50% had melancholia.
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Austin CL, Draper B, Larson KW, Thompson SJ. Biodegradable temporising matrix: use of negative pressure wound therapy shows a significantly higher success rate. J Wound Care 2023; 32:159-166. [PMID: 36930194 DOI: 10.12968/jowc.2023.32.3.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE The purpose of this case series was to evaluate the efficacy of a synthetic biodegradable temporising matrix (BTM; PolyNovo Biomaterials Pty Ltd, Australia) and compare the outcome of BTM patients with and without negative pressure wound therapy (NPWT). METHOD A retrospective chart review was conducted on patients admitted with deep full-thickness burns, traumatic or complex wound injuries treated with BTM. Electronic medical records and images were evaluated by a team of clinical professionals. Endpoints included: the measure of successful BTM integration; and comparison between patients treated with and without NPWT. Additional measures were BTM total surface area, BTM sites, timeliness of BTM application and any complications. RESULTS A total of 28 patients were evaluated and 23 (82.1%) demonstrated overall successful BTM integration. Patients treated with BTM in conjunction with NPWT (n=16) demonstrated a significantly higher (p=0.046) integration rate compared to patients treated without NPWT (n=12) (93.8% versus 58.3%, respectively). Patients treated with BTM with NPWT continued to successfully integrate and sustain favourable outcomes despite the presence of severe infection or the development of haematomas. CONCLUSION A significantly higher integration rate was demonstrated when BTM was used in conjunction with NPWT. The results of this study further support the efficacy of successful integration of BTM as a replacement for tissue loss in the treatment of deep, full-thickness burns, traumatic and complex wound injuries, and particularly favourable outcomes with the use of NPWT. To the best of our knowledge, this is the first reported case series comparing the clinical outcomes of BTM with and without the use of NPWT.
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Affiliation(s)
- Cindy L Austin
- Trauma & Burn Research, Mercy Hospital, Springfield, MO, US
| | - Brian Draper
- General & Trauma Surgery, Mercy Hospital, Springfield, MO, US
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Cvejic RC, Watkins TR, Walker AR, Reppermund S, Srasuebkul P, Draper B, Withall A, Winkler D, Honan I, Mackechnie D, Trollor J. Factors associated with discharge from hospital to residential aged care for younger people with neuropsychiatric disorders: an exploratory case-control study in New South Wales, Australia. BMJ Open 2022; 12:e065982. [PMID: 36456001 PMCID: PMC9716979 DOI: 10.1136/bmjopen-2022-065982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To examine the sociodemographic and diagnostic factors associated with a discharge from hospital to residential aged care (RAC) for younger people (aged 15-64 years) with neuropsychiatric disorders. DESIGN An exploratory case-control study using a historic cohort of people with neuropsychiatric disorders. Cases were people transferred to RAC on hospital discharge during the study period. Controls were people not transferred to RAC on discharge during the study period. SETTING Public and private hospital admissions in New South Wales (NSW), Australia. PARTICIPANTS People aged 15-64 years with a neuropsychiatric disorder hospitalised in NSW between July 2002 and June 2015 (n=5 16 469). OUTCOME MEASURES The main outcome was transferred to RAC on discharge from hospital. We calculated ORs for sociodemographic and diagnostic factors to determine factors that may impact discharge to RAC. RESULTS During the period of data capture, 4406 people were discharged from hospitals to RAC. Discharge to RAC was most strongly associated with diagnoses of progressive neurological and cognitive disorders. Acute precipitants of RAC transfer included a broad range of conditions and injuries (eg, Wernicke's encephalopathy, stroke, falls) in the context of issues such as older age, not being partnered (married or de facto), living in areas of lower socioeconomic status, functional issues and the need for palliative care. CONCLUSIONS There are multiple intersecting and interacting pathways culminating in discharge from hospital to RAC among younger people with neuropsychiatric disorders. Improved capacity for interdisciplinary home care and alternative housing and support options for people with high support needs are required.
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Affiliation(s)
- Rachael Cherie Cvejic
- Department of Developmental Disability Neuropsychiatry, UNSW Sydney, UNSW, New South Wales, Australia
| | - Tim R Watkins
- Department of Developmental Disability Neuropsychiatry, UNSW Sydney, UNSW, New South Wales, Australia
| | - Adrian R Walker
- Department of Developmental Disability Neuropsychiatry, UNSW Sydney, UNSW, New South Wales, Australia
| | - Simone Reppermund
- Department of Developmental Disability Neuropsychiatry, UNSW Sydney, UNSW, New South Wales, Australia
- Centre for Healthy Brain Ageing, UNSW Sydney, UNSW, New South Wales, Australia
| | - Preeyaporn Srasuebkul
- Department of Developmental Disability Neuropsychiatry, UNSW Sydney, UNSW, New South Wales, Australia
| | - Brian Draper
- Eastern Suburbs Older Persons Mental Health Service, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Adrienne Withall
- School of Population Health, UNSW Sydney, UNSW, New South Wales, Australia
| | - Di Winkler
- Summer Foundation, Blackburn, Victoria, Australia
- Living with Disability Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Ingrid Honan
- Cerebral Palsy Alliance, Allambie Heights, New South Wales, Australia
| | | | - Julian Trollor
- Centre for Healthy Brain Ageing, UNSW Sydney, UNSW, New South Wales, Australia
- Department of Developmental Disability Neuropsychiatry, University of New South Wales, Sydney, New South Wales, Australia
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11
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Tang S, Reily NM, Batterham PJ, Draper B, Shand F, Han J, Aadam B, Christensen H. Correlates of non-receipt of formal mental health services among Australian men experiencing thoughts of suicide. Journal of Affective Disorders Reports 2022. [DOI: 10.1016/j.jadr.2022.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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12
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Draper B. Melancholia in late life in New South Wales and Victoria, Australia, 1871-1905: symptoms, behaviours and outcomes. Hist Psychiatry 2022; 33:467-474. [PMID: 36408549 DOI: 10.1177/0957154x221117000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In the late nineteenth century, the prognosis of late-life melancholia was believed to be poor. The medical casebooks of 40 patients aged 60+years, admitted to two Hospitals for the Insane in New South Wales with melancholia between 1871 and 1905, were examined. Psychosis (87.5%), depressed mood (80%), suicidal behaviour (55%), physical ill health (55%), restlessness (50%) and fears of harm to self (50%) were identified. Main outcomes were discharge (40%) and death (37.5%). Victoria's Kew Hospital patient register for 1872-88 revealed 669 melancholia admissions with 30 aged 60+. Outcomes worsened significantly with age (chi square = 16.19, df = 4, p < 0.005), mainly due to higher mortality. Nineteenth-century late-life melancholia was a severe disorder despite many cases recovering.
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Affiliation(s)
- Brian Draper
- Discipline of Psychiatry and Mental Health, University of NSW, Sydney, and Eastern Suburbs Older Persons' Mental Health Service, Randwick, Australia
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13
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Veinovic M, Hill TY, Lavrencic L, Broe GA, Delbaere K, Donovan T, Draper B, Lasschuit D, Mann R, Sullivan K, Timbery A, Radford K. Telephone cognitive screening with older Aboriginal Australians: A preliminary study. Australas J Ageing 2022. [DOI: 10.1111/ajag.13147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/30/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | - Thi Yen Hill
- Neuroscience Research Australia Sydney New South Wales Australia
- Prince of Wales Hospital and Community Health Services Sydney New South Wales Australia
| | - Louise Lavrencic
- Neuroscience Research Australia Sydney New South Wales Australia
- University of New South Wales Sydney New South Wales Australia
- Ageing Futures Institute University of New South Wales Sydney New South Wales Australia
| | - Gerald A. Broe
- Neuroscience Research Australia Sydney New South Wales Australia
- University of New South Wales Sydney New South Wales Australia
| | - Kim Delbaere
- Neuroscience Research Australia Sydney New South Wales Australia
- University of New South Wales Sydney New South Wales Australia
- Ageing Futures Institute University of New South Wales Sydney New South Wales Australia
| | - Terrence Donovan
- Neuroscience Research Australia Sydney New South Wales Australia
| | - Brian Draper
- University of New South Wales Sydney New South Wales Australia
- Eastern Suburbs Older Persons Mental Health Service, Euroa Centre Prince of Wales Hospital Sydney New South Wales Australia
| | - Danielle Lasschuit
- Neuroscience Research Australia Sydney New South Wales Australia
- Prince of Wales Hospital and Community Health Services Sydney New South Wales Australia
| | - Rebecca Mann
- Neuroscience Research Australia Sydney New South Wales Australia
| | - Kylie Sullivan
- Neuroscience Research Australia Sydney New South Wales Australia
| | - Alison Timbery
- Neuroscience Research Australia Sydney New South Wales Australia
| | - Kylie Radford
- Neuroscience Research Australia Sydney New South Wales Australia
- University of New South Wales Sydney New South Wales Australia
- Ageing Futures Institute University of New South Wales Sydney New South Wales Australia
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14
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Day S, Couzner L, Laver KE, Withall A, Draper B, Cations M. Cross-sector learning collaboratives can improve post-diagnosis care integration for people with young onset dementia. Health Soc Care Community 2022; 30:e6135-e6144. [PMID: 36177663 DOI: 10.1111/hsc.14051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/08/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Post-diagnosis young onset dementia (YOD) care is often fragmented, with services delivered across aged care, healthcare, and social care sectors. The aim of this project was to test the feasibility and potential effectiveness of a learning collaborative implementation strategy for improving the cross-sector integration of care for people with YOD and to generate data to refine the implementation strategy for scaleup. We conducted a longitudinal mixed methods process evaluation and recruited one representative from three Australian aged care organisations, three disability care organisations and three organisations (n = 9) contracted to deliver care navigation services. One representative from each organisation joined a learning collaborative within their local area and completed a six-module online education package incorporating written resources, webinars, collaboration and expert mentoring. Participants identified gaps in services in their region and barriers to care integration and developed a shared plan to implement change. Normalisation Process Theory was applied to understand the acceptability, penetration and sustainability of the implementation strategy as well as barriers and enabling factors. Dementia knowledge measured by the Dementia Knowledge and Awareness Scale was high among the professionals at the start of the implementation period (mean = 39.67, SD = 9.84) and did not change by the end (mean = 39.67, SD = 8.23). Quantitative data demonstrated that clinicians dedicated on average half of the recommended time commitment to the project. However, qualitative data identified that the learning collaborative strategy enhanced commitment to implementing integrated care and promoted action towards integrating previously disparate care services. Participant commitment to the project was influenced by their sense of obligation to their team, and teams that established clear expectations and communication strategies early were able to collaborate and use the implementation plan more effectively (demonstrating collective action). Teams were less likely to engage in the collective action or reflexive monitoring required to improve care integration if they did not feel engaged with their learning collaborative. Learning collaboratives hold promise as a strategy to improve cross-sector service collaboration for people with YOD and their families but must maximise group cohesion and shared commitment to change.
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Affiliation(s)
- Sally Day
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Leah Couzner
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Kate E Laver
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Adrienne Withall
- School of Public Health and Community Medicine, UNSW Sydney, Adelaide, New South Wales, Australia
| | - Brian Draper
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Adelaide, New South Wales, Australia
| | - Monica Cations
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia
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15
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Cations M, Wilton-Harding B, Laver KE, Brodaty H, Low LF, Collins N, Lie D, McKellar D, Macfarlane S, Draper B. Psychiatric service delivery for older people in hospital and residential aged care: An updated systematic review. Aust N Z J Psychiatry 2022; 57:811-833. [PMID: 36317325 DOI: 10.1177/00048674221134510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To review studies reporting on the effectiveness of psychiatry service delivery for older people and people with dementia in hospital and residential aged care. METHODS A systematic search of four databases was conducted to obtain peer-reviewed literature reporting original research published since June 2004 evaluating a psychiatry service for older people (aged 60 years and over) or people with dementia in inpatient or residential aged care settings. RESULTS From the 38 included studies, there was consistent low-to-moderate quality evidence supporting the effectiveness of inpatient older persons' mental health wards (n = 14) on neuropsychiatric symptoms, mood, anxiety and quality of life. Inpatient consultation/liaison old age psychiatry services (n = 9) were not associated with improved depression, quality of life or mortality in high-quality randomised studies. However, low-quality evidence demonstrated improved patient satisfaction with care and reduced carer stress. The highest quality studies demonstrated no effect of psychiatric in-reach services to residential aged care (n = 9) on neuropsychiatric symptoms but a significant reduction in depressive symptoms among people with dementia. There was low-quality evidence that long-stay intermediate care wards (n = 6) were associated with reduced risk for dangerous behavioural incidents and reduced costs compared to residential aged care facilities. There was no effect of these units on neuropsychiatric symptoms or carer stress. CONCLUSIONS AND IMPLICATIONS The scarcity of high-quality studies examining the effectiveness of old age psychiatry services leaves providers and policy-makers to rely on low-quality evidence when designing services. Future research should consider carefully which outcomes to include, given that staff skill and confidence, length of stay, recommendation uptake, patient- and family-reported experiences, and negative outcomes (i.e. injuries, property damage) are as important as clinical outcomes.
