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Biomedical subjects

B Draper

Publications and source records attributed to B Draper.

At least 19 recordsLinked to original sources
PubMed2005

Vocally disruptive behaviour in dementia: development of an evidence based practice guideline.

Vocally Disruptive Behaviour (VDB) is a term that includes screaming, abusive language, moaning, perseveration, and repetitive and inappropriate requests. It is one of the most challenging behaviours for nursing home staff, caregivers for people with dementia, and other nursing home residents. As with other behavioural disturbances, multiple causal factors have been identified in the literature and individual cases may have a number of interacting factors. There is a lack of consensus about how to treat VDB. Systematic treatment studies are few and there is a lack of empirical data supporting the effectiveness of specific interventions commonly used in clinical practice. This hinders clinicians and may result in the use of inappropriate treatments. Our aim was to systematically review the literature in order to develop a practice guideline for the assessment and management of VDB. The review will examine the typology, risk factors and management of VDB.

Aged↗
PubMed2004

The relationship between self-destructive behaviour and nursing home environment.

The aim of this study was to explore the relationship between self-destructive behaviour and nursing home environment. We performed a cross-sectional study comprising 647 residents in 11 nursing homes in Sydney, Australia using the Harmful Behaviours Scale (HBS), Abbreviated Mental Test Scale and the Resident Classification Index. The Directors of Nursing completed a questionnaire that rated physical design, staff and resident characteristics and demographics were obtained from nursing home records. On regression analysis a greater number of design features for frail and residents with dementia in general, and increased security measures were associated with greater HBS total score and risk-taking and passive self-harm subscales. A residential environment in which the residents were more functionally dependent and more likely to be in a shared room, managerial policies less geared towards managing difficult behaviour and less staff availability and training were associated with the 'uncooperativeness' factor. There were no significant predictors of the other two factors. The relationship between nursing home environment and self-destructive behaviours and the environment is complex and there needs to be an individualized approach to placement.

Adaptation, Psychological↗
PubMed2004

The prevalence of "cognitive impairment no dementia" in community-dwelling elderly: a pilot study.

OBJECTIVE: To determine the prevalence of "cognitive impairment no dementia" (CIND) and "amnestic mild cognitive impairment" (aMCI) in a population sample of 70-79-year-olds and the risk factors for CIND. METHOD: Cross sectional population survey. SETTING: Sutherland Shire, Sydney, Australia. SUBJECTS: 150 community-dwelling 70-79-year-olds were screened by telephone, 42 of whom were assessed at home. MEASURES: Demographics, subjective ratings of physical and emotional health and memory, cardiovascular risk factors, medications, the Mini-Mental State Examination, Boston Naming Test, Trail Making Tests A and B, Block Design, Rey Auditory Verbal Learning Test (RAVLT), Visual Reproduction, Logical Memory, letter and category fluency, the National Adult Reading Test (NART), the Geriatric Depression Scale (GDS) and the "state" section of the State-Trait Anxiety Inventory (STAI-S). RESULTS: From the 400 subjects contacted initially, 150 consented to be interviewed and 131 eligible subjects were recruited. Of a 1-in-3 random sample of 42 subjects assessed at home, 14 (33.3%) subjects met criteria for CIND, 1 (2.4%) had possible dementia and the 27 remaining (64.3%) were cognitively normal. Four (9.5%) met criteria for aMCI. Subjects with CIND were older, had lower ranking occupations and were less likely to be currently working than those classified as cognitively normal. Ten subjects with CIND did not meet criteria for aMCI because they lacked subjective memory impairment (n = 3) or had cognitive deficits other than memory (n = 7). All subjects with aMCI met criteria for CIND. CONCLUSIONS: One-third of individuals in this population sample met criteria for CIND. CIND is a broader definition than aMCI. Further research is needed to determine the longitudinal course and clinical utility of these definitions of cognitive impairment.

Aged↗
PubMed2003

Dynamics of the pi(-)p-->pi(0)pi(0)n reaction for p(pi(-))<750 MeV/c.

Data are presented for the reaction pi(-)p-->pi(0)pi(0)n in the range from threshold to p(pi(-))=750 MeV/c. The systematics of the data and multipole analyses are examined for sensitivity to a f(0)(600) ("sigma") meson. A one-pion-exchange mechanism is found to be very weak, or absent. The reaction appears to become dominated by sequential pi(0) decays through the Delta(1232) resonance as the beam momentum increases, along with substantial interference effects from several competing mechanisms.

Journal Article↗
PubMed2001

Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors.

