The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2013
A life course epidemiologic approach suggests that personality may have lifelong pathways of infl... more A life course epidemiologic approach suggests that personality may have lifelong pathways of influence on risk of dementia and mild cognitive impairment (MCI). This article aimed to systematically review case-control and prospective studies on the association between personality and risk of these cognitive disorders. Studies were identified through Scopus, Medline, PubMed, and PsycINFO. Searches combined terms for personality with those for dementia and MCI. Data were extracted and checked by a second reviewer, systematically reviewed, and meta-analyzed where appropriate. Twelve longitudinal and three case-control studies were included. Five of nine studies found that higher neuroticism was associated with greater dementia risk (pooled hazard ratio [HR] per unit increase on neuroticism score, HR = 1.13, 95% confidence interval [CI] = 1.08-1.18, z = 5.11, p <0.001, N = 3,285), and two studies showed it increased risk of MCI. Three of four studies showed that higher conscientiousne...
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2008
The relationships between total serum cholesterol (TC) and dementia and between TC and cognitive ... more The relationships between total serum cholesterol (TC) and dementia and between TC and cognitive decline were investigated in a systematic review of 18 prospective studies. Follow-ups ranged from 3 to 29 years, and included a total of 14,331 participants evaluated for Alzheimer disease (AD), 9,458 participants evaluated for Vascular dementia (VaD), 1,893 participants evaluated for cognitive decline, and 4,793 participants evaluated for cognitive impairment. Compatible results were pooled using meta-analysis. Consistent associations between high midlife TC and increased risk of AD, and high midlife TC and increased risk of any dementia were found. There was no evidence supporting an association between late-life TC and AD, or between late-life TC and any dementia. No study reported a significant association between TC (measured in midlife or late-life) and VaD. An association between high midlife TC and cognitive impairment was found but there was only weak evidence for an associatio...
The public know little about risk factors for dementia. The aim of this study was to explore beli... more The public know little about risk factors for dementia. The aim of this study was to explore belief structures underlying how plausible risk factors for dementia appear to the general public. Two thousand members of the Australian public were surveyed by telephone on their beliefs regarding dementia risk factors. Factor analysis was performed on 17 modifiable behaviours that were rated by participants as increasing, not changing or decreasing the risk of dementia. Three factors were obtained - Health and Lifestyle, Activity, and Nutrition. Items loading on the Health and Lifestyle factor were management of cardiovascular risk factors, drinking more water, reducing stress, coffee and tea, and alcohol intake. Items loading on the Activity factor were mental, physical and social activity and getting out and about more. Items loading on the Nutrition factor were eating foods high in omega-3 fatty acids, antioxidants and estrogen, using non-aluminium cookware and taking vitamin and nutri...
Dementia behavior long-term care observational data a b s t r a c t Objectives: The objectives of... more Dementia behavior long-term care observational data a b s t r a c t Objectives: The objectives of the current research were (1) to test and evaluate the investigator-designed Behavior, Engagement, and Affect Measure (BEAM) touchpad direct observational data collection tool, and (2) to implement this tool to investigate residents' patterns of behavioral agitation, engagement, affect, behaviors associated with positive mood, general time-activity use, and social interactions within long-term care. Design: Raters collected cross-sectional observational data and conducted semistructured interviews with participants of the Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE) Study. Researchers tested the BEAM's reliability and validity and evaluated the instrument's discriminate validity for sampling resident behaviors. Setting: Data were collected in 36 long-term care homes. The sample included low-care hostels, high-care nursing homes, and residential facilities offering aging-in-place. Participants: Participants were 406 residents aged 52 to 105 years, with and without dementia. Measurements: Researchers collected direct observational data using the BEAM and operationalized behavioral domains based largely on concepts from Kitwood's model of person-centered care. Care staff reported on resident behavior using standardized measures of agitation, depression, quality of life, and social engagement. Results: The BEAM showed moderate-to-substantial interrater reliability and slight-to-moderate correlations with staff-report data gathered through standardized questionnaire measures. Observations showed that residents spent the greatest amount of time stationary and expressing little emotion, although actively engaged with their environment. Residents were observed to be coping adequately and experiencing a positive social and/or positive care interaction in approximately half of observations; however, close to a third of ratings identified "ill-being." Residents showed more positive behavior, appeared happier and less anxious, and exhibited higher "well-being" during structured activity than during free time or meals. Conclusion: The BEAM is a reliable and valid observational tool for measuring behavior in long-term care. Long-term care residents expressed little emotion and experienced limited positive social interaction in their daily routine. Increased provision of structured activities may increase resident experiences of positive behavior, affect, and well-being.
The Australian Government has commenced a two-year pilot of consumer-directed care (CDC) across 5... more The Australian Government has commenced a two-year pilot of consumer-directed care (CDC) across 500 home and community aged care packages. This policy paper discusses the model being trialled in Australia in light of the UK&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Individual Budgets&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; Pilot Programme and the USA&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Cash and Counselling Demonstration. The results of these randomised controlled studies suggest that older people vary in their preferences for consumer direction and that many find the administrative tasks of implementing CDC programs difficult. The relatively restricted model of CDC that the Australian Government is trialling may minimise the problems encountered in the overseas programs, but does not allow consumers to hire family or friends which they preferred to do overseas.