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Affiliation(s)
- Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Bethany Wilton-Harding
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Kate E Laver
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, Discipline of Psychiatry & Mental Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia.,Discipline of Psychiatry & Mental Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Lee-Fay Low
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Noel Collins
- Great Southern Mental Health Service, Albany, WA, Australia.,West Australian Country Health Service, Albany, WA, Australia.,The Rural Clinical School of Western Australia, The University of Western Australia, Albany, WA, Australia
| | - David Lie
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia.,The University of Queensland, Brisbane, QLD, Australia
| | - Duncan McKellar
- Northern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia.,Office of the Chief Psychiatrist, SA Health, Adelaide, SA, Australia
| | - Steve Macfarlane
- Department of Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Brian Draper
- Discipline of Psychiatry & Mental Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
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16
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Lappin JM, Zahra E, Darke S, Shand F, Sharma S, Draper B, Connors MH, Dear B, Titov N, Campbell G. Presentations to the emergency department with self-harm or suicidal behaviours: A role for digital mental health services? J Psychiatr Res 2022; 154:50-55. [PMID: 35930868 DOI: 10.1016/j.jpsychires.2022.07.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/07/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022]
Abstract
UNLABELLED Emergency Department (ED) is an important site for assessing people presenting with self-harm or suicidal behaviors. Digital mental health services (DMHS) offer evidence-based interventions for mental health issues, but are often under-utilised, and information about them is rarely provided in ED. This feasibility study explored whether offering information about a DMHS to individuals presenting to ED with self-harm/suicidal behaviors resulted in self-enrolment in DMHS interventions for anxiety, depression and/or chronic pain. METHODS all individuals aged 18+ presenting with self-harm/suicidal behaviors to a metropolitan ED were screened for symptoms of anxiety, depression and/or chronic pain. Those with these symptoms were invited to participate in a study investigating enrolment with a DMHS. Study participants were provided with information about DMHS and followed up at one month. RESULTS 260 individuals presented with self-harm/suicidal behaviors over the 6-month study period. Many reported low mood (73.5%, n = 191) anxiety (67.2%, n = 174) and/or chronic pain (18.5%, n = 48). Half of those eligible for DMHS agreed at point of ED discharge to be contacted about participation in the DMHS study (51.4%, n = 108). One-third of these participated in the study (35.2%, n = 38). Rates of past-month high-risk SB (65.8%, n = 25), depression (92.1%, n = 35), anxiety (78.9%, n = 30) and chronic pain (57.9%, n = 22) were very high. Of these, 39.5% (n = 15) self-enrolled with the DMHS; almost all (80.0%, n = 13) engaged with an online intervention. CONCLUSIONS A subset of people presenting to emergency department with suicidal behaviors will engage with DMHS. Better understanding is needed of factors contributing to uptake of DMHS in this group.
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Affiliation(s)
- Julia M Lappin
- School of Psychiatry, UNSW, Australia; National Drug and Alcohol Research Centre, UNSW, Australia; South Eastern Sydney Local Health District, Australia.
| | - Emma Zahra
- National Drug and Alcohol Research Centre, UNSW, Australia
| | - Shane Darke
- National Drug and Alcohol Research Centre, UNSW, Australia
| | | | | | - Brian Draper
- School of Psychiatry, UNSW, Australia; South Eastern Sydney Local Health District, Australia
| | - Michael H Connors
- School of Psychiatry, UNSW, Australia; South Eastern Sydney Local Health District, Australia
| | - Blake Dear
- Department of Psychology, Macquarie University, Australia
| | - Nickolai Titov
- Department of Psychology, Macquarie University, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, UNSW, Australia; School of Psychology, University of Queensland, Australia
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17
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Lee W, DiGiacomo M, Draper B, Agar MR, Currow DC. A Focus Group Study of Palliative Physician and Consultation-Liaison Psychiatrist Perceptions of Dealing with Depression in the Dying. J Palliat Care 2022; 37:535-544. [PMID: 36083631 PMCID: PMC9465534 DOI: 10.1177/08258597221121453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To ascertain palliative physicians’ and
consultation-liaison psychiatrists’ perceptions of depression care processes in
patients with very poor prognoses, exploring key challenges and postulating
solutions. Methods: A qualitative focus group study involving three
1-h online focus groups (2 palliative medicine and 1 psychiatry) were conducted
between November-December 2020. Fellows and trainees were recruited from
Australian and New Zealand Society of Palliative Medicine (n = 11) and Royal
Australian and New Zealand College of Psychiatrists (n = 4). Data underwent
conventional qualitative content analysis. Results: Participants
perceived depression care to be complex and challenging. Perceived barriers
included: inadequate palliative care psychiatry skills with variation in
clinical approaches; lack of supportive health infrastructure (poor access to
required interventions and suboptimal linkage between palliative care and
psychiatry); lack of research support; and societal stigma. Suggested solutions
included integrating care processes between palliative care and psychiatry to
improve clinician training, establish supportive health systems and promote
innovative research designs. Conclusions: Developing clinician
training, supportive health systems and innovative research strategies centering
on integrating palliative care and psychiatry care processes may be integral to
optimising depression care when providing care to people with very poor
prognoses.
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Affiliation(s)
- Wei Lee
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, 110561University of Technology Sydney, Ultimo, NSW 2007, Australia.,St Vicent's Clinical School, University of New South Wales, Sydney, Australia
| | - Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, 110561University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Brian Draper
- School of Psychiatry, 7800University of New South Wales, Sydney, Australia
| | - Meera R Agar
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, 110561University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - David C Currow
- Faculty of Science, Medicine and Health, 8691University of Wollongong, Wollongong, Australia
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18
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Numbers K, Jang S, Brodaty H, Sachdev PS, Draper B, Reppermund S. Instrumental Activities of Daily Living by Subjective and Objective Measures: The Impact of Depression and Personality. Front Aging Neurosci 2022; 14:829544. [PMID: 35936773 PMCID: PMC9353936 DOI: 10.3389/fnagi.2022.829544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Previous research shows that depression and personality are independently associated with self- and informant-reports of the ability to perform instrumental activities of daily living (IADLs). However, less is known about the association between depression and personality and performance-based measures of IADLs. We aimed to determine how depression and personality predict self-and informant-reports of IADL compared to performance-based measures of IADLs in a sample of older adults with normal cognition (NC) and Mild Cognitive Impairment (MCI). Methods Participants consisted of 385 older adults with NC (n = 235), or a diagnosis of MCI (n = 150), aged between 76 and 99-years from the Sydney Memory and Ageing Study. Participants underwent comprehensive neuropsychological and clinical assessments to determine global cognition and clinical diagnoses. Personality traits were measured by the NEO Five-Factor Inventory (NEO-FFI) and depression by the Geriatric Depression Scale (GDS). Subjective IADLs were self- and informant-reported Bayer Activities of Daily Living (B-ADL) scales and objective IADL was the Sydney Test of Activities of Daily Living in Memory Disorders (STAM). Linear regressions examined the relationship between depression and personality and the three types of IADL measures, controlling for all covariates and global cognition. Results Participant-reported IADL, although associated with global cognition, was more strongly associated with GDS and NEO-FFI scores (conscientiousness and neuroticism). Informant-reported IADL was strongly associated with both global cognition and participants' GDS scores. STAM scores were not associated with participants' GDS or NEO-FFI scores; instead, they were predicted by demographics and global cognition. Conclusion These results suggest that performance-based measures of IADL may provide more objective and reliable insight into an individual's underlying functional ability and are less impacted by the participants' mood and personality compared to subjectively reported IADL. We argue that performance-based IADL measures are preferable when trying to accurately assess everyday functional ability and its relationship to cognitive status. Where performance-based measures are not available (e.g., in some clinical settings), informant ratings should be sought as they are less influenced by the participant's personality and mood compared to self-reports.
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Affiliation(s)
- Katya Numbers
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Sujin Jang
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Brian Draper
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Simone Reppermund
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Department of Developmental Disability Neuropsychiatry, Faculty of Medicine and Health, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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19
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Chen JTH, Wuthrich VM, Rapee RM, Draper B, Brodaty H, Cutler H, Low LF, Georgiou A, Johnco C, Jones M, Meuldijk D, Partington A. Improving mental health and social participation outcomes in older adults with depression and anxiety: Study protocol for a randomised controlled trial. PLoS One 2022; 17:e0269981. [PMID: 35759476 PMCID: PMC9236237 DOI: 10.1371/journal.pone.0269981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/28/2022] [Indexed: 11/22/2022] Open
Abstract
Background Increasing both the frequency and quality of social interactions within treatments for anxiety and depressive disorders in older adults may improve their mental health outcomes and quality of life. This study aims to evaluate the clinical efficacy and cost utility of an enhanced cognitive behavioural therapy (CBT) plus social participation program in a sample of older adults with depression and/or anxiety. Methods A total of 172 community-dwelling adults aged 65 years or older with an anxiety and/or depressive disorder will be randomly allocated to either an enhanced CBT plus social participation program (n = 86) or standard CBT (n = 86). Both treatments will be delivered during 12 weekly individual sessions utilising structured manuals and workbooks. Participants will be assessed at pre-treatment, post-treatment, and 12-month follow-up. The primary outcome evaluates mean change in clinician-rated diagnostic severity of anxiety and depressive disorders from baseline to post-treatment (primary endpoint) based on a semi-structured diagnostic interview. Secondary outcomes evaluate changes in symptomatology on self-report anxiety and depression measures, as well as changes in social/community participation, social network, and perceived social support, loneliness, quality of life, and use of health services. Economic benefits will be evaluated using a cost-utility analysis to derive the incremental cost utility ratios for the enhanced CBT program. Discussion Outcomes from this study will provide support for the establishment of improved psychosocial treatment for older adults with anxiety and/or depression. Study outcomes will also provide health systems with a clear means to reduce the impact of poor emotional health in older age and its associated economic burden. In addition to the empirical validation of a novel treatment, the current study will contribute to the current understanding of the role of social participation in older adult wellbeing. Trial registration Prospectively registered on the Australian New Zealand Clinical Trials Registry (ID: ACTRN12619000242123; registered 19th February 2019) and the ISRCTN registry (ID: ISRCTN78951376; registered 10th July 2019).
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Affiliation(s)
- Jessamine Tsan-Hsiang Chen
- Centre for Emotional Health, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- * E-mail:
| | - Viviana M. Wuthrich
- Centre for Emotional Health, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Ronald M. Rapee
- Centre for Emotional Health, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Brian Draper
- Older Persons’ Mental Health Services, Prince of Wales Hospital, Sydney, New South Wales, Australia
- Centre of Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Henry Brodaty
- Older Persons’ Mental Health Services, Prince of Wales Hospital, Sydney, New South Wales, Australia
- Centre of Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Henry Cutler
- Macquarie Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | - Lee-Fay Low
- Ageing, Work and Health Research Unit, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Carly Johnco
- Centre for Emotional Health, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Michael Jones
- Centre for Emotional Health, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Denise Meuldijk
- Centre for Emotional Health, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Partington
- Macquarie Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
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20
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Draper B. G Vernon Davies: unsung pioneer of old age psychiatry in Victoria. Australas Psychiatry 2022; 30:203-205. [PMID: 34748713 DOI: 10.1177/10398562211045085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To provide a biography of G Vernon Davies who took up a career in old age psychiatry in 1955 at the age of 67 at Mont Park Hospital in an era when there few psychiatrists working in the field. CONCLUSION In the 1950s and 1960s, Vernon Davies worked as an old age psychiatrist and published papers containing sensible practical advice informed by contemporary research and experience, broadly applicable to both primary and secondary care, presented in a compassionate and empathetic manner. His clinical research in old age psychiatry resulted in the first doctoral degree in psychiatry awarded at the University of Melbourne at the age of 79. Before commencing old age psychiatry, he served in the Australian Army Medical Corps as a Regimental Medical Officer and received the Distinguished Service Order. He spent 3 years as a medical missionary in the New Hebrides before settling at Wangaratta where he worked as a physician for over 30 years. He contributed to his local community in a broad range of activities. Vernon Davies is an Australian pioneer of old age psychiatry.
