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Biomedical subjects

A F Jorm

Publications and source records attributed to A F Jorm.

At least 19 recordsLinked to original sources
PubMed1998

Psychotic symptoms in the elderly: a prospective study in a population sample.

BACKGROUND: Most of what is known about psychotic symptoms in older persons is based on hospital series of severe disorders. METHOD: In the course of a longitudinal community-based survey of older persons, the presence of psychotic symptoms was assessed on two occasions 3-4 years apart. RESULTS: The point prevalence was 5.7%. Risk factors were cognitive impairment, living alone, being male, having had limited education, social isolation, poor health and depressive symptoms. Of the 65 persons who were symptomatic at the start, only six of those still alive had one or more psychotic symptoms after 3-4 years. The incidence was 6.0% over a period of 3.6 years. CONCLUSIONS: Risk factors for psychotic symptoms in later life lie in age-related cognitive impairment in interaction with a range of environmental and psychosocial variables.

Aged↗
PubMed1998

Impact of chronic systemic and neurological disorders on disability, depression and life satisfaction.

OBJECTIVE: To assess the effects of a range of chronic systemic and neurological disorders on three life quality indicators: disability, depressive symptoms and life satisfaction. METHODS: As part of the Sydney Older Persons Study, a community survey was carried out with 434 non-demented people aged 75 or over living in Sydney, Australia. Subjects were given a medical examination covering the following disorders: heart disease, chronic lung disease, bone and joint disease, stroke, visual loss, peripheral vascular disease, obesity, other systemic diseases, gait ataxia, gait slowing (including Parkinsonism) and cognitive impairement short of dementia. They were also assessed on a clinician-rated disability scale and given self-report depression and life satisfaction scales. RESULTS: Gait slowing affected all three indicators of life quality. Heart disease and chronic lung disease affected disability and depressive symptoms, but not life satisfaction. These associations were present when the effects of age, sex, education and all other disorders were controlled in multiple regression analyses. However, when disability was also controlled, none of the physical disorders predicted life satisfaction and only heart disease continued to predict depressive symptoms. CONCLUSION: Of the physical disorders considered in the study, gait slowing, heart disease and chronic lung disease had the greatest impact on life quality. These disorders affect depressive symptoms and life satisfaction largely because they increase disability.

Aged↗
PubMed1998

Attitudes and participation of the elderly in population surveys: data from a longitudinal study on aging and dementia in Stockholm.

The aim of this article was to assess the attitudes of older adults (age >74 years) toward research participation. A questionnaire was mailed to the study population (n=1197) which included people who had participated in a longitudinal study once, twice, three times, or more. The participants showed a positive attitude in general as 79% saw an advantage of participation and 72% did not report any negative reaction. Older elderly with impaired cognitive functioning and lower education showed the least positive attitude, reporting the first contact and the cognitive testing as the most stressful situations. The group who had participated more than once was the most positive, but more often refused some parts of the clinical examination. We conclude that: (1) more attention is necessary to the initial contact; (2) reduction of stressful or tiring examinations is recommended; and (3) complete information about the research, including the right to refuse individual parts of the study, must be given. Such procedures will improve both the quality and the ethics of the research.

Aged↗
PubMed1998

Symptoms of depression and anxiety during adult life: evidence for a decline in prevalence with age.

BACKGROUND: To test the hypothesis that the prevalence, in the general population, of symptoms of depression and anxiety declines with age. METHODS: A general population sample of 2725 persons aged 18 to 79 years was administered two inventories for current symptoms of depression and anxiety, together with measures of neuroticism and of exposures that may confer increased risk of such symptoms. RESULTS: Symptoms of depression showed a decline with age in both men and women. For anxiety, the decline was statistically significant for women but not consistently so for men. For the risk factors examined, there was a decline with age in the neuroticism score, the frequency of adverse life events, being seriously short of money and having had parents who separated or divorced. Further analysis showed that the association between age and a declining symptom score cannot be entirely attributed to these risk factors, with the single exception of neuroticism. The latter is itself likely to be contaminated by current symptoms. CONCLUSION: Unless these findings are due to bias in the sample of those who agreed to participate, they add to the evidence that symptoms of depression and to a lesser extent of anxiety decline in prevalence with age. Some risk factors also decline with age. It now has to be determined if these cross-sectional observations are also to be found in longitudinal data; and what process may underlie this striking change in mental health during adulthood.