BACKGROUND: There is wide variation in the rates of behavioural and psychological symptoms of dementia (BPSD) reported in nursing homes. AIMS: This study aimed to investigate: (1) the prevalence of BPSD in nursing home residents using the BEHAVE-AD; (2) the relationships of BPSD with (a) demographic, (b) dementia, (c) diurnal and (d) nursing home variables; and (3) the inter-relationships between different types of BPSD, as measured by subscales of the BEHAVE-AD. RESULTS: Over 90% of residents exhibited at least one behavioural disturbance. Specifically, there was evidence of psychosis in 60%, depressed mood in 42% and activity disturbances or aggression in 82% of residents. Younger, more functionally impaired residents with a chart diagnosis of psychosis had higher BPSD rates, as did those residing in larger nursing homes. Individual BPSD were significantly intercorrelated. CONCLUSIONS: BPSD are ubiquitous in nursing home residents. Behavioural disturbances are frequently associated with psychosis and/or depression. The findings suggest the need for psychogeriatric services to nursing homes and smaller facilities.

Adult↗
PubMed2001

Use of psychotropics in Sydney nursing homes: associations with depression, psychosis, and behavioral disturbances.

The purpose of this study was to determine the prevalence of psychotropic use in nursing home residents, the extent to which psychotropic dosage is consistent with published guidelines, and the relationships between psychotropic class and psychiatric and behavioral disturbances. Six hundred forty-seven subjects, mean age 82.3 years, residing in 11 nursing homes in the eastern suburbs of Sydney, Australia, were assessed using the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), the Abbreviated Mental Test Scale, and the Even Briefer Assessment Scale for Depression (EBAS-DEP). Details of psychotropic prescription and diagnoses of depression, dementia, and psychosis were obtained from nursing home charts. Psychotropics were prescribed for 333 (51.5%) residents, 381 (58.9%) if "as required" (PRN) use is included. Prescription of multiple psychotropics was present in 148 (22.7%) residents. Antidepressants were prescribed for 19.8% of residents, with subtherapeutic doses less likely in residents on selective serotonin reuptake inhibitors. On logistic regression, the use of antidepressants was predicted by the affective disturbances subscale on the BEHAVE-AD. Only 30.4% of residents with significant depressive symptoms on the EBAS-DEP were prescribed antidepressants. Antipsychotics were prescribed for 21.3% residents at a mean dosage of 73 mg chlorpromazine equivalence. Residents on antipsychotics had significantly higher scores on the delusions, hallucinations, activity disturbance, and aggressiveness subscales of the BEHAVE-AD. On logistic regression, only the activity disturbance subscale and chart diagnoses of dementia and psychosis were significant predictors. Psychosis (58.8%) and behavioral disturbances (91.9%) were more prevalent in residents prescribed antipsychotics than in residents not prescribed antipsychotics (42.5% and 76.6%, respectively). High rates of behavioral and psychological symptoms of dementia remained in residents prescribed antipsychotics and high rates of depressive symptoms in residents prescribed antidepressants, suggesting a role for nonpharmacological strategies.

Aged↗
PubMed2000

The effectiveness of old age psychiatry services.

The objective of this study was to review outcomes of acute service delivery in old age psychiatry. Sources of data included Medline, PsycINFO and Cochrane Collaboration databases of English language papers to 1998 on service delivery evaluation in 'old age psychiatry', 'psychogeriatrics' and 'geriatric psychiatry', supplemented by a manual search of references from relevant literature. All controlled trials, audits, and surveys of the outcomes of service delivery in old age psychiatry located in acute hospitals and community settings were included. Service delivery by medical, adult psychiatry and consultation/liaison services were included. With the exception of outreach services to nursing homes, long term institutional care was excluded. All data were extracted by the author. Data quality was assessed by applying an evidence hierarchy. Evaluation strategies were qualitatively reviewed. Controlled trials, audits and surveys were each found to provide important data in the evaluation of service delivery. There is better quality evidence to support the effectiveness of components of old age psychiatry services than other service types. The majority of studies indicate that old age psychiatry services have positive acute treatment outcomes, particularly with depression. There is insufficient evidence to determine which processes of care are associated with better outcomes. Pluralistic evaluations indicate that carers often have unmet needs and are not as positive about outcomes. There have been no controlled comparisons of service delivery provided by other services. In conclusion, controlled trials and audits indicate that old age psychiatry services are effective. Further pluralistic evaluations and comparisons with other services are required.

Acute Disease↗
PubMed2000

Case-controlled study of nursing home residents referred for treatment of vocally disruptive behavior.