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Affiliation(s)
- Brian Draper
- School of Psychiatry, University of NSW, Sydney, Australia.,Eastern Suburbs Older Persons Mental Health Service, Randwick, NSW Australia
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21
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Tang S, Reily NM, Arena AF, Sheanoda V, Han J, Draper B, Batterham PJ, Mackinnon AJ, Christensen H. Predictors of not receiving mental health services among people at risk of suicide: A systematic review. J Affect Disord 2022; 301:172-188. [PMID: 35032506 DOI: 10.1016/j.jad.2022.01.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/12/2021] [Accepted: 01/11/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND The majority of people who die by suicide are unknown to formal mental health services. The current review identified predictors of non-receipt of mental health services among individuals experiencing suicidal thoughts or behaviours. Such data provides insight into the needs and preferences of these individuals and inform improvements to existing services. METHODS PsycInfo, PubMed/Medline, CINAHL, and Web of Science were systematically searched from 1st January 1980 up to 20th September 2021. Included studies examined predictors of not receiving formal mental health services among people at risk of suicide. Study quality was assessed by adapting the Joanna-Briggs Institute Checklist for Analytical Cross-Sectional Studies. Findings were presented with narrative synthesis. PROSPERO registration: CRD42021256795. RESULTS Included studies (n = 35, sample range = 46-19,243) were predominately conducted in the United States. Non-receipt of services in nationally representative studies was varied (25.7-91.8%). Results indicate that non-receipt of mental health services among people with suicidality is associated with minority ethnicity, better perceived general health, lower psychological distress, lower severity of suicidality, no mental health diagnosis, lower perceived need for treatment and lower use of medical services. LIMITATIONS Limitations included few studies conducted in low-middle income countries, limited literature on key predictors of interest, and exclusion of informal sources of support. CONCLUSION Individuals with suicidality who are unknown to mental health services have diverse attributes. For some, non-use of services may result from low suicidal distress and perceived need for treatment. Further research is needed to understand why these predictors are associated with service non-use.
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Affiliation(s)
| | | | | | | | - Jin Han
- Black Dog Institute, UNSW Sydney, NSW, Australia
| | - Brian Draper
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, NSW, Australia
| | - Philip J Batterham
- Black Dog Institute, UNSW Sydney, NSW, Australia; Centre for Mental Health Research, Research School of Population Health, Australian National University, Canberra, ACT, Australia
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22
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Lee W, Pulbrook M, Sheehan C, Kochovska S, Chang S, Hosie A, Lobb E, Draper B, Agar MR, Currow DC. Evidence of Effective Interventions for Clinically Significant Depressive Symptoms in Individuals with Extremely Short Prognoses Is Lacking: A Systematic Review. J Palliat Med 2022; 25:341-342. [PMID: 35230902 DOI: 10.1089/jpm.2021.0594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Wei Lee
- University of Technology Sydney, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Ultimo, New South Wales, Australia.,St Vincent's Health Network Sydney, Sydney, New South Wales, Australia
| | - Marley Pulbrook
- St Vincent's Health Network Sydney, Sydney, New South Wales, Australia
| | | | - Slavica Kochovska
- University of Technology Sydney, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Ultimo, New South Wales, Australia
| | - Sungwon Chang
- University of Technology Sydney, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Ultimo, New South Wales, Australia
| | - Annmarie Hosie
- University of Technology Sydney, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Ultimo, New South Wales, Australia.,St Vincent's Health Network Sydney, Sydney, New South Wales, Australia.,The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
| | - Elizabeth Lobb
- Calvary Hospital, Kogarah, New South Wales, Australia.,The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
| | - Brian Draper
- School of Psychiatry, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Meera R Agar
- University of Technology Sydney, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Ultimo, New South Wales, Australia
| | - David C Currow
- University of Technology Sydney, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Ultimo, New South Wales, Australia
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23
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Abstract
OBJECTIVE Post-diagnosis service delivery for young-onset dementia (with onset prior to 65 years) recently moved to the disability system in an attempt to address systemic barriers to best practice in aged care. The objective of this study was to examine experiences and satisfaction with disability services so far among people with young-onset dementia and their care partners and identify strategies for service and system improvement. METHODS The 151 participating Australians living with young-onset dementia or providing informal care to a person with young-onset dementia were recruited via social media, advocacy bodies and specialist medical clinics. A cross-sectional online survey asked participants to provide a timeline of their interactions with the disability system so far and rate their satisfaction with the disability system, aged care and disability services. RESULTS Participants reported a mean age at symptom onset of 55 years. In all, 53% were diagnosed with Alzheimer's disease and 25% were diagnosed with frontotemporal dementia. Sixty percent had received an approved plan from the National Disability Insurance Scheme, although 3% were rejected. More than 27% waited longer than 6 months to receive their plan, and half waited at least a month post-approval to access services. Less than 30% agreed that the National Disability Insurance Scheme understands dementia, and fewer than half felt that the process of accessing National Disability Insurance Scheme funding is easy and fast enough. Nonetheless, respondents remained overwhelmingly in favour of young-onset dementia services remaining in the disability system rather than in aged care. CONCLUSIONS While people with young-onset dementia and their care partners strongly agree with their inclusion in the National Disability Insurance Scheme, a relatively low level of experience with dementia in the disability workforce and a lack of integration with the healthcare and aged care systems continue to create important barriers for accessing the services they need.
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Affiliation(s)
- Monica Cations
- College of Education, Social Work and Psychology, Flinders University, Adelaide, SA, Australia
| | - Sally Day
- College of Education, Social Work and Psychology, Flinders University, Adelaide, SA, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Adrienne Withall
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Brian Draper
- School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
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24
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Lavrencic LM, Delbaere K, Broe GA, Daylight G, Draper B, Cumming RG, Garvey G, Allan W, Hill TY, Lasschuit D, Schofield PR, Radford K. Dementia Incidence, APOE Genotype, and Risk Factors for Cognitive Decline in Aboriginal Australians: A Longitudinal Cohort Study. Neurology 2022; 98:e1124-e1136. [PMID: 35140131 DOI: 10.1212/wnl.0000000000013295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/17/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Aboriginal Australians are disproportionately affected by dementia, with incidence in remote populations approximately double non-Indigenous populations. This study aimed to identify dementia incidence and risk factors in Aboriginal Australians residing in urban areas, which are currently unknown. METHODS A population-based cohort of Aboriginal Australians aged 60+ was assessed at baseline and 6-year follow-up. Life-course risk factors (baseline) were examined for incident dementia or mild cognitive impairment (MCI) using logistic regression analyses; adjustments were made for age. APOE genotyping was available for 86 people. RESULTS Data were included from 155 participants aged 60-86 years (mean=65.70, SD=5.65; 59 male). There were 16 incident dementia cases (age-standardised rate 35.97/1,000 person-years, 95% CI 18.34-53.60); and 36 combined incident MCI and dementia cases. Older age (OR 2.29, 1.42-3.70), male sex (OR 4.14, 1.60-10.77), unskilled work history (OR 5.09, 1.95-13.26), polypharmacy (OR 3.11, 1.17-8.28), and past smoking (OR 0.24, 0.08-0.75) were associated with incident MCI/dementia in the final model. APOE ε4 allele frequency was 24%; heterozygous or homozygous ε4 was associated with incident MCI/dementia (bivariate OR 3.96, 1.25-12.50). DISCUSSION These findings provide the first evidence for higher dementia incidence in Aboriginal Australians from urban areas, where the majority of Aboriginal people reside. This study also sheds light on sociodemographic, health and genetic factors associated with incident MCI/dementia at older ages in this population, which is critical for targeted prevention strategies.
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Affiliation(s)
- Louise M Lavrencic
- Neuroscience Research Australia, Randwick, NSW, Australia 2031 .,University of New South Wales, Sydney, NSW, Australia 2052.,Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia 2052
| | - Kim Delbaere
- Neuroscience Research Australia, Randwick, NSW, Australia 2031.,University of New South Wales, Sydney, NSW, Australia 2052.,Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia 2052
| | - Gerald A Broe
- Neuroscience Research Australia, Randwick, NSW, Australia 2031.,University of New South Wales, Sydney, NSW, Australia 2052.,Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia 2052
| | - Gail Daylight
- Neuroscience Research Australia, Randwick, NSW, Australia 2031
| | - Brian Draper
- University of New South Wales, Sydney, NSW, Australia 2052.,Prince of Wales Hospital, Randwick, NSW, Australia 2031
| | - Robert G Cumming
- School of Public Health, University of Sydney, Camperdown, NSW, Australia 2006
| | - Gail Garvey
- Menzies School of Health Research, Brisbane, QLD, Australia 4000
| | - Wendy Allan
- Neuroscience Research Australia, Randwick, NSW, Australia 2031
| | - Thi Yen Hill
- Neuroscience Research Australia, Randwick, NSW, Australia 2031.,Prince of Wales Hospital, Randwick, NSW, Australia 2031
| | - Danielle Lasschuit
- Neuroscience Research Australia, Randwick, NSW, Australia 2031.,Prince of Wales Hospital, Randwick, NSW, Australia 2031
| | - Peter R Schofield
- Neuroscience Research Australia, Randwick, NSW, Australia 2031.,University of New South Wales, Sydney, NSW, Australia 2052
| | - Kylie Radford
- Neuroscience Research Australia, Randwick, NSW, Australia 2031.,University of New South Wales, Sydney, NSW, Australia 2052.,Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia 2052
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25
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Lee W, Chang S, DiGiacomo M, Draper B, Agar MR, Currow DC. Caring for depression in the dying is complex and challenging - survey of palliative physicians. BMC Palliat Care 2022; 21:11. [PMID: 35034640 PMCID: PMC8761382 DOI: 10.1186/s12904-022-00901-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is prevalent in people with very poor prognoses (days to weeks). Clinical practices and perceptions of palliative physicians towards depression care have not been characterised in this setting. The objective of this study was to characterise current palliative clinicians' reported practices and perceptions in depression screening, assessment and management in the very poor prognosis setting. METHODS In this cross-sectional cohort study, 72 palliative physicians and 32 psychiatrists were recruited from Australian and New Zealand Society of Palliative Medicine and Royal Australian and New Zealand College of Psychiatrists between February and July 2020 using a 23-item anonymous online survey. RESULTS Only palliative physicians results were reported due to poor psychiatry representation. Palliative physicians perceived depression care in this setting to be complex and challenging. 40.0% reported screening for depression. All experienced uncertainty when assessing depression aetiology. Approaches to somatic symptom assessment varied. Physicians were generally less likely to intervene for depression than in the better prognosis setting. Most reported barriers to care included the perceived lack of rapidly effective therapeutic options (77.3%), concerns of patient burden and intolerance (71.2%), and the complexity in diagnostic differentiation (53.0%). 66.7% desired better collaboration between palliative care and psychiatry. CONCLUSIONS Palliative physicians perceived depression care in patients with very poor prognoses to be complex and challenging. The lack of screening, variations in assessment approaches, and the reduced likelihood of intervening in comparison to the better prognosis setting necessitate better collaboration between palliative care and psychiatry in service delivery, training and research.
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Affiliation(s)
- Wei Lee
- University of Technology Sydney, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Ultimo, NSW, 2007, Australia.
