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Biomedical subjects

M G Cole

Publications and source records attributed to M G Cole.

At least 19 recordsLinked to original sources
PubMed2001

The impact of geriatric post-discharge services on mental state.

OBJECTIVE: To determine the impact of geriatric post-discharge services on mental state. METHODS: Three computer databases, MEDLINE, HealthSTAR and the Cochrane Database of Systematic Reviews were searched for relevant articles; the bibliographies of retrieved articles were searched for additional references. RESULTS: 11 trials were located that met the four inclusion criteria: (i) original study; (ii) published in English or French; (iii) controlled trial (randomized or non-randomized) of a geriatric post-discharge service; and (iv) including at least one measure of mental state. All trials met most of the validity criteria for intervention studies of the Evidence-Based Medicine Working Group. Three trials reported a small effect on emotional state or self-perceived health and eight trials reported no effect. CONCLUSION: There is little evidence that geriatric post-discharge services have an impact on the mental state of aged subjects. Future services and studies should be designed to address the issue of mental state outcomes in this population.

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PubMed2001

Psychosocial risk factors in poststroke depression: a systematic review.

OBJECTIVE: To review systematically the psychosocial risk factors for poststroke depression. METHODS: Medline was searched using the key words "poststroke depression" (PSD) for the period January 1, 1966, to June 30, 2000; using the key words "cerebrovascular disease" and "depression" it was searched from June 1, 1996, to June 30, 2000. Corollary articles were obtained from the bibliographies. Inclusion criteria were as follows: original research in French or English; prospective, case-control or cross-sectional study design; assessment of PSD in the first 6 months following the stroke; an acceptable definition of depression; an acceptable definition of stroke; and at least one psychosocial risk factor. Interrater reliability was tested for the selection and quality of the articles. A qualitative risk factor analysis was conducted. RESULTS: The risk factors most consistently associated with PSD are a past history of depression, past personal psychiatric history, dysphasia, functional impairments, living alone, and poststroke social isolation. Risk factors not associated with PSD are dementia and cognitive impairment. Controversial risk factors are age, socioeconomic status (SES), prior social distress, dependency in regard to activities of daily living (ADL), and sex. CONCLUSIONS: Over approximately 30 years, some 25 qualitative studies have addressed psychosocial risk factors for PSD. Further studies should aim for quantitative analysis. The results suggest that identifying psychiatric history and preventing social deterioration and impairment should be part of multidisciplinary efforts to care for poststroke patients.

Activities of Daily Living↗
PubMed2001

Feasibility and effectiveness of treatments for post-stroke depression in elderly inpatients: systematic review.

To determine the feasibility and effectiveness of antidepressive treatments for post-stroke depression in elderly medical inpatients, MEDLINE was searched for potentially relevant articles published from January 1987 to August 1997 using the keywords "depression or depressive disorder" (exploded) and "aged." Thirteen reports met the following inclusion criteria: (1) published in English or French; (2) minimum age criterion of 55 and over or mean age 65 and over; (3) post-stroke subjects admitted to a medical, geriatric, or rehabilitation service; (4) used accepted criteria for depression; (5) examined treatment(s) for depression; and (6) reported outcomes as a depression diagnosis and/or symptom level. Data were abstracted independently from each article by two reviewers. The limited evidence suggests contraindications to treatment of 83% of a group to receive a heterocyclic antidepressant compared with 11% of a group to receive a selective serotonin reuptake inhibitor (SSRI); rates of discontinuation and study completion are similar for heterocyclics, SSRIs and psychostimulants. All of the treatments appear to be at least modestly effective in the short term.

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PubMed2001

Detection of delirium using the confusion assessment method.

Delirium in hospitalized elderly patients is a phenomenon requiring a lot of nursing attention. It is also a disorder contributing to poor health outcomes in this population. Because of their 24-hour work schedule, nurses are frequently the first to observe acute changes in patients' mental health status and to initiate early interventions. However, delirium is not always easily identified. Therefore, the goal of this article is to increase nurses' knowledge and awareness of early signs of delirium using the Confusion Assessment Method (CAM) routinely and systematically.