Adolescent↗
PubMed1998

An association study of a functional polymorphism of the serotonin transporter gene with personality and psychiatric symptoms.

A functional polymorphism in the regulatory region of the serotonin transporter gene has been reported to be associated with anxiety-related personality traits. We attempted to replicate this finding in an association study involving 759 Caucasians selected from the general Australian population. We found no associations with personality traits (including neuroticism, negative affect and behavioral inhibition), anxiety and depressive symptoms, or alcohol misuse.

Alcoholism↗
PubMed1998

Occupation type as a predictor of cognitive decline and dementia in old age.

OBJECTIVE: To assess whether an individual's main occupation predicts cognitive decline or dementia. METHODS: The data were taken from a longitudinal study of 518 men aged 70 or over. Main occupation was coded into one of John Holland's six occupational categories. The subjects completed four cognitive tests and were diagnosed for dementia on two occasions three and a half years apart. The cognitive tests were the Mini-Mental State Examination, Episodic Memory Test, Symbol-Letter Modalities Test and National Adult Reading Test. Informants also completed the Informant Questionnaire on Cognitive Decline in the Elderly. Dementia was diagnosed by the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised (DSM-III-R) and ICD-10 criteria using the Canberra Interview for the Elderly. RESULTS: Cross-sectional analysis of the wave 1 data showed that the realistic occupations, which include trade, technical and some service occupations, had poorer cognitive performance and a higher prevalence of DSM-III-R dementia. These differences held even when age, education and native English were statistically controlled. The greatest occupational difference was on the National Adult Reading Test, which estimates pre-morbid ability. By contrast, there were no occupational differences in longitudinal change in cognitive test performance, informant reports of cognitive decline or incident cases of dementia over three and a half years. CONCLUSION: Cross-sectional occupational differences on cognitive tests and in dementia prevalence are due to differences in pre-morbid ability rather than to differences in rate of cognitive decline.

Aged↗
PubMed1998

Screening for cognitive impairment in general practice: toward a consensus.

We considered whether general practitioners should examine all older patients over a certain age for cognitive impairment in screening for early dementia. We invited presentations from key experts, selectively reviewed the literature, and developed a consensus statement. The efficacy of and benefits from unselective use of cognitive testing and informant questionnaires for detecting early dementia in older patients attending general practice are limited. Positive predictive values of cognitive screening for dementia are less than 50%, even for older patient populations. Higher values may be obtained by testing patients who have a relevant history of cognitive or functional decline. Whatever procedures are adopted for screening older general practice attenders for cognitive impairment or early dementia, investigation is still required into the relative merits of different health professionals performing the screening, the positive and negative effects on patients and their families, and the cost-benefit ratio. The majority view of workshop participants was that cognitive testing should occur for older patients when there is a reason to suspect dementia. Testing may occur in an individual considered to be at risk because of an informant history of cognitive or functional decline, clinical observation, or, sometimes, very old age. No single instrument for cognitive screening is suitable for global use. Screening programs must be supported by training and supplemented by education for professionals and families in management of dementia.

Age of Onset↗
PubMed1998

Prisoner of war experience: effects on wives.

The aim of this study was to compare the wives of Australian soldiers who had been imprisoned during World War II (POWs) with a control group of non-POWs' wives and also to compare the POWs and non-POWs themselves in respect to several psychological and family life characteristics on which differences might be expected to arise from the long-term effects of imprisonment. A random sample of 145 of these veterans and their wives completed several self-administered mood and family life scales, an inventory of somatic symptoms, questions about the impact of the war on the veteran in the postwar decades, and several social background questions. The POWs themselves were more depressed and reported more somatic symptoms and a greater postwar impact of the war than the non-POWs. However, these differences were not accompanied by concomitant differences among their wives. There was some evidence of an influence of the POW's mood on his wife's mood in significant correlations between husbands' and wives' depression and anxiety scale scores in POW couples alone. Otherwise, there was very little indication that the POW experience had any long-term effect on the marriage relationship as measured by the variables included in this study.

Adaptation, Psychological↗
PubMed1998

Predictors of GP service use: a community survey of an elderly Australian sample.