- St Vincent's Clinical School, University of New South Wales, 390 Victoria St, Darlinghurst, NSW, 2010, Australia.
| | - Sungwon Chang
- University of Technology Sydney, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Ultimo, NSW, 2007, Australia
| | - Michelle DiGiacomo
- University of Technology Sydney, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Ultimo, NSW, 2007, Australia
| | - Brian Draper
- School of Psychiatry, University of New South Wales Sydney, Sydney, NSW, 2052, Australia
| | - Meera R Agar
- University of Technology Sydney, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Ultimo, NSW, 2007, Australia
| | - David C Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia
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26
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Couzner L, Day S, Draper B, Withall A, Laver KE, Eccleston C, Elliott KE, McInerney F, Cations M. What do health professionals need to know about young onset dementia? An international Delphi consensus study. BMC Health Serv Res 2022; 22:14. [PMID: 34974838 PMCID: PMC8722147 DOI: 10.1186/s12913-021-07411-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/13/2021] [Indexed: 12/12/2022] Open
Abstract
Background People with young onset dementia (YOD) have unique needs and experiences, requiring care and support that is timely, appropriate and accessible. This relies on health professionals possessing sufficient knowledge about YOD. This study aims to establish a consensus among YOD experts about the information that is essential for health professionals to know about YOD. Methods An international Delphi study was conducted using an online survey platform with a panel of experts (n = 19) on YOD. In round 1 the panel individually responded to open-ended questions about key facts that are essential for health professionals to understand about YOD. In rounds 2 and 3, the panel individually rated the collated responses in terms of their importance in addition to selected items from the Dementia Knowledge Assessment Scale. The consensus level reached for each statement was calculated using the median, interquartile range and percentage of panel members who rated the statement at the highest level of importance. Results The panel of experts were mostly current or retired clinicians (57%, n = 16). Their roles included neurologist, psychiatrist and neuropsychiatrist, psychologist, neuropsychologist and geropsychologist, physician, social worker and nurse practitioner. The remaining respondents had backgrounds in academia, advocacy, or other areas such as law, administration, homecare or were unemployed. The panel reached a high to very high consensus on 42 (72%) statements that they considered to be important for health professionals to know when providing care and services to people with YOD and their support persons. Importantly the panel agreed that health professionals should be aware that people with YOD require age-appropriate care programs and accommodation options that take a whole-family approach. In terms of identifying YOD, the panel agreed that it was important for health professionals to know that YOD is aetiologically diverse, distinct from a mental illness, and has a combination of genetic and non-genetic contributing factors. The panel highlighted the importance of health professionals understanding the need for specialised, multidisciplinary services both in terms of diagnosing YOD and in providing ongoing support. The panel also agreed that health professionals be aware of the importance of psychosocial support and non-pharmacological interventions to manage neuropsychiatric symptoms. Conclusions The expert panel identified information that they deem essential for health professionals to know about YOD. There was agreement across all thematic categories, indicating the importance of broad professional knowledge related to YOD identification, diagnosis, treatment, and ongoing care. The findings of this study are not only applicable to the delivery of support and care services for people with YOD and their support persons, but also to inform the design of educational resources for health professionals who are not experts in YOD.
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Affiliation(s)
- Leah Couzner
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Sally Day
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Brian Draper
- School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia
| | - Adrienne Withall
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Kate E Laver
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | | | | | | | - Monica Cations
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia. .,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
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27
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Strutt PA, Barnier AJ, Savage G, Picard G, Kochan NA, Sachdev P, Draper B, Brodaty H. Hearing loss, cognition, and risk of neurocognitive disorder: evidence from a longitudinal cohort study of older adult Australians. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2022; 29:121-138. [PMID: 33371769 DOI: 10.1080/13825585.2020.1857328] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Addressing midlife hearing loss could prevent up to 9% of new cases of dementia, the highest of any potentially modifiable risk factor identified in the 2017 commissioned report in The Lancet. In Australia, hearing loss is the second-most common chronic health condition in older people, affecting 74% of people aged over 70. Estimates indicate that people with severe hearing loss are up to 5-times more likely to develop dementia, but these estimates vary between studies due to methodological limitations. Using data from the Sydney Memory and Aging Study, in which 1,037 Australian men and women aged between 70 and 90 years were enrolled and completed biennial assessments from 2005-2017, investigations between hearing loss and baseline cognitive performance as well as longitudinal risk of neurocognitive disorder were undertaken. Individuals who reported moderate-to-severe hearing difficulties had poorer cognitive performances in the domains of Attention/Processing Speed and Visuospatial Ability, and on an overall index of Global Cognition, and had a 1.5-times greater risk for the neurocognitive disorder during 6-years' follow-up. Hearing loss independently predicted risk for MCI but not dementia. The presence of hearing loss is an important consideration for neuropsychological case formulation in older adults with cognitive impairment. Hearing loss may increase cognitive load, resulting in observable cognitive impairment on neuropsychological testing. Individuals with hearing loss who demonstrate impairment in non-amnestic domains may experience benefits from the provision of hearing devices; This study provides support for a randomized control trial of hearing devices for improvement of cognitive function in this group.
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Affiliation(s)
- Paul A Strutt
- Department of Cognitive Science, Macquarie University, Sydney, Australia.,Centre for Ageing, Cognition, and Wellbeing, Macquarie University, Sydney, Australia
| | - Amanda J Barnier
- Department of Cognitive Science, Macquarie University, Sydney, Australia.,Centre for Ageing, Cognition, and Wellbeing, Macquarie University, Sydney, Australia
| | - Greg Savage
- Centre for Ageing, Cognition, and Wellbeing, Macquarie University, Sydney, Australia.,Department of Psychology, Macquarie University, Sydney, Australia
| | - Gabrielle Picard
- Centre for Ageing, Cognition, and Wellbeing, Macquarie University, Sydney, Australia.,Department of Psychology, Macquarie University, Sydney, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia.,Neuropsychiatric Institute, The Prince of Wales Hospital, Randwick, Australia
| | - Brian Draper
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
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28
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Day S, Roberts S, Launder NH, Goh AMY, Draper B, Bahar-Fuchs A, Loi SM, Laver K, Withall A, Cations M. Age of Symptom Onset and Longitudinal Course of Sporadic Alzheimer's Disease, Frontotemporal Dementia, and Vascular Dementia: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2021; 85:1819-1833. [PMID: 34958038 DOI: 10.3233/jad-215360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Understanding how the age of dementia symptom onset affects the longitudinal course of dementia can assist with prognosis and care planning. OBJECTIVE To synthesize evidence regarding the relationship of age of symptom onset with the longitudinal course of sporadic Alzheimer's disease (AD), vascular dementia (VaD), and frontotemporal dementia (FTD). METHODS We searched Medline, CINAHL, Embase, PsycINFO, PubMed, and Scopus for longitudinal studies that examined the impact of sporadic AD, VaD, or FTD symptom onset age on measures of cognition, function, or behavioral symptoms. Studies that examined age at diagnosis only were excluded. Quantitative meta-analysis was conducted where studies reported sufficient data for pooling. RESULTS Thirty studies met all inclusion criteria (people with AD (n = 26), FTD (n = 4)) though no studies examined VaD. Earlier onset of AD was associated with more rapid annual cognitive decline (estimate = -0.07; 95% CI -0.14 to 0.00; p = 0.045). Most studies that stratified their sample reported that younger AD onset (usually < 65 years) was associated with more rapid cognitive decline. Other evidence was inconclusive. CONCLUSION Younger people with AD appear to have a poorer prognosis in terms of faster cognitive decline than older people with AD. More research is required to determine the impact of symptom onset age in VaD and FTD, and on functional decline in all dementias.
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Affiliation(s)
- Sally Day
- College of Education, Psychology and Social Work, Flinders University, Adelaide SA, Australia
| | - Stefanie Roberts
- Department of Psychiatry, The University of Melbourne, Melbourne VIC, Australia.,National Ageing Research Institute, Melbourne VIC, Australia
| | - Nathalie H Launder
- Department of Psychiatry, The University of Melbourne, Melbourne VIC, Australia
| | - Anita M Y Goh
- Department of Psychiatry, The University of Melbourne, Melbourne VIC, Australia.,National Ageing Research Institute, Melbourne VIC, Australia
| | - Brian Draper
- School of Psychiatry, UNSW Sydney, New South Wales, Australia
| | - Alex Bahar-Fuchs
- Department of Psychiatry, The University of Melbourne, Melbourne VIC, Australia
| | - Samantha M Loi
- Department of Psychiatry, The University of Melbourne, Melbourne VIC, Australia.,Neuropsychiatry, Royal Melbourne Hospital, Parkville VIC, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Adrienne Withall
- School of Population Health, UNSW Sydney, New South Wales, Australia.,Ageing Futures Institute, UNSW Sydney, New South Wales, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide SA, Australia
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29
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Veinovic M, Hill TY, Lavrencic L, Lasschuit D, Broe GA, Delbaere K, Draper B, Garvey G, Radford K. Telephone cognitive screening with older aboriginal Australians: A preliminary study. Alzheimers Dement 2021. [DOI: 10.1002/alz.055849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Thi Yen Hill
- Neuroscience Research Australia Sydney NSW Australia
- Prince of Wales Hospital Randwick NSW Australia
| | - Louise Lavrencic
- Neuroscience Research Australia Sydney NSW Australia
- UNSW Ageing Futures Institute Sydney NSW Australia
- University of New South Wales Sydney NSW Australia
| | - Danielle Lasschuit
- Neuroscience Research Australia Sydney NSW Australia
- Prince of Wales Hospital Randwick NSW Australia
| | - Gerald A Broe
- Neuroscience Research Australia Sydney NSW Australia
- UNSW Ageing Futures Institute Sydney NSW Australia
- University of New South Wales Sydney NSW Australia
| | - Kim Delbaere
- Neuroscience Research Australia Sydney NSW Australia
- UNSW Ageing Futures Institute Sydney NSW Australia
- University of New South Wales Sydney NSW Australia
| | - Brian Draper
- Centre for Healthy Brain Ageing (CHeBA), UNSW Sydney NSW Australia
| | - Gail Garvey
- Menzies School of Health Research Brisbane QLD Australia
| | - Kylie Radford
- Neuroscience Research Australia Sydney NSW Australia
- UNSW Ageing Futures Institute Sydney NSW Australia
- University of New South Wales Sydney NSW Australia
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30
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Draper B. Older people in hospitals for the insane in New South Wales, Australia, 1849-1905. Hist Psychiatry 2021; 32:436-448. [PMID: 34269082 DOI: 10.1177/0957154x211029479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Older people had high admission rates to hospitals for the insane in New South Wales, Australia, in the second half of the nineteenth century. The medical casebooks of 226 patients aged 60 years and over admitted to two hospitals for the insane between 1849 and 1905 were examined. Aggressive behaviour (35.4%), suicidal behaviour (23.9%), fears of harm to self (19.9%) and alcohol issues (13.7%) were identified. Physical health factors (35.8%), functional impairment (18.6%) and poor nourishment (8.8%) were noted. Common diagnoses were mania (36.7%), dementia (31.9%) and melancholia (17.7%). Twenty-first-century diagnoses were assigned in nearly 94 per cent of cases with concordance that varied by diagnosis. The majority of admissions had serious mental disorders, with only 29.6 per cent being discharged.