The aim of this study was to identify factors associated with vocally disruptive behavior (VDB) in nursing home patients referred to aged care services for treatment, using a case-control methodology. Characteristics of the VDB, reasons for referral, perceived causal factors, and psychotropic use were noted. Twenty-five subjects and controls were examined with the Screaming Behavior Mapping Instrument, the Cornell Scale for Depression in Dementia, the Dementia Behavior Disturbance Scale, and measures of cognition, functional capacity, social activities, and emotional reactions of nursing staff. VDB was associated with other disturbed behaviors, depression, anxiety, severe dementia, functional impairment, communication difficulties, use of psychotropic medication, social isolation, and emotional distress in the nursing staff. Reasons for referral may relate more to the stress experienced by nursing home staff in managing VDB than to specific attributes of the VDB itself.

Aged↗
PubMed1999

Psychiatry of old age: from section to faculty.

OBJECTIVE: To describe the processes that led to formation of the RANZCP Faculty of Psychiatry of Old Age (FPOA). METHOD AND RESULTS: Two criteria needed to be fulfilled before Faculty status could be approved. One was to demonstrate a recognised body of knowledge concerning psychiatry of old age, and the other was to be able to offer a comprehensive training program in this subspecialty. CONCLUSIONS: On 1 January 1999, FPOA came into existence.

Aged↗
PubMed1999

The Senior Psychiatrist Survey III: attitudes towards personal ageing, life experiences and psychiatric practice.

OBJECTIVE: The aim of this study is: to explore whether there is a relationship between the effects of gender, age and perceptions of personal health on psychiatrist's reactions to personal ageing; and to determine the effects of psychiatrist's reactions to personal ageing upon their approach to clinical practice, retirement planning and post-retirement activities. METHOD: A postal survey was conducted. Respondents were Fellows of the Royal Australian and New Zealand College of Psychiatrists resident in Australia or New Zealand. Of 1086 eligible subjects, 529 participated. The main outcome measures were: Reactions to Ageing Questionnaire (RAQ); self-rated health; location and type of psychiatric practice; the perceived benefits and drawbacks of age on psychiatric practice and case selection; and retirement plans. RESULTS: Positive attitudes towards personal ageing were significantly associated with old age, males and good or excellent self-rated health. Negative attitudes were associated with working in universities and anticipated retirement due to poor health. Field of practice, anticipated post-retirement activities and approach to clinical practice were not found to have a significant effect on attitudes towards personal ageing. CONCLUSIONS: The effects of life experiences on psychiatrists' attitudes towards personal ageing are complex. Attitudes towards personal ageing have little impact on psychiatric practice.

Adult↗
PubMed1999

The Senior Psychiatrist Survey I: age and psychiatric practice.

OBJECTIVE: The aim of this study is to determine the effects of age on the practice, roles, status and attitudes of psychiatrists within the Royal Australian and New Zealand College of Psychiatrists (RANZCP). METHOD: A postal survey of Fellows of the RANZCP resident in Australia or New Zealand was conducted. The main outcome measures were: age; location and type of psychiatric practice; hours of work; attitudes towards re-accreditation; changes in work practices over the career; and the perceived benefits and drawbacks of age to psychiatric practice and case selection. RESULTS: Of 1086 eligible subjects, 629 participated. The mean age of the sample was 52.7 years (SD = 13.5). Those psychiatrists favouring re-accreditation were younger. Psychiatrists practising psychotherapy, forensic psychiatry or general psychiatry; working in psychiatric hospitals and private practice were more likely to be older. Older psychiatrists worked shorter hours. There was largely no association between case selection and age. Psychiatrists reporting increased credibility and respect as a benefit of their current age upon their psychiatric practice were older, as were those identifying fatigue and an inability to keep up to date as a drawback of age. Psychiatrists reporting a lack of credibility and respect were younger, as were those who reported increased enthusiasm and optimism. CONCLUSIONS: Age is associated with benefits and drawbacks to the practice of psychiatry and this may be reflected in the different practice profiles of older and younger psychiatrists.

Adult↗
PubMed1999

The Senior Psychiatrist Survey II: experience and psychiatric practice.

OBJECTIVE: The aim of this study is to determine the effects of experience on the practice, roles, status and attitudes of psychiatrists within the Royal Australian and New Zealand College of Psychiatrists (RANZCP). METHOD: A postal survey of Fellows of the RANZCP resident in Australia or New Zealand was conducted. The main outcome measures were: years of psychiatric experience; higher medical qualifications; location and type of psychiatric practice; attitudes about senior psychiatrists and mentorship; changes in work practices over the career; and the perceived benefits and drawbacks of experience on psychiatric practice and case selection. RESULTS: Of 1086 eligible subjects, 629 participated. Over 96% of respondents, particularly the younger and less experienced, believed that senior psychiatrists have wisdom to offer to junior colleagues. This wisdom principally related to mentorship/supervision. Increased 'respect and tolerance' of patients as a benefit of experience was more likely to be reported by respondents who were more experienced. Respondents more confident about treating younger patients and treating functional psychoses were more likely to be less experienced, as were those reluctant to take on psychotherapy cases. Those respondents reluctant to take on 'dangerous or acting-out patients' were more experienced. The field of psychiatric practice significantly influenced case selection. CONCLUSIONS: Senior psychiatrists have accumulated wisdom through experience that is sought by junior colleagues via mentorship. It is recommended that the RANZCP should specifically address the needs of early career and senior psychiatrists.