As part of a study of an elderly community-dwelling Australian population, predictors of general practitioner (GP) service use were identified. The sample of 897 persons, aged 70 years or older and living in Canberra and Queanbeyan, were interviewed about their health and well-being. Data on the number of GP visits in the following 12-month period were obtained from the Health Insurance Commission. There were important gender differences in the prediction of both contact and volume of service use. Need variables (physical health in men, and disability and anxiety in women) were the most important predictors. Men who were older or who had lower occupational status used more medical services, as did women with less education or higher levels of extraversion. Men with lower social support were less likely to contact a GP, but social support was not related to volume of service use for either men or women. Since at most 21% of the variance in the volume of GP service use could be explained, despite the wide range of predictors considered and the different statistical approaches adopted, better measures of service use and predictors need to be developed.

Activities of Daily Living↗
PubMed1998

Health habits and risk of cognitive impairment and dementia in old age: a prospective study on the effects of exercise, smoking and alcohol consumption.

Previous research has yielded inconsistent results on the effects of exercise, smoking and alcohol use on cognitive impairment and dementia in old age. We analysed data from the Sydney Older Persons Study to see if these health habits were associated with cognitive functioning, dementia or Alzheimer's disease. Health habits were assessed in Wave 1 of the study, when the subjects were aged 75 years or over. Three years later, the subjects were tested for cognitive functioning and clinically examined for dementia and Alzheimer's disease. The analysis was restricted to the 327 subjects examined in Wave 2 who were non-demented in Wave 1. There were few significant associations between health habits and cognitive performance and these were not found consistently across cognitive measures. No associations were found with dementia or Alzheimer's disease. While these health habits do not affect risk for dementia and cognitive impairment in the very elderly, who are at highest risk for these disorders, we cannot discount a role at younger ages.

Aged↗
PubMed1998

Posttraumatic stress disorder and other predictors of health care consumption by Vietnam veterans.

A total of 641 randomly selected Australian veterans of the Vietnam War were interviewed about their use of health care in the previous two weeks to determine what factors contributed to health care consumption. Seventy-three variables were examined by univariate linear regression and then grouped into seven categories relating to age, physical and mental health, predisposition to posttraumatic stress disorder (PTSD), deployment and repatriation experiences, and membership in veterans groups. PTSD was associated with an additional cost of $79 in health care for the two-week period. Each physical diagnosis was associated with an additional $28. Alcohol consumption was not related to health care costs. Other important variables contributing to costs were depression, educational status, the quality of the repatriation experience, and social support.

Adult↗
PubMed1998

The incidence of dementia: a meta-analysis.

OBJECTIVE: To carry out a meta-analysis of the age-specific incidence of all dementias, including AD and vascular dementia. BACKGROUND: Several meta-analyses have been carried out on dementia prevalence, but none on its incidence. METHODS: We used loess-curve fitting to analyze data from 23 published studies reporting age-specific incidence data. RESULTS: The incidence of both dementia and AD rose exponentially up to the age of 90 years, with no sign of leveling off. The incidence rates for vascular dementia varied greatly from study to study, but the trend was also for an exponential rise with age. There was no sex difference in dementia incidence (p = 0.21), but women tended to have a higher incidence of AD in very old age, and men tended to have a higher incidence of vascular dementia at younger ages. East Asian countries had a lower incidence of dementia than Europe (p = 0.0004), and also tended to have a lower incidence of AD. CONCLUSIONS: The incidence of dementia rises exponentially to the age of 90 years. Any sex differences are small, and incidence is lower in East Asia than in Europe.

Age Factors↗
PubMed1997

Alzheimer's disease: risk and protection.

Only four risk factors for Alzheimer's disease can be regarded as confirmed--old age, family history of dementia, apo-E genotype and Down syndrome. Other disputed risk factors with some supporting evidence include ethnic group, head trauma and aluminium in drinking water. Possible protection factors, such as anti-inflammatory drugs, oestrogen replacement therapy and a high education level, are of great interest because they suggest possible preventive action.

Adult↗
PubMed1997

Alcohol consumption and cognitive performance in a random sample of Australian soldiers who served in the Second World War.