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Affiliation(s)
- Brian Draper
- School of Psychiatry, University of NSW, Sydney, Australia
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31
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Lavrencic L, Broe GA, Daylight G, Delbaere K, Draper B, Duma S, Fulham M, Hill TY, Lasschuit D, Piguet O, Poulos L, Rae C, Timbery A, Radford K. Developing a protocol for neuroimaging to investigate brain ageing and dementia in collaboration with aboriginal Australian communities. Alzheimers Dement 2021. [DOI: 10.1002/alz.051947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Louise Lavrencic
- Neuroscience Research Australia Sydney NSW Australia
- UNSW Ageing Futures Institute Sydney NSW Australia
- University of New South Wales Sydney NSW Australia
| | - Gerald A. Broe
- Neuroscience Research Australia Sydney NSW Australia
- UNSW Ageing Futures Institute Sydney NSW Australia
- University of New South Wales Sydney NSW Australia
| | - Gail Daylight
- Neuroscience Research Australia Sydney NSW Australia
| | - Kim Delbaere
- Neuroscience Research Australia Sydney NSW Australia
- UNSW Ageing Futures Institute Sydney NSW Australia
- University of New South Wales Sydney NSW Australia
| | - Brian Draper
- University of New South Wales Sydney NSW Australia
- Prince of Wales Hospital Sydney Australia
- Centre for Healthy Brain Ageing (CHeBA) UNSW Sydney NSW Australia
| | | | - Michael Fulham
- Royal Prince Alfred Hospital Camperdown NSW Australia
- University of Sydney Sydney NSW Australia
| | - Thi Yen Hill
- Neuroscience Research Australia Sydney NSW Australia
- Prince of Wales Hospital Randwick NSW Australia
| | - Danielle Lasschuit
- Neuroscience Research Australia Sydney NSW Australia
- Prince of Wales Hospital Randwick NSW Australia
| | - Olivier Piguet
- The University of Sydney Brain & Mind Centre Sydney NSW Australia
| | - Lauren Poulos
- Neuroscience Research Australia Sydney NSW Australia
| | - Caroline Rae
- Neuroscience Research Australia Sydney NSW Australia
- University of New South Wales Sydney NSW Australia
| | | | - Kylie Radford
- Neuroscience Research Australia Sydney NSW Australia
- UNSW Ageing Futures Institute Sydney NSW Australia
- University of New South Wales Sydney NSW Australia
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32
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Lavrencic L, Yong Z, Daylight G, Broe GA, Draper B, Radford K. Behavioural and psychological symptoms of dementia in aboriginal australians. Alzheimers Dement 2021. [DOI: 10.1002/alz.055105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Louise Lavrencic
- UNSW Ageing Futures Institute Sydney NSW Australia
- University of New South Wales Sydney NSW Australia
- Neuroscience Research Australia Sydney NSW Australia
| | | | - Gail Daylight
- Neuroscience Research Australia Sydney NSW Australia
| | - Gerald A Broe
- UNSW Ageing Futures Institute Sydney NSW Australia
- University of New South Wales Sydney NSW Australia
- Neuroscience Research Australia Sydney NSW Australia
| | - Brian Draper
- University of New South Wales Sydney NSW Australia
- Prince of Wales Hospital Sydney Australia
- Centre for Healthy Brain Ageing (CHeBA), UNSW Sydney NSW Australia
| | - Kylie Radford
- UNSW Ageing Futures Institute Sydney NSW Australia
- University of New South Wales Sydney NSW Australia
- Neuroscience Research Australia Sydney NSW Australia
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Abstract
BACKGROUND Medical practitioners experience high levels of mental disorders but may be reluctant to seek care. AIMS To determine medical practitioner attitudes towards other doctors with anxiety/depression, barriers to seeking mental healthcare, treatments received for depression and the effects of age. METHODS Data from the National Mental Health Survey of Doctors and Medical Students, conducted in Australia, were analysed (N = 10 038 medical practitioners). Attitudes to anxiety/depression were assessed with 12 statements (total stigma score, range 12-60). Barriers to seeking professional help, and coping strategies used, for anxiety/depression were measured. Practitioners with a history of depression were asked what personal supports and treatments were received. Practitioners were compared by age-younger (40 years and younger), middle-aged (41-60) and older (61+). RESULTS Attitudes and help-seeking behaviours varied with age. Older doctors had a more positive outlook and less total stigma, with the exception that they believed a doctor with anxiety/depression was less reliable. Younger practitioners were most likely to report barriers, such as confidentiality, impact on career progression and registration, to seeking help. For practitioners with depression, counselling and counselling plus medication were most likely to be received by the younger and middle-aged groups, whereas medication alone was most likely to be received by the middle-aged and older groups. CONCLUSIONS Stigmatizing attitudes towards mental disorder and barriers to help-seeking remain prevalent within the medical profession. Our results suggest doctors' health programs should address mental health stigma in younger practitioners and facilitate education about psychological treatments in older practitioners.
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Affiliation(s)
- C Wijeratne
- Sydney School of Medicine, University of Notre Dame Australia, Sydney, New South Wales 2010, Australia.,School of Psychiatry, University of New South Wales 2052, Sydney, New South Wales, Australia
| | - C Johnco
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales 2109, Australia.,Centre for Cognition, Ageing and Wellbeing, Macquarie University, Sydney, New South Wales 2052, Australia
| | - B Draper
- School of Psychiatry, University of New South Wales 2052, Sydney, New South Wales, Australia
| | - J Earl
- Centre for Cognition, Ageing and Wellbeing, Macquarie University, Sydney, New South Wales 2052, Australia
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Haber PS, Riordan BC, Winter DT, Barrett L, Saunders J, Hides L, Gullo M, Manning V, Day CA, Bonomo Y, Burns L, Assan R, Curry K, Mooney-Somers J, Demirkol A, Monds L, McDonough M, Baillie AJ, Clark P, Ritter A, Quinn C, Cunningham J, Lintzeris N, Rombouts S, Savic M, Norman A, Reid S, Hutchinson D, Zheng C, Iese Y, Black N, Draper B, Ridley N, Gowing L, Stapinski L, Taye B, Lancaster K, Stjepanović D, Kay-Lambkin F, Jamshidi N, Lubman D, Pastor A, White N, Wilson S, Jaworski AL, Memedovic S, Logge W, Mills K, Seear K, Freeburn B, Lea T, Withall A, Marel C, Boffa J, Roxburgh A, Purcell-Khodr G, Doyle M, Conigrave K, Teesson M, Butler K, Connor J, Morley KC. New Australian guidelines for the treatment of alcohol problems: an overview of recommendations. Med J Aust 2021; 215 Suppl 7:S3-S32. [PMID: 34601742 DOI: 10.5694/mja2.51254] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022]
Abstract
OF RECOMMENDATIONS AND LEVELS OF EVIDENCE Chapter 2: Screening and assessment for unhealthy alcohol use Screening Screening for unhealthy alcohol use and appropriate interventions should be implemented in general practice (Level A), hospitals (Level B), emergency departments and community health and welfare settings (Level C). Quantity-frequency measures can detect consumption that exceeds levels in the current Australian guidelines (Level B). The Alcohol Use Disorders Identification Test (AUDIT) is the most effective screening tool and is recommended for use in primary care and hospital settings. For screening in the general community, the AUDIT-C is a suitable alternative (Level A). Indirect biological markers should be used as an adjunct to screening (Level A), and direct measures of alcohol in breath and/or blood can be useful markers of recent use (Level B). Assessment Assessment should include evaluation of alcohol use and its effects, physical examination, clinical investigations and collateral history taking (Level C). Assessment for alcohol-related physical problems, mental health problems and social support should be undertaken routinely (GPP). Where there are concerns regarding the safety of the patient or others, specialist consultation is recommended (Level C). Assessment should lead to a clear, mutually acceptable treatment plan which specifies interventions to meet the patient's needs (Level D). Sustained abstinence is the optimal outcome for most patients with alcohol dependence (Level C). Chapter 3: Caring for and managing patients with alcohol problems: interventions, treatments, relapse prevention, aftercare, and long term follow-up Brief interventions Brief motivational interviewing interventions are more effective than no treatment for people who consume alcohol at risky levels (Level A). Their effectiveness compared with standard care or alternative psychosocial interventions varies by treatment setting. They are most effective in primary care settings (Level A). Psychosocial interventions Cognitive behaviour therapy should be a first-line psychosocial intervention for alcohol dependence. Its clinical benefit is enhanced when it is combined with pharmacotherapy for alcohol dependence or an additional psychosocial intervention (eg, motivational interviewing) (Level A). Motivational interviewing is effective in the short term and in patients with less severe alcohol dependence (Level A). Residential rehabilitation may be of benefit to patients who have moderate-to-severe alcohol dependence and require a structured residential treatment setting (Level D). Alcohol withdrawal management Most cases of withdrawal can be managed in an ambulatory setting with appropriate support (Level B). Tapering diazepam regimens (Level A) with daily staged supply from a pharmacy or clinic are recommended (GPP). Pharmacotherapies for alcohol dependence Acamprosate is recommended to help maintain abstinence from alcohol (Level A). Naltrexone is recommended for prevention of relapse to heavy drinking (Level A). Disulfiram is only recommended in close supervision settings where patients are motivated for abstinence (Level A). Some evidence for off-label therapies baclofen and topiramate exists, but their side effect profiles are complex and neither should be a first-line medication (Level B). Peer support programs Peer-led support programs such as Alcoholics Anonymous and SMART Recovery are effective at maintaining abstinence or reductions in drinking (Level A). Relapse prevention, aftercare and long-term follow-up Return to problematic drinking is common and aftercare should focus on addressing factors that contribute to relapse (GPP). A harm-minimisation approach should be considered for patients who are unable to reduce their drinking (GPP). Chapter 4: Providing appropriate treatment and care to people with alcohol problems: a summary for key specific populations Gender-specific issues Screen women and men for domestic abuse (Level C). Consider child protection assessments for caregivers with alcohol use disorder (GPP). Explore contraceptive options with women of reproductive age who regularly consume alcohol (Level B). Pregnant and breastfeeding women Advise pregnant and breastfeeding women that there is no safe level of alcohol consumption (Level B). Pregnant women who are alcohol dependent should be admitted to hospital for treatment in an appropriate maternity unit that has an addiction specialist (GPP). Young people Perform a comprehensive HEEADSSS assessment for young people with alcohol problems (Level B). Treatment should focus on tangible benefits of reducing drinking through psychotherapy and engagement of family and peer networks (Level B). Aboriginal and Torres Strait Islander peoples Collaborate with Aboriginal or Torres Strait Islander health workers, organisations and communities, and seek guidance on patient engagement approaches (GPP). Use validated screening tools and consider integrated mainstream and Aboriginal or Torres Strait Islander-specific approaches to care (Level B). Culturally and linguistically diverse groups Use an appropriate method, such as the "teach-back" technique, to assess the need for language and health literacy support (Level C). Engage with culture-specific agencies as this can improve treatment access and success (Level C). Sexually diverse and gender diverse populations Be mindful that sexually diverse and gender diverse populations experience lower levels of satisfaction, connection and treatment completion (Level C). Seek to incorporate LGBTQ-specific treatment and agencies (Level C). Older people All new patients aged over 50 years should be screened for harmful alcohol use (Level D). Consider alcohol as a possible cause for older patients presenting with unexplained physical or psychological symptoms (Level D). Consider shorter acting benzodiazepines for withdrawal management (Level D). Cognitive impairment Cognitive impairment may impair engagement with treatment (Level A). Perform cognitive screening for patients who have alcohol problems and refer them for neuropsychological assessment if significant impairment is suspected (Level A). SUMMARY OF KEY RECOMMENDATIONS AND LEVELS OF EVIDENCE Chapter 5: Understanding and managing comorbidities for people with alcohol problems: polydrug use and dependence, co-occurring mental disorders, and physical comorbidities Polydrug use and dependence Active alcohol use disorder, including dependence, significantly increases the risk of overdose associated with the administration of opioid drugs. Specialist advice is recommended before treatment of people dependent on both alcohol and opioid drugs (GPP). Older patients requiring management of alcohol withdrawal should have their use of pharmaceutical medications reviewed, given the prevalence of polypharmacy in this age group (GPP). Smoking cessation can be undertaken in patients with alcohol dependence and/or polydrug use problems; some evidence suggests varenicline may help support reduction of both tobacco and alcohol consumption (Level C). Co-occurring mental disorders More intensive interventions are needed for people with comorbid conditions, as this population tends to have more severe problems and carries a worse prognosis than those with single pathology (GPP). The Kessler Psychological Distress Scale (K10 or K6) is recommended for screening for comorbid mental disorders in people presenting for alcohol use disorders (Level A). People with alcohol use disorder and comorbid mental disorders should be offered treatment for both disorders; care should be taken to coordinate intervention (Level C). Physical comorbidities Patients should be advised that alcohol use has no beneficial health effects. There is no clear risk-free threshold for alcohol intake. The safe dose for alcohol intake is dependent on many factors such as underlying liver disease, comorbidities, age and sex (Level A). In patients with alcohol use disorder, early recognition of the risk for liver cirrhosis is critical. Patients with cirrhosis should abstain from alcohol and should be offered referral to a hepatologist for liver disease management and to an addiction physician for management of alcohol use disorder (Level A). Alcohol abstinence reduces the risk of cancer and improves outcomes after a diagnosis of cancer (Level A).