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PubMed2000

Feasibility and effectiveness of treatments for depression in elderly medical inpatients: a systematic review.

To determine the feasibility and effectiveness of treatments for depressed elderly medical inpatients, MEDLINE was searched for potentially relevant articles published from January 1987 to August 1997, using the keywords "depression or depressive disorder" (exploded) and "aged." The bibliographies of relevant articles were searched for additional references. Fifteen reports met the following inclusion criteria: (a) published in English or French; (b) minimum age criterion of 55 and over or mean age 65 and over; (c) subjects admitted to the medical service of an acute care hospital; (d) used accepted criteria for depression; (e) examined treatment(s) for depression; and (f) reported outcomes as a depression diagnosis and/or symptom level. Information was abstracted independently from each article by two reviewers, tabulated, and compared. The limited evidence suggests contraindications to treatment in 38% to 87% of subjects who received a heterocyclic antidepressant compared to 4% of subjects who received the selective serotonin reuptake inhibitor (SSRI) fluoxetine; rates of discontinuation and study completion were similar for heterocyclics, the SSRIs, and psychostimulants. All of the treatments (including social support/psychotherapy) appeared to be at least modestly effective in the short term.

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PubMed1999

Prognosis of depression in elderly community and primary care populations: a systematic review and meta-analysis.

OBJECTIVE: The purpose of this study was to determine the prognosis of depression in elderly community and primary care populations. METHOD: MEDLINE and PsycINFO were searched for potentially relevant articles published from January 1981 to November 1996 and from January 1984 to November 1996, respectively. The bibliographies of relevant articles were searched for additional references. Twelve studies met the following five inclusion criteria: original research, published in English or French, study population of community residents or primary care patients, subjects' mean age 60 years and over, and reported affective state as an outcome. The validity of the studies was assessed according to the criteria for prognostic studies described by the Evidence-Based Medicine Working Group. Information about the population, proportion of depressed subjects detected and treated by primary care physicians, length of follow-up, outcomes, and prognostic factors was systematically abstracted from each report. RESULTS: All of the studies had some methodologic limitations. A meta-analysis of outcomes at 24 months estimated that 33% of subjects were well, 33% were depressed, and 21% had died. There was statistically significant heterogeneity in the outcomes across studies. The length of follow-up and lower age limit for enrollment explained part of the heterogeneity for the percent well but not for the other outcomes. Physical illness, disability, cognitive impairment, and more severe depression were associated with worse outcomes but inconsistently so. CONCLUSIONS: Depression in elderly community and primary care populations has a poor prognosis, is perhaps chronic or relapsing or both, and is probably undertreated. Despite the methodologic limitations of the studies and this meta-analysis, these findings seem to support efforts to develop detection and treatment programs for depression in these populations.

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PubMed1998

Impact of geriatric home screening services on mental state: a systematic review.

The purpose of this report was to determine the impact of geriatric home screening services on mental state. Two computer databases, MEDLINE and HealthSTAR, were searched for relevant articles published from January 1975 to June 1997, and the bibliographies of retrieved articles were searched for additional references. Seven trials were located that met the four inclusion criteria: (a) original study; (b) published in English or French; (c) controlled trial (randomized or nonrandomized) of a geriatric home screening service; and (d) the trial included at least one measure of mental state. All trials met most of the validity criteria for intervention studies of the Evidence-Based Medicine Working Group. Two trials reported a small effect on morale or self-perceived health and five trials reported no effect. Thus, there was little evidence that geriatric home screening services had an impact on the mental state of aged subjects.

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PubMed1998

Detection and diagnosis of delirium in the elderly: psychiatrist diagnosis, confusion assessment method, or consensus diagnosis?