OBJECTIVE: To examine the association between the average daily alcohol intake of older men in 1982 and cognitive performance and brain atrophy nine years later. SUBJECTS: Random sample of 209 Australian men living in the community who were veterans of the second world war. Their mean age in 1982 was 64.3 years. MAIN OUTCOME MEASURES: 18 standard neuropsychological tests measuring a range of intellectual functions. Cortical, sylvian, and vermian atrophy on computed tomography. RESULTS: Compared with Australian men of the same age in previous studies these men had sustained a high rate of alcohol consumption into old age. However, there was no significant correlation, linear or non-linear, between alcohol consumption in 1982 and results in any of the neuropsychological tests in 1991; neither was alcohol consumption associated with brain atrophy on computed tomography. CONCLUSION: No evidence was found that apparently persistent lifelong consumption of alcohol was related to the cognitive functioning of these men in old age.

Aged↗
PubMed1997

Impact of pet ownership on elderly Australians' use of medical services: an analysis using Medicare data.

OBJECTIVES: To determine whether pet ownership by elderly people is associated with lower use of health services. DESIGN: Survey of physical and mental health, and retrospective 12-month review of Medicare records of the number of general practitioner and specialist services. PARTICIPANTS AND SETTING: Elderly people living in Canberra (Australian Capital Territory) and Queanbeyan (New South Wales), surveyed in 1994 for the second stage of a larger longitudinal study. RESULTS: Elderly pet owners did not differ from non-owners on any of the physical or mental health measures or in use of health services. CONCLUSION: Given the high use of health services by older people, our findings suggest that the claim that pet ownership leads to savings in health services should be viewed with caution.

Aged↗
PubMed1997

"Mental health literacy": a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment.

OBJECTIVES: To assess the public's recognition of mental disorders and their beliefs about the effectiveness of various treatments ("mental health literacy"). DESIGN: A cross-sectional survey, in 1995, with structured interviews using vignettes of a person with either depression or schizophrenia. PARTICIPANTS: A representative national sample of 2031 individuals aged 18-74 years; 1010 participants were questioned about the depression vignette and 1021 about the schizophrenia vignette. RESULTS: Most of the participants recognised the presence of some sort of mental disorder: 72% for the depression vignette (correctly labelled as depression by 39%) and 84% for the schizophrenia vignette (correctly labelled by 27%). When various people were rated as likely to be helpful or harmful for the person described in the vignette for depression, general practitioners (83%) and counsellors (74%) were most often rated as helpful, with psychiatrists (51%) and psychologists (49%) less so. Corresponding data for the schizophrenia vignette were: counsellors (81%), GPs (74%), psychiatrists (71%) and psychologists (62%). Many standard psychiatric treatments (antidepressants, antipsychotics, electroconvulsive therapy, admission to a psychiatric ward) were more often rated as harmful than helpful, and some nonstandard treatments were rated highly (increased physical or social activity, relaxation and stress management, reading about people with similar problems). Vitamins and special diets were more often rated as helpful than were antidepressants and antipsychotics. CONCLUSION: If mental disorders are to be recognised early in the community and appropriate intervention sought, the level of mental health literacy needs to be raised. Further, public understanding of psychiatric treatments can be considerably improved.

Adolescent↗
PubMed1997

GP attendance by elderly Australians: evidence for unmet need in elderly men.

OBJECTIVES: To examine GP service use by elderly people and, in particular, to compare those who had not consulted a GP in one year with those who were low attenders and those who were high attenders. DESIGN: Medicare data on GP service use were matched to data collected by interview in 1990-1991 and reinterview in 1994 as part of a community study on health and well-being. SETTING: Canberra and Queanbeyan in the Australian Capital Territory. PARTICIPANTS: People aged 70 years and over, living in the community. MAIN OUTCOME MEASURES: The number of visits made to a GP in 12 months. RESULTS: Medicare data were available for 624 of the 897 participants interviewed (70%). While the women non-attenders reported similar levels of physical illness and symptoms to the low attenders, men non-attenders reported significantly higher levels of illness (P < 0.01) than the low-attender group. The health of men who were non-attenders was very similar to men who were high attenders of GP services. Men who had not seen a GP in one year reported significantly more pain (P = 0.002) and less social support than both low attenders and high attenders (P = 0.012 and P = 0.049, respectively). CONCLUSION: We identified a group of men who had not attended a GP in one year, despite significant levels of morbidity. Such a group may benefit from consultation with a GP and could be targeted in any attempt to improve elderly men's health.

Aged↗