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Cations M, Loi SM, Draper B, Swaffer K, Velakoulis D, Goh AM. A call to action for the improved identification, diagnosis, treatment and care of people with young onset dementia. Aust N Z J Psychiatry 2021; 55:837-840. [PMID: 34382425 DOI: 10.1177/00048674211037542] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Samantha M Loi
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Brian Draper
- Faculty of Medicine School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Kate Swaffer
- Faculty of Science, Medicine, and Health School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Anita My Goh
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.,National Ageing Research Institute, Melbourne, VIC, Australia
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Hosie A, Agar M, Caplan GA, Draper B, Hedger S, Rowett D, Tuffin P, Cheah SL, Phillips JL, Brown L, Sidhu M, Currow DC. Clinicians' delirium treatment practice, practice change, and influences: A national online survey. Palliat Med 2021; 35:1553-1563. [PMID: 34096396 DOI: 10.1177/02692163211022183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Recent studies cast doubt on the net effect of antipsychotics for delirium. AIM To investigate the influence of these studies and other factors on clinicians' delirium treatment practice and practice change in palliative care and other specialties using the Theoretical Domains Framework. DESIGN Australia-wide online survey of relevant clinicians. SETTING/PARTICIPANTS Registered nurses (72%), doctors (16%), nurse practitioners (6%) and pharmacists (5%) who cared for patients with delirium in diverse settings, recruited through health professionals' organisations. RESULTS Most of the sample (n = 475): worked in geriatrics/aged (31%) or palliative care (30%); in hospitals (64%); and saw a new patient with delirium at least weekly (61%). More (59%) reported delirium practice change since 2016, mostly by increased non-pharmacological interventions (53%). Fifty-five percent reported current antipsychotic use for delirium, primarily for patient distress (79%) and unsafe behaviour (67%). Common Theoretical Domains Framework categories of influences on respondents' delirium practice were: emotion (54%); knowledge (53%) and physical (43%) and social (21%) opportunities. Palliative care respondents more often reported: awareness of any named key study of antipsychotics for delirium (73% vs 39%, p < 0.001); changed delirium treatment (73% vs 53%, p = 0.017); decreased pharmacological interventions (60% vs 15%, p < 0.001); off-label medication use (86% vs 51%, p < 0.001: antipsychotics 79% vs 44%, p < 0.001; benzodiazepines 61% vs 26%, p < 0.001) and emotion as an influence (82% vs 39%, p < 0.001). CONCLUSION Clinicians' use of antipsychotic during delirium remains common and is primarily motivated by distress and safety concerns for the patient and others nearby. Supporting clinicians to achieve evidence-based delirium practice requires further work.
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Affiliation(s)
- Annmarie Hosie
- The University of Notre Dame Australia, School of Nursing and Midwifery, Darlinghurst, NSW, Australia.,St Vincent's Health Network Sydney, The Cunningham Centre for Palliative Care, Darlinghurst, NSW, Australia
| | - Meera Agar
- University of Technology Sydney, Faculty of Health, Improving Palliative, Aged and Chronic Care through Research and Translation, Ultimo, NSW, Australia
| | - Gideon A Caplan
- Prince of Wales Hospital, Prince of Wales Clinical School, Randwick, NSW, Australia.,University of New South Wales, Department of Geriatric Medicine, Randwick, NSW Australia
| | - Brian Draper
- University of New South Wales, School of Psychiatry, Randwick, NSW Australia
| | - Stephen Hedger
- Flinders University, College of Medicine and Public Health, Adelaide, SA, Australia
| | - Debra Rowett
- University of South Australia, Clinical and Heath Sciences, Adelaide, SA, Australia
| | - Penny Tuffin
- Royal Perth Hospital, Palliative Care Department and Pain Service, Perth, WA, Australia.,Curtin University, Perth, WA, Australia
| | - Seong Leang Cheah
- University of Technology Sydney, Faculty of Health, Improving Palliative, Aged and Chronic Care through Research and Translation, Ultimo, NSW, Australia
| | - Jane L Phillips
- University of Technology Sydney, Faculty of Health, Improving Palliative, Aged and Chronic Care through Research and Translation, Ultimo, NSW, Australia.,Queensland University of Technology, School of Nursing, Brisbane, QLD, Australia
| | - Linda Brown
- University of Technology Sydney, Faculty of Health, Improving Palliative, Aged and Chronic Care through Research and Translation, Ultimo, NSW, Australia
| | - Manraaj Sidhu
- University of Technology Sydney, Faculty of Health, Improving Palliative, Aged and Chronic Care through Research and Translation, Ultimo, NSW, Australia
| | - David C Currow
- University of Technology Sydney, Faculty of Health, Improving Palliative, Aged and Chronic Care through Research and Translation, Ultimo, NSW, Australia
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Do VQ, Draper B, Harvey L, Driscoll T, Braithwaite J, Brodaty H, Mitchell R. Examining trajectories of hospital readmission in older adults hospitalised with hip fracture from residential aged care and the community. Arch Osteoporos 2021; 16:120. [PMID: 34405278 DOI: 10.1007/s11657-021-00966-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/06/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Hip fracture trajectories have not been examined for older adults in aged care or living in the community. Trajectories of health care use were defined by distinct predictive factors. These results can inform the development of targeted strategies to reduce health service use following hip fracture. OBJECTIVE To examine hospital service use trajectories of older adults who were hospitalised for hip fracture and living in a residential aged care facility (RACF) or the community, and to identify factors predictive of trajectory group membership. These findings may inform future programmes aimed at reducing unexpected hospitalisations and subsequently reduce health care costs. METHODS A group-based trajectory analysis of hospitalisations was conducted for adults aged ≥ 65 years hospitalised for hip fracture during 2008-2009 in New South Wales, Australia. Linked hospitalisation and RACF data were examined for a 5-year period. Group-based trajectory models were derived for RACF and community-dwelling older adults based on the number of subsequent hospital admissions following the index hip fracture. Multinomial logistic regression examined predictors of trajectory group membership for subsequent hospital admissions. RESULTS There were 5752 hip fracture hospitalisations, with two-thirds of hip fractures occurring in community-dwellers. Key predictors of trajectory group membership for both RACF residents and community-dwellers were age group, sex, hospital length of stay and cognitive impairment. Assistance with activities of daily living and complex health care needs were also predictive of group membership in RACF residents. Location of residence and time to move to a RACF were additional predictors of group membership for community-dwellers. CONCLUSION Health service use trajectories differed for RACF residents and community-dwellers; however, there were similar patient characteristics that defined trajectory group membership. Low users of hospital services living in RACFs or the community included older adults with generally unfavourable health conditions, potentially indicating that palliative care or advanced care directives and community-care initiatives, respectively, have played a part in the lowered frequency of rehospitalisation.
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Affiliation(s)
- Vu Quang Do
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie Park, NSW, 2109, Australia.
| | - Brian Draper
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.,Dementia Centre for Research Collaboration - Assessment and Better Care, University of New South Wales, Sydney, Australia
| | - Lara Harvey
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia.,Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Tim Driscoll
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie Park, NSW, 2109, Australia
| | - Henry Brodaty
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.,Dementia Centre for Research Collaboration - Assessment and Better Care, University of New South Wales, Sydney, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie Park, NSW, 2109, Australia
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Lee W, Sheehan C, Chye R, Chang S, Loo C, Draper B, Agar M, Currow DC. Study protocol for SKIPMDD: subcutaneous ketamine infusion in palliative care patients with advanced life limiting illnesses for major depressive disorder (phase II pilot feasibility study). BMJ Open 2021; 11:e052312. [PMID: 34183351 PMCID: PMC8240583 DOI: 10.1136/bmjopen-2021-052312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/10/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Major depressive disorder (MDD) in people with advanced life-limiting illnesses can have significant impact on the quality-of-life of those affected. The management of MDD in the palliative care setting can be challenging as typical antidepressants may not work in time nor be tolerated due to coexisting organ dysfunctions, symptom burden and frailty. Parenteral ketamine was found to exhibit effective and rapid-onset antidepressant effect even against treatment-resistant depression in the psychiatric population. However, there is currently neither feasibility study nor available prospective study available to inform of the safety, tolerability and efficacy of such for MDD in the palliative setting. METHODS AND ANALYSIS This is an open-labelled, single arm, phase II pilot feasibility study involving adult patients with advanced life-limiting illnesses and MDD across four palliative care services in Australia. It has an individual dose-titration design (0.1-0.4 mg/kg) with weekly treatments of subcutaneous ketamine infusion over 2 hours. The primary outcome is feasibility. The secondary outcomes are related to the safety, tolerability and antidepressant efficacy of ketamine, participants' satisfaction in relation to the trial process and the reasons for not completing the study at various stages. The feasibility data will be reported using descriptive statistics. Meanwhile, side effects, tolerability and efficacy data will be analysed using change of assessment scores from baseline. ETHICS AND DISSEMINATION Ethics approval was acquired (South Western Sydney Local Health District: HREC/18/LPOOL/466). The results of this study will be submitted for publication in peer-reviewed journals and presented at relevant conferences. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trial Registry Number: ACTRN12618001586202; Pre-results.
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Affiliation(s)
- Wei Lee
- Improving Care for Palliative Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Richard Chye
- Palliative Care, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
- University of Notre Dame, Darlinghurst, Sydney, Australia
| | - Sungwon Chang
- Improving Care for Palliative Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Colleen Loo
- Black Dog Institute, Randwick, New South Wales, Australia
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Brian Draper
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Meera Agar
- Improving Care for Palliative Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - David C Currow
- Improving Care for Palliative Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Cancer Institute New South Wales, St Leonards, New South Wales, Australia
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Wand APF, Pourmand D, Draper B. Using interpreters with culturally and linguistically diverse older adults: What do we need to know? Australas J Ageing 2021; 39:175-177. [PMID: 33051998 DOI: 10.1111/ajag.12751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Anne Pamela Frances Wand
- Department of Aged Care Psychiatry, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Discipline of Psychiatry, School of Medicine, University of New South Wales, Sydney, Australia
| | - Diba Pourmand
- Transcultural Mental Health Centre, Parramatta, New South Wales, Australia
| | - Brian Draper
- Department of Aged Care Psychiatry, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Discipline of Psychiatry, School of Medicine, University of New South Wales, Sydney, Australia
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Wijeratne C, Johnco C, Draper B, Earl JK. Older Physicians' Reporting of Psychological Distress, Alcohol Use, Burnout and Workplace Stressors. Am J Geriatr Psychiatry 2021; 29:478-487. [PMID: 33023799 DOI: 10.1016/j.jagp.2020.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Most of the published data on the psychological health of physicians has focused on the youngest members of the profession. The aims of this analysis were to determine how psychological morbidity changes across the career cycle. METHODS We report data from the cross-sectional National Mental Health Survey of Doctors and Medical Students, conducted in Australia. Age differences in psychological distress, suicidal ideation, alcohol use, burnout, workplace, and personal stressors were examined for younger (40 years and younger), middle aged (41-60), and older (61+) physicians. RESULTS A total of 10,038 physicians responded. Older physicians reported significantly less psychological distress, burnout and suicidal ideation than younger and middle aged colleagues, findings that were maintained after adjusting for sex and excluding trainees. There were no group differences in overall alcohol use and high risk drinking. On multivariate analysis, the largest contributor to psychological distress in older physicians was a past history of mental disorder. There was a decline across age groups in the endorsement as "very stressful" of work-life conflict and work-anxiety stressors such as fear of making mistakes. Older physicians were least likely to feel very stressed by all workplace stressors. CONCLUSION The better psychological health of older physicians highlights the need to consider physician health according to age and career stage. Apart from the decline in work stressors, in particular work-life conflict, there may be a survivor effect such that physicians who practice into older age have developed greater resilience and professional maturation.
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Affiliation(s)
- Chanaka Wijeratne
- Sydney School of Medicine (CW), University of Notre Dame Australia, Sydney, Australia.
| | - Carly Johnco
- Centre for Emotional Health, Department of Psychology (CJ), Macquarie University, Sydney, Australia; Centre for Cognition, Ageing and Wellbeing (CJ), Macquarie University, Sydney, Australia
| | - Brian Draper
- School of Psychiatry (BD), University of New South Wales, Sydney, Australia
| | - Joanne K Earl
- Department of Psychology (JKE), Macquarie University, Sydney, Australia
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Lennon MJ, Lam BCP, Crawford J, Brodaty H, Kochan NA, Trollor JN, Numbers K, Draper B, Thalamuthu A, Sachdev PS. Does Antihypertensive Use Moderate the Effect of Blood Pressure on Cognitive Decline in Older People? J Gerontol A Biol Sci Med Sci 2021; 76:859-866. [PMID: 33225353 DOI: 10.1093/gerona/glaa232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND While midlife hypertension is deleterious, late-life hypertension has been associated with better cognitive outcomes in several studies. Many questions remain, including the relative benefit or harm of a blood pressure (BP) target and antihypertensive therapy of <120 in very old individuals. METHODS The Sydney Memory and Aging Study (n = 1015) comprises a cohort of 70- to 90-year-olds, who were followed biennially for 8 years. Global cognition was assessed with a battery of 10 neuropsychological tests. Blood pressure was measured at Waves 1 and 2 and classified into 3 systolic groupings: group 1 (≤120 mmHg), group 2 (121-140 mmHg), and group 3 (>140 mmHg). Multiple regression, linear mixed modeling, and Cox regression examined the effect of BP and antihypertensives. RESULTS There were no overall significant differences in global cognition or dementia between the disparate BP groups. However, in those not taking antihypertensives, the systolic BP (SBP) > 140 mmHg group had a significantly worse global cognitive trajectory compared to SBP ≤ 120 mmHg (b = -0.067, 95% CI [-0.129, -0.006], p = .030). Within the SBP ≤ 120 mmHg group those taking antihypertensives had significantly worse global cognition trajectories compared to those not taking antihypertensives even when controlling for past history of hypertension (b = -0.077, 95% CI [-0.147, -0.007], p = .030). CONCLUSIONS Untreated hypertension in old age is related to worse global cognitive decline. However, ongoing treatment at new recommendations of lower SBP targets may be related to poorer cognitive decline and should be considered carefully in older populations.