Adult↗
PubMed1999

Stress in carers of the elderly. A controlled study of patients attending a Sydney family medical practice.

AIM: To examine stress in carers of the elderly who attended a solo family medical practice. METHOD: Eighty-seven carers were compared with 102 non-caregiving controls. Subjects were asked to complete survey questionnaires either in the surgery or at home. The General Health Questionnaire (CHQ) was used to assess psychological morbidity, the Relative Stress Scale as a measure of subjective burden and information was collected on activities of daily living and instrumental activities of daily living. RESULTS: No significant difference was found in GHQ scores, reflecting the high level of stress in this family practice sample (mean GHQ = 4.7, standard deviation = 6.2). Psychological morbidity in carers was associated with the provision of assistance with instrumental activities of daily living such as shopping, cooking and finances. CONCLUSIONS: We suggest that because carers often encounter specific challenges which may be amenable to intervention, general practitioners should familiarise themselves with these issues, determine the caregiving status of their patients and provide information about community services to carers.

Adult↗
PubMed1999

Treatment of vocally disruptive behaviour of multifactorial aetiology.

OBJECTIVE: To describe the treatment of vocally disruptive behaviour (VDB) of multifactorial aetiology. METHOD: Three case reports were used to illustrate the treatment of multifactorial VDB. RESULTS: A biopsychosocial assessment is required to identify the different aetiologies involved and the way they interact. Acute medical and psychiatric factors may demand that interventions are introduced simultaneously rather than in succession. CONCLUSION: Successful interventions require the combination of biopsychosocial strategies tailored to the individual case with realistic goals that include the acceptance of a residual level of VDB as a reasonable outcome.

Aged↗
PubMed1999

The International Psychogeriatric Association--ninth congress. 15-20 August 1999, Vancouver, Canada.

In contrast to previous International Psychogeriatric Association (IPA) meetings, there was a preponderance of sessions dedicated to pharmacological management of cognitive decline due to Alzheimer's disease (AD), especially by cholinesterase inhibitors. Donepezil (Eisai Co Ltd) and rivastigmine (Novartis AG) were most frequently featured, while propentofylline (Hoechst AG) has emerged as an agent potentially efficacious in both AD and vascular dementia. A second focus was the treatment of the behavioral and psychological symptoms of dementia (BPSD), particularly by the atypical antipsychotics risperidone (Janssen Pharmaceutica NV), olanzapine (Eli Lilly & Co) and quetiapine (AstraZeneca plc), but also by anticonvulsants. Some attempts were made to redress the balance by examining non-pharmacological treatments. There were surprisingly few presentations on the management of depression. Fortunately, most of the presentations focused on the difficult issue of comorbid depression and medical illness. Overall, there were no major disclosures of new drugs. Most new data was simply a refinement of previously published material.

Journal Article↗
PubMed1998

Quantification of factors contributing to length of stay in an acute psychogeriatric ward.

OBJECTIVE: To identify variables that predict length of stay (LOS) in an acute psychogeriatric ward; quantify psychiatric, medical and social factors that contribute to LOS; and identify factors that prolong LOS. DESIGN: Prospective audit of admissions over 12 months. SETTING: Acute psychogeriatric ward in teaching hospital. PATIENTS: 73 consecutive patients with a total of 88 admissions. MAIN OUTCOME MEASURES: Main psychiatric, medical and social reasons for admission; Physical Health Schema; total LOS; number of days attributable to psychiatric, medical, social and treatment (non-response and adverse reactions) reasons; DSM-IV diagnosis; global clinical outcome; discharge living arrangements; discharge psychotropic medication. MAIN RESULTS: Presence of depressive symptoms was the most common psychiatric reason for admission and carer stress the main social reason for admission. Principal diagnosis of major depression and carer stress were significant predictors of LOS and accounted for 24.3% of the variance (p < 0.0001). Physical health and psychiatric comorbidity were not able to predict LOS. The proportion of psychiatric, medical and social reasons involved in LOS varied significantly by principal diagnosis (p < 0.001). Almost 42% of bed days were attributable to delays--for medical, social (eg placement problems), treatment (adverse events, non-response) or hospital system reasons. CONCLUSIONS: The quantification of factors contributing to LOS in an acute psychogeriatric unit allows for more accurate identification of issues that can be addressed to improve the efficiency of bed utilization.

Acute Disease↗