The clinical diagnosis of delirium has traditionally been based on an assessment by one or more physicians. Because of the transient, ubiquitous, and fluctuating nature of the symptoms of delirium, however, this approach may be flawed. Therefore, we decided to compare diagnosis based on one assessment by a psychiatrist, diagnosis by a nurse clinician (using the Confusion Assessment Method [CAM] and multiple observation points), and diagnosis by consensus. The study subjects were 87 patients aged 65 and over who were admitted consecutively from the emergency department to the medical wards, and who scored 3 or more on the Short Portable Mental Status Questionnaire. All subjects were assessed independently by one of three psychiatrists (a chart review and clinical examination) and a nurse clinician (using the CAM and multiple observation points). A consensus conference, attended by the three psychiatrists and the nurse clinician, used all available information to reach a consensus diagnosis. Compared to the consensus diagnosis, the clinical diagnosis by a psychiatrist had a sensitivity of .73 (95% confidence interval [CI]: .61-.85), a specificity of .93 (95% CI: .79-1.0), and an agreement kappa coefficient of .58 (95% CI: .41-.74). The nurse clinician diagnosis had a sensitivity of .89 (95% CI: .81-.97), a specificity of 1.00, and an agreement kappa coefficient of .86 (95% CI: .75-.97). These results suggest that one clinical assessment by a psychiatrist may not be the best method for detecting and diagnosing delirium in the elderly. A consensus diagnosis or diagnosis by a trained rater (using the CAM and multiple observation points) may be more sensitive approaches.

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PubMed1998

Delirium risk factors in elderly hospitalized patients.

OBJECTIVE: Delirium is frequent in elderly hospitalized patients. Many studies have examined its risk factors, but results have been quite variable. Thus, the goal of this study is to identify through systematic literature review the risk factors associated with the development of delirium in hospitalized geriatric patients. MEASUREMENTS AND MAIN RESULTS: First, MEDLINE/CURRENT CONTENTS databases were screened for relevant articles published from 1966 to December 1995, and from bibliographies of identified articles additional reports were selected. Second, the reports were screened by two different investigators and retained only if meeting the five following criteria: (1) original research in French or English; (2) prospective study; (3) patients over age 50; (4) minimum of one risk factor examined; (5) acceptable definition of delirium. Third, the methodology of each study was graded according to specific criteria for risk factor studies. Fourth, risk factors were identified and tabulated, unadjusted odds ratios (ORs) were computed, and where appropriate a combined OR with the Mantel-Haenszel estimator was calculated. Twenty-seven articles were retained meeting all of the above criteria. Among these studies, 11 were done on medical patients, 9 on surgical patients, 2 on medical and surgical patients, and 5 on psychiatric patients. In total 1,365 subjects with delirium were studied. Sixty-one different risk factors were examined, the five most common being dementia, medication, medical illness, age, and male gender. Mantel-Haenszel estimator was calculated for 10 risk factors, the most strongly associated being dementia (OR 5.2; 95% confidence interval [CI] 4.2, 6.3), medical illness (OR 3.8; 95% CI 2.2, 6.4), alcohol abuse (OR 3.3; 95% CI 1.9, 5.5), and depression (OR 1.9; 95% CI 1.3, 2.6). Methodologic weaknesses were present in many studies. CONCLUSIONS: Despite methodologic limitations, certain risk factors for delirium seem to be consistent and could help identify high-risk patients. These risk factors include dementia, advanced age, and medical illness. Other risk factors appear to play a contributory role in the development of delirium in elderly hospitalized patients.

Age Factors↗
PubMed1998

Delirium: prevention, treatment, and outcome studies.

The purpose of this paper was to contribute to a new conceptual understanding of delirium by reviewing evidence related to its prevention, treatment, and outcome. The review process involved a systematic search of the literature on each topic, assessment of the validity of the studies retrieved, and examination of their results. The literature search identified 10 studies on prevention, 13 studies on treatment, and 15 studies on outcome. Most studies had methodological limitations. Abroad spectrum of interventions appeared to be modestly effective in preventing delirium in young and old surgical patients but not elderly medical patients; systematic detection and intervention programs and special nursing care appeared to add large benefits to traditional medical care in young and old surgical patients and modest benefits in elderly medical patients; haloperidol, chlorpromazine, and mianserin appeared to be useful in controlling the symptoms of delirium in both surgical and medical patients; and good levels of premorbid function seemed to be related to better outcomes. Although the above findings do not contribute to a new conceptual understanding of delirium, they do suggest directions for further research on the treatment of delirium.