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Affiliation(s)
- Matthew J Lennon
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Aging (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Ben Chun Pan Lam
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Aging (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - John Crawford
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Aging (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Henry Brodaty
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Aging (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia.,Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Nicole A Kochan
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Aging (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Julian N Trollor
- Centre for Healthy Brain Aging (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia.,Neuropsychiatric Institute, Eastern Suburbs Mental Health Service, Randwick, Australia
| | - Katya Numbers
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Aging (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Brian Draper
- Centre for Healthy Brain Aging (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia.,Eastern Suburbs Older Persons' Mental Health Service, Randwick, Australia
| | - Anbupalam Thalamuthu
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Aging (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Perminder S Sachdev
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Aging (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia.,Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, Australia
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Samaras K, Crawford JD, Draper B, Trollor JN, Brodaty H, Sachdev PS. Response to Comment on Samara et al. Metformin Use Is Associated With Slowed Cognitive Decline and Reduced Incident Dementia in Older Adults With Type 2 Diabetes: The Sydney Memory and Ageing Study. Diabetes Care 2020;43:2691-2701. Diabetes Care 2021; 44:e74. [PMID: 33741702 DOI: 10.2337/dci20-0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Katherine Samaras
- Diabetes and Metabolism Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia .,Department of Endocrinology, St Vincent's Hospital, Darlinghurst, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales Sydney, New South Wales, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia
| | - Brian Draper
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia.,Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia
| | - Julian N Trollor
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia.,Department of Developmental Disability Neuropsychiatry, University of New South Wales Sydney, New South Wales, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia.,Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia
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Castelli Dransart DA, Lapierre S, Erlangsen A, Canetto SS, Heisel M, Draper B, Lindner R, Richard-Devantoy S, Cheung G, Scocco P, Gusmão R, De Leo D, Inoue K, De Techterman V, Fiske A, Hong JP, Landry M, Lepage AA, Marcoux I, Na PJ, Neufeld E, Ummel D, Winslov JH, Wong C, Wu J, Wyart M. A systematic review of older adults' request for or attitude toward euthanasia or assisted-suicide. Aging Ment Health 2021; 25:420-430. [PMID: 31818122 DOI: 10.1080/13607863.2019.1697201] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Prevalence rates of death by euthanasia (EUT) and physician-assisted suicide (PAS) have increased among older adults, and public debates on these practices are still taking place. In this context, it seemed important to conduct a systematic review of the predictors (demographic, physical health, psychological, social, quality of life, religious, or existential) associated with attitudes toward, wishes and requests for, as well as death by EUT/PAS among individuals aged 60 years and over. METHOD The search for quantitative studies in PsycINFO and MEDLINE databases was conducted three times from February 2016 until April 2018. Articles of probable relevance (n = 327) were assessed for eligibility. Studies that only presented descriptive data (n = 306) were excluded. RESULTS This review identified 21 studies with predictive analyses, but in only 4 did older adults face actual end-of-life decisions. Most studies (17) investigated attitudes toward EUT/PAS (9 through hypothetical scenarios). Younger age, lower religiosity, higher education, and higher socio-economic status were the most consistent predictors of endorsement of EUT/PAS. Findings were heterogeneous with regard to physical health, psychological, and social factors. Findings were difficult to compare across studies because of the variety of sample characteristics and outcomes measures. CONCLUSION Future studies should adopt common and explicit definitions of EUT/PAS, as well as research designs (e.g. mixed longitudinal) that allow for better consideration of personal, social, and cultural factors, and their interplay, on EUT/PAS decisions.
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Affiliation(s)
| | - Sylvie Lapierre
- Department of Psychology, Université du Québec à Trois Rivières, Trois Rivières, Canada
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre, Copenhagen, Denmark
| | | | - Marnin Heisel
- Department of Psychiatry, Western University, Canada
| | - Brian Draper
- School of Psychiatry, University of NSW, Sidney Australia, and Eastern Suburbs Older Person's Mental Health Prince of Wales Hospital Randwick, Australia
| | | | - Stephane Richard-Devantoy
- Department of Psychiatry, McGill University, and Douglas Mental Health University Institute, Montreal, Canada
| | - Gary Cheung
- Department of Psychological Medecine, School of Medecine, University of Auckland, New Zealand
| | | | | | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia
| | - Ken Inoue
- Research and Education Faculty, Medical Sciences Cluster Health Service Center, Kochi University, Japan
| | - Vincent De Techterman
- School of Social Work Fribourg, HES-SO University of Applied Sciences and Art Western Switzerland, Switzerland
| | - Amy Fiske
- Department of Psychology, West Virginia University, USA
| | - Jin Pyo Hong
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Marjolaine Landry
- Department of Nursing, Université du Québec à Trois Rivières, Canada
| | - Andrée-Anne Lepage
- Department of Psychology, Université du Québec à Trois Rivières, Trois Rivières, Canada
| | - Isabelle Marcoux
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Peter Jongho Na
- Department of Psychiatry, New York University Langone Health, USA
| | | | - Deborah Ummel
- Department of Psychoeducation, Université de Sherbrooke, Montréal, Canada
| | | | | | - Jing Wu
- Department of Sociology and Work Science, University of Gothenburg, Sweden
| | - Marilyn Wyart
- Unit of Geropsychiatry, Clinique Saint Antoine, Montarnaud, France
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Paradise M, Crawford JD, Lam BCP, Wen W, Kochan NA, Makkar S, Dawes L, Trollor J, Draper B, Brodaty H, Sachdev PS. Association of Dilated Perivascular Spaces With Cognitive Decline and Incident Dementia. Neurology 2021; 96:e1501-e1511. [PMID: 33504642 DOI: 10.1212/wnl.0000000000011537] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 12/08/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To determine whether severe perivascular space (PVS) dilation is associated with longitudinal cognitive decline and incident dementia over 4 and 8 years, respectively, we analyzed data from a prospective cohort study. METHODS A total of 414 community-dwelling older adults aged 72-92 years were assessed at baseline and biennially for up to 8 years, with cognitive assessments, consensus dementia diagnoses, and 3T MRI. The numbers of PVS in 2 representative slices in the basal ganglia (BG) and centrum semiovale (CSO) were counted and severe PVS pathology defined as the top quartile. The effects of severe PVS pathology in either region or both regions and those with severe BG PVS and severe CSO PVS were examined. White matter hyperintensity volume, cerebral microbleed number, and lacune number were calculated. RESULTS Participants with severe PVS pathology in both regions or in the CSO alone had greater decline in global cognition over 4 years, even after adjustment for the presence of other small vessel disease neuroimaging markers. The presence of severe PVS pathology in both regions was an independent predictor of dementia across 8 years (odds ratio 2.91, 95% confidence interval 1.43-5.95, p = 0.003). The presence of severe PVS pathology in all groups examined was associated with greater dementia risk at either year 4 or 6. CONCLUSIONS Severe PVS pathology is a marker for increased risk of cognitive decline and dementia, independent of other small vessel disease markers. The differential cognitive associations for BG and CSO PVS may represent differences in their underlying pathology.
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Affiliation(s)
- Matthew Paradise
- From the Centre for Healthy Brain Ageing (CHeBA) (M.P., J.D.C., B.C.P.L., W.W., N.A.K., S.M., J.T., B.D., H.B., P.S.S.), School of Psychiatry, UNSW Medicine, University of New South Wales; Neuropsychiatric Institute (P.S.S.), The Prince of Wales Hospital (L.D., B.D., H.B.) ; and Department of Developmental Disability Neuropsychiatry, School of Psychiatry (J.T.), UNSW Sydney, Australia.
| | - John D Crawford
- From the Centre for Healthy Brain Ageing (CHeBA) (M.P., J.D.C., B.C.P.L., W.W., N.A.K., S.M., J.T., B.D., H.B., P.S.S.), School of Psychiatry, UNSW Medicine, University of New South Wales; Neuropsychiatric Institute (P.S.S.), The Prince of Wales Hospital (L.D., B.D., H.B.) ; and Department of Developmental Disability Neuropsychiatry, School of Psychiatry (J.T.), UNSW Sydney, Australia
| | - Ben C P Lam
- From the Centre for Healthy Brain Ageing (CHeBA) (M.P., J.D.C., B.C.P.L., W.W., N.A.K., S.M., J.T., B.D., H.B., P.S.S.), School of Psychiatry, UNSW Medicine, University of New South Wales; Neuropsychiatric Institute (P.S.S.), The Prince of Wales Hospital (L.D., B.D., H.B.) ; and Department of Developmental Disability Neuropsychiatry, School of Psychiatry (J.T.), UNSW Sydney, Australia
| | - Wei Wen
- From the Centre for Healthy Brain Ageing (CHeBA) (M.P., J.D.C., B.C.P.L., W.W., N.A.K., S.M., J.T., B.D., H.B., P.S.S.), School of Psychiatry, UNSW Medicine, University of New South Wales; Neuropsychiatric Institute (P.S.S.), The Prince of Wales Hospital (L.D., B.D., H.B.) ; and Department of Developmental Disability Neuropsychiatry, School of Psychiatry (J.T.), UNSW Sydney, Australia
| | - Nicole A Kochan
- From the Centre for Healthy Brain Ageing (CHeBA) (M.P., J.D.C., B.C.P.L., W.W., N.A.K., S.M., J.T., B.D., H.B., P.S.S.), School of Psychiatry, UNSW Medicine, University of New South Wales; Neuropsychiatric Institute (P.S.S.), The Prince of Wales Hospital (L.D., B.D., H.B.) ; and Department of Developmental Disability Neuropsychiatry, School of Psychiatry (J.T.), UNSW Sydney, Australia
| | - Steve Makkar
- From the Centre for Healthy Brain Ageing (CHeBA) (M.P., J.D.C., B.C.P.L., W.W., N.A.K., S.M., J.T., B.D., H.B., P.S.S.), School of Psychiatry, UNSW Medicine, University of New South Wales; Neuropsychiatric Institute (P.S.S.), The Prince of Wales Hospital (L.D., B.D., H.B.) ; and Department of Developmental Disability Neuropsychiatry, School of Psychiatry (J.T.), UNSW Sydney, Australia
| | - Laughlin Dawes
- From the Centre for Healthy Brain Ageing (CHeBA) (M.P., J.D.C., B.C.P.L., W.W., N.A.K., S.M., J.T., B.D., H.B., P.S.S.), School of Psychiatry, UNSW Medicine, University of New South Wales; Neuropsychiatric Institute (P.S.S.), The Prince of Wales Hospital (L.D., B.D., H.B.) ; and Department of Developmental Disability Neuropsychiatry, School of Psychiatry (J.T.), UNSW Sydney, Australia
| | - Julian Trollor
- From the Centre for Healthy Brain Ageing (CHeBA) (M.P., J.D.C., B.C.P.L., W.W., N.A.K., S.M., J.T., B.D., H.B., P.S.S.), School of Psychiatry, UNSW Medicine, University of New South Wales; Neuropsychiatric Institute (P.S.S.), The Prince of Wales Hospital (L.D., B.D., H.B.) ; and Department of Developmental Disability Neuropsychiatry, School of Psychiatry (J.T.), UNSW Sydney, Australia
| | - Brian Draper
- From the Centre for Healthy Brain Ageing (CHeBA) (M.P., J.D.C., B.C.P.L., W.W., N.A.K., S.M., J.T., B.D., H.B., P.S.S.), School of Psychiatry, UNSW Medicine, University of New South Wales; Neuropsychiatric Institute (P.S.S.), The Prince of Wales Hospital (L.D., B.D., H.B.) ; and Department of Developmental Disability Neuropsychiatry, School of Psychiatry (J.T.), UNSW Sydney, Australia
| | - Henry Brodaty
- From the Centre for Healthy Brain Ageing (CHeBA) (M.P., J.D.C., B.C.P.L., W.W., N.A.K., S.M., J.T., B.D., H.B., P.S.S.), School of Psychiatry, UNSW Medicine, University of New South Wales; Neuropsychiatric Institute (P.S.S.), The Prince of Wales Hospital (L.D., B.D., H.B.) ; and Department of Developmental Disability Neuropsychiatry, School of Psychiatry (J.T.), UNSW Sydney, Australia
| | - Perminder S Sachdev
- From the Centre for Healthy Brain Ageing (CHeBA) (M.P., J.D.C., B.C.P.L., W.W., N.A.K., S.M., J.T., B.D., H.B., P.S.S.), School of Psychiatry, UNSW Medicine, University of New South Wales; Neuropsychiatric Institute (P.S.S.), The Prince of Wales Hospital (L.D., B.D., H.B.) ; and Department of Developmental Disability Neuropsychiatry, School of Psychiatry (J.T.), UNSW Sydney, Australia
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Abstract
Clinicians may lack knowledge and confidence regarding self-harm in older adults and hold attitudes that interfere with delivering effective care. A 1-hour educational intervention for hospital-based clinicians and general practitioners (GPs) was developed, delivered, and evaluated. Of 119 multidisciplinary clinicians working in aged care and mental health at two hospitals, 100 completed pre/post-evaluation questions. There were significant improvements in knowledge, confidence in managing, and attitudes regarding self-harm in late life, and the education was rated as likely to change clinical practice. No GP education sessions could be conducted. A brief educational intervention had immediate positive impacts for hospital-based clinicians albeit with high baseline knowledge. The sustainability of these effects and effectiveness of the intervention for GPs warrant examination.
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Lee W, Pulbrook M, Sheehan C, Kochovska S, Chang S, Hosie A, Lobb E, Parker D, Draper B, Agar MR, Currow DC. Clinically Significant Depressive Symptoms Are Prevalent in People With Extremely Short Prognoses-A Systematic Review. J Pain Symptom Manage 2021; 61:143-166.e2. [PMID: 32688012 DOI: 10.1016/j.jpainsymman.2020.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Currently, systematic evidence of the prevalence of clinically significant depressive symptoms in people with extremely short prognoses is not available to inform its global burden, assessment, and management. OBJECTIVES To determine the prevalence of clinically significant depressive symptoms in people with advanced life-limiting illnesses and extremely short prognoses (range of days to weeks). METHODS A systematic review and meta-analysis (random-effects model) were performed (PROSPERO: CRD42019125119). MEDLINE, Embase, PsycINFO, CINAHL, and CareSearch were searched for studies (1994-2019). Data were screened for the prevalence of clinically significant depressive symptoms (assessed using validated depression-specific screening tools or diagnostic criteria) of adults with advanced life-limiting illnesses and extremely short prognoses (defined by survival or functional status). Quality assessment was performed using the Joanna Briggs Institute Systematic Reviews Checklist for Prevalence Studies for individual studies and Grading of Recommendations Assessment, Development and Evaluation (GRADE) across studies. RESULTS Thirteen studies were included. The overall pooled prevalence of clinically significant depressive symptoms in adults with extremely short prognoses (n = 10 studies; extremely short prognoses: N = 905) using depression-specific screening tools was 50% (95% CI: 29%-70%; I2 = 97.6%). Prevalence of major and minor depression was 10% (95% CI: 4%-16%) and 5% (95% CI: 2%-8%), respectively. Major limitations included high heterogeneity, selection bias, and small sample sizes in individual studies. CONCLUSIONS Clinically, significant depressive symptoms were prevalent in people with advanced life-limiting illnesses and extremely short prognoses. Clinicians need to be proactive in the recognition and assessment of these symptoms to allow for timely intervention.
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Affiliation(s)
- Wei Lee
- University of Technology Sydney, Ultimo, New South Wales, Australia; St Vincent Hospital, Darlinghurst, New South Wales, Australia.
| | - Marley Pulbrook
- St Vincent Hospital, Darlinghurst, New South Wales, Australia
| | | | | | - Sungwon Chang
- University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Annmarie Hosie
- St Vincent Hospital, Darlinghurst, New South Wales, Australia; University of Notre Dame Australia, New South Wales, Australia
| | - Elizabeth Lobb
- Calvary Hospital, Kogarah, New South Wales, Australia; University of Notre Dame Australia, New South Wales, Australia
| | - Deborah Parker
- University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Brian Draper
- University of New South Wales, Randwick, New South Wales, Australia
| | - Meera R Agar
- University of Technology Sydney, Ultimo, New South Wales, Australia
| | - David C Currow
- University of Technology Sydney, Ultimo, New South Wales, Australia
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Rossie M, Croot K, Allison KC, Brodaty H, Crawford JD, Lee T, Henry JD, Draper B, Close J, Ong MY, Lam BCP, Sachdev PS, Kochan NA. Predictors of acceptability and emotional response to computerized neuropsychological assessments in older adults: The CogSCAN Study. Alzheimers Dement 2020. [DOI: 10.1002/alz.044730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Matilda Rossie
- Centre for Healthy Brain Ageing University of New South Wales Sydney NSW Australia
| | - Karen Croot
- Centre for Healthy Brain Ageing University of New South Wales Sydney Australia
| | | | - Henry Brodaty
- Dementia Centre for Research Collaboration (DCRC) UNSW Sydney Sydney NSW Australia
| | - John D. Crawford
- Centre for Healthy Brain Ageing (CHeBA) University of New South Wales (UNSW) Sydney Sydney NSW Australia
| | - Teresa Lee
- Prince of Wales Hospital Sydney Australia
| | | | - Brian Draper
- Centre for Healthy Brain Ageing (CHeBA) University of New South Wales (UNSW) Sydney Sydney NSW Australia
| | | | - Min Yee Ong
- University of New South Wales Sydney Australia
| | - Ben C. P. Lam
- Centre for Healthy Brain Ageing (CHeBA) University of New South Wales (UNSW) Sydney Sydney NSW Australia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing (CHeBA) University of New South Wales (UNSW) Sydney Sydney NSW Australia
| | - Nicole A. Kochan
- Centre for Healthy Brain Ageing (CHeBA) University of New South Wales (UNSW) Sydney Sydney NSW Australia
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Mitchell R, Draper B, Close J, Harvey L, Brodaty H, Do V, Driscoll T, Braithwaite J. Trajectories of Hospital Readmission After A Fall Injury for Older Adults Living in Aged Care or The Community. Int J Popul Data Sci 2020. [DOI: 10.23889/ijpds.v5i5.1476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
IntroductionFall injuries are one of the leading causes of hospitalisation for adults aged ≥65 years. Distinguishing key characteristics of older adults who are either living in aged care or in the community who have multiple hospital readmissions after a fall injury may inform targeted approaches to the prevention of hospital readmissions.
Objectives and ApproachTo examine trajectories of hospital readmission of older adults living in aged care or the community after a fall injury hospitalisation and to identify factors predictive of trajectory group membership. A group-based trajectory analysis of hospital readmissions of adults aged ≥65 years who had a fall injury hospitalisation during 2008-09 in New South Wales, Australia was conducted. Linked hospitalisation and aged care data were examined for a 5 year period to 2013. Group-based trajectory models were derived based on number of subsequent readmissions following the index admission. Multinominal logistic regression examined predictors of trajectory group membership.
ResultsThere were 24,729 fall injury hospitalisations; 78.8% of fallers were living in the community and 21.2% in aged care. Five distinct trajectory groups were identified for community-living (i.e. Moderate-declining, Chronic, Low-constant, Low-declining, and High users) and four trajectory groups for aged care residents (i.e. Low, Moderate-declining, Moderate-chronic, and High users). Key predictors of trajectory group membership for both community-living and aged care residents were age group, number of comorbidities, and dementia status. For aged care residents, depression, assistance with activities of daily living, and number of subsequent fall injury admissions were also predictors of group membership, with time to move to an aged care facility a predictor of group membership for community-living.
Conclusion / ImplicationsIdentifying trajectories of ongoing hospital use informs targeting of strategies to reduce hospital admissions and design of services to allow community-living individuals to remain as long as possible within their own residence.
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49
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Croot K, Allison KC, Sachdev PS, Brodaty H, Crawford JD, Lam BC, Lee T, Henry JD, Draper B, Close J, Ong MY, Rossie M, Kochan NA. Development of the Computer and Technology Attitude Questionnaire (CaTAQ) to inform performance on computerised cognitive testing in older adults in the CogSCAN Study. Alzheimers Dement 2020. [DOI: 10.1002/alz.045676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Karen Croot
- Centre for Healthy Brain Ageing University of New South Wales Sydney Australia
| | | | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing (CHeBA) University of New South Wales (UNSW) Sydney Sydney NSW Australia
| | - Henry Brodaty
- Dementia Centre for Research Collaboration (DCRC) UNSW Sydney Sydney NSW Australia
| | - John D. Crawford
- Centre for Healthy Brain Ageing (CHeBA) University of New South Wales (UNSW) Sydney Sydney NSW Australia
| | - Ben C.P. Lam
- Centre for Healthy Brain Ageing (CHeBA) University of New South Wales (UNSW) Sydney Sydney NSW Australia
| | - Teresa Lee
- Prince of Wales Hospital Sydney Australia
| | | | - Brian Draper
- Centre for Healthy Brain Ageing (CHeBA) University of New South Wales (UNSW) Sydney Sydney NSW Australia
| | | | - Min Yee Ong
- University of New South Wales Sydney Australia
| | - Matilda Rossie
- Centre for Healthy Brain Ageing University of New South Wales Sydney NSW Australia
| | - Nicole A. Kochan
- Centre for Healthy Brain Ageing (CHeBA) University of New South Wales (UNSW) Sydney Sydney NSW Australia
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50
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Lavrencic L, Donovan T, Moffatt L, Allan W, Daylight G, Garvey G, Hill TY, Draper B, Cumming R, Broe GA, Delbaere K, Radford K. Identifying dementia risk factors and implementing a culturally grounded risk‐reduction intervention in urban and regional Aboriginal Australian communities. Alzheimers Dement 2020. [DOI: 10.1002/alz.041446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Louise Lavrencic
- Ageing Futures Institute UNSW Sydney NSW Australia
- University of New South Wales Sydney NSW Australia
- Neuroscience Research Australia Sydney NSW Australia
| | | | - Lindy Moffatt
- Neuroscience Research Australia Sydney NSW Australia
| | - Wendy Allan
- Neuroscience Research Australia Sydney NSW Australia
| | - Gail Daylight
- Neuroscience Research Australia Sydney NSW Australia
| | - Gail Garvey
- Menzies School of Health Research Brisbane Australia
| | - Thi Yen Hill
- Neuroscience Research Australia Sydney NSW Australia
- Prince of Wales Hospital Randwick NSW Australia
| | - Brian Draper
- University of New South Wales Sydney Australia
- Prince of Wales Hospital Sydney Australia
- Dementia Collaborative Research Centre ‐ ABC, UNSW Australia Sydney Australia
- Centre for Healthy Brain Ageing (CHeBA) University of New South Wales (UNSW) Sydney Sydney NSW Australia
| | | | - Gerald A Broe
- Ageing Futures Institute UNSW Sydney NSW Australia
- University of New South Wales Sydney NSW Australia
- Neuroscience Research Australia Sydney NSW Australia
| | - Kim Delbaere
- University of New South Wales Sydney NSW Australia
- Neuroscience Research Australia Sydney NSW Australia
- UNSW Ageing Futures Institute Sydney NSW Australia
| | - Kylie Radford
- Ageing Futures Institute UNSW Sydney NSW Australia
- University of New South Wales Sydney NSW Australia
- Neuroscience Research Australia Sydney NSW Australia
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