Age Factors↗
PubMed1997

Depression in elderly medical inpatients: a meta-analysis of outcomes.

OBJECTIVE: To determine the prognosis of elderly medical inpatients with depression. DATA SOURCES: A MEDLINE search for relevant articles published from January 1980 to September 1996 and a search of the PSYCH INFO database for articles published from January 1984 to September 1996. The bibliographies of identified articles were searched for additional references. STUDY SELECTION: Eight reports (involving 265 patients with depression) met the following 5 inclusion criteria: original research, published in English or French, population of general medical inpatients, mean age of depressed patients 60 years and over, and affective state reported as an outcome. The validity of the studies was assessed according to the criteria for prognostic studies described by the Evidence-Based Medicine Working Group. DATA EXTRACTION: Information about the patient population, the proportion of cases detected and treated by attending physicians, the length of follow-up, the affective outcome and the prognostic factors was abstracted from each report. DATA SYNTHESIS: All of the studies had some methodologic limitations. A meta-analysis of outcomes at 3 months or less indicated that 18% of patients were well, 43% were depressed and 22% were dead. At 12 months or more, 19% were well, 29% were depressed and 53% were dead. Factors associated with worse outcomes included more severe depression, more serious physical illness and symptoms of depression before admission. CONCLUSIONS: Elderly medical inpatients who are depressed appear to have a very poor prognosis: the recovery rate among these patients is low and the mortality rate high.

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PubMed1997

Idiopathic musical hallucinations in the elderly.

The purpose of this study was to determine the phenomenology and treatment of idiopathic musical hallucinations in the elderly by reviewing all relevant case reports. A systematic literature search yielded 32 case reports that met the following four inclusion criteria: (1) published in English, French, or Italian; (2) cases aged 65 years of age or older; (3) absence of major focal neurologic disease; and (4) absence of drug toxicity. Information was subsequently abstracted from each case reported and tabulated. Idiopathic musical hallucinations in the elderly occurred predominantly in females who had a hearing impairment, one third of whom were depressed. Treatment of depressed patients with antidepressants and nondepressed patients with anticonvulsants/anxiolytics seemed to result in improvement of many cases.

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PubMed1997

Depression in older medical inpatients: one-year course and outcome.

OBJECTIVE: This 1-year follow-up survey of 214 medical inpatients aged 65 and older describes the outcome of major depressive episode (MDE), determines the incidence of new episodes and identifies factors associated with outcome and with new episodes of MDE. METHOD: Follow-up information was obtained from 160 patients, 69 men and 91 women. RESULTS: Of the 48 cases of MDE who were interviewed, 44% improved. Underlying dysthymic disorder strongly influenced outcome: of 21 cases of MDE alone, 62% were improved at follow-up; of the 27 cases in which MDE was superimposed on dysthymic disorder initially, only 30% were improved. New episodes of MDE occurred in 21% of patients, and were associated with dysthymic disorder initially and with change of meaning of life. CONCLUSIONS: Among older medical inpatients, MDE, particularly when superimposed upon dysthymic disorder, is a persistent condition. Randomized trials are necessary to identify efficacious treatments.

Activities of Daily Living↗
PubMed1997

The prognosis of depression in old age.

The authors sought to determine the prognosis of depression in old age by reviewing original literature on this topic from three computer databases. All reports used at least 20 patients over age 60, followed up for at least 1 year, with affective status as outcome, and a quantitative meta-analysis was performed to combine results. Sixteen hospital-based and five community-based studies were selected, involving 1,487 and 249 depressed subjects, respectively. Most studies had serious methodological limitations. For combined results, 60% of patients in the hospital-based studies were well or had relapses-with-recovery, and 14%-22% were continuously ill; 19%-34% of community subjects were well; 27% were continuously ill, and most of the remainder had died. Physical illness, cognitive impairment, and severe depressive symptoms were frequently but inconsistently related to poor prognosis. Future studies must attend to composition of study populations and outcome assessment and control of extraneous prognostic factors.

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