Australia or internationally about dementia in persons from culturally and linguistically diverse... more Australia or internationally about dementia in persons from culturally and linguistically diverse (CALD) backgrounds. This limits our ability to plan for and provide evidence-based medical care, social care and aged care services to persons from CALD backgrounds. This paper describes challenges to conducting CALD dementia research; these include sampling, having valid instruments and costs. Nine key research recommendations in the areas of epidemiology, community knowledge, carers, service delivery, screening and assessment, medical management, residential aged care and minority CALD reached by consensus by an expert group are presented. The paper closes with some strategies to encourage CALD research. The material presented here will provide guidance for future research endeavours. In 2007 there were an estimated 220 050 people with dementia in Australia [1]. By 2030 this figure will have more than doubled to 465 460 and by 2050 the figure will reach 731 030 [1]. In 2007, 18% of Australian residents aged 65 and over were born overseas [2].
I enjoy my current work situation' and 'Our work organisation is good'. There were significant di... more I enjoy my current work situation' and 'Our work organisation is good'. There were significant differences between homes in levels of strain related to dementia care that were not accounted for by the level of behavioural disturbance. Conclusions. Nursing home staff tended to perceive residents in more negative than positive ways. Staff were generally satisfied with their work. Factors other than resident behavioural disturbance are important influences in nursing staff strain.
Investigate factors associated with waiting times for home care packages and outcomes for care re... more Investigate factors associated with waiting times for home care packages and outcomes for care recipients and carers. Analyses of data collected every four months for 12 months from 55 community-dwelling older adults eligible for government-subsidised packaged care and their carers. Thirty of fifty-five participants were offered a package; they waited from one to 237 days. Baseline quality of life was higher for those offered a package than those not. Baseline care needs and unmet needs, neuropsychiatric symptoms, and cognitive decline did not predict offers. Package receipt compared to non-package receipt was associated with decreased carer burden over time but did not affect levels of unmet care needs, care needs or quality of life. Being offered a home care package was not based on waiting time or unmet care needs. Reforms should include a transparent system of wait listing and prioritisation.
Objectives: To determine whether humour therapy reduces depression ( primary outcome), agitation ... more Objectives: To determine whether humour therapy reduces depression ( primary outcome), agitation and behavioural disturbances and improves social engagement and quality-of-life in nursing home residents.
The American Journal of Geriatric Psychiatry, 2014
To examine the clinical utility of the Cornell Scale for Depression in Dementia (CSDD) in nursing... more To examine the clinical utility of the Cornell Scale for Depression in Dementia (CSDD) in nursing homes. 14 nursing homes in Sydney and Brisbane, Australia. 92 residents with a mean age of 85 years. Consenting residents were assessed by care staff for depression using the CSDD as part of their routine assessment. Specialist clinicians conducted assessment of depression using the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders for residents without dementia or the Provisional Diagnostic Criteria for Depression in Alzheimer Disease for residents with dementia to establish expert clinical diagnoses of depression. The diagnostic performance of the staff completed CSDD was analyzed against expert diagnosis using receiver operating characteristic (ROC) curves. The CSDD showed low diagnostic accuracy, with areas under the ROC curve being 0.69, 0.68 and 0.70 for the total sample, residents with dementia and residents without dementia, respectively. At the standard CSDD cutoff score, the sensitivity and specificity were 71% and 59% for the total sample, 69% and 57% for residents with dementia, and 75% and 61% for residents without dementia. The Youden index (for optimizing cut-points) suggested different depression cutoff scores for residents with and without dementia. When administered by nursing home staff the clinical utility of the CSDD is highly questionable in identifying depression. The complexity of the scale, the time required for collecting relevant information, and staff skills and knowledge of assessing depression in older people must be considered when using the CSDD in nursing homes.
Background: Depression is a common psychiatric disorder in older people. The study aimed to exami... more Background: Depression is a common psychiatric disorder in older people. The study aimed to examine the screening accuracy of the Geriatric Depression Scale (GDS) and the Collateral Source version of the Geriatric Depression Scale (CS-GDS) in the nursing home setting.
AFQT scores than MCI-discordant pairs; MCI-discordant pairs had lower scores than normal-concorda... more AFQT scores than MCI-discordant pairs; MCI-discordant pairs had lower scores than normal-concordant pairs. Within-pair AFQT differences were observed only in dizygotic discordant pairs; normal twins scored higher. Overall results were similar for age 55 AFQT even after adjusting for age 20 scores. Conclusions: Neuropsychologically-defined MCI is present in the sixth decade of life (50s) in non-clinically referred, community-dwelling adults. A unique feature of the discordant twin design enabled us to identify unobserved heterogeneity. The subgroups of normal twins are phenotypically the same, but differed in premorbid cognitive ability based on genetic risk (i.e., having a normal or MCI co-twin). Differences based on genetic risk for the MCI phenotypes followed the same pattern. Premorbid ability is not the entire story, however, because differences persist even after adjusting for premorbid ability. Finally, genetic influences cannot cause differences in genetically-identical monozygotic twins. Therefore, the fact that premorbid cognitive differences within discordant pairs were accounted for by only dizygotic twins suggests that the link between premorbid cognitive ability and MCI is due to some degree of shared genetic influences.
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2013
A life course epidemiologic approach suggests that personality may have lifelong pathways of infl... more A life course epidemiologic approach suggests that personality may have lifelong pathways of influence on risk of dementia and mild cognitive impairment (MCI). This article aimed to systematically review case-control and prospective studies on the association between personality and risk of these cognitive disorders. Studies were identified through Scopus, Medline, PubMed, and PsycINFO. Searches combined terms for personality with those for dementia and MCI. Data were extracted and checked by a second reviewer, systematically reviewed, and meta-analyzed where appropriate. Twelve longitudinal and three case-control studies were included. Five of nine studies found that higher neuroticism was associated with greater dementia risk (pooled hazard ratio [HR] per unit increase on neuroticism score, HR = 1.13, 95% confidence interval [CI] = 1.08-1.18, z = 5.11, p <0.001, N = 3,285), and two studies showed it increased risk of MCI. Three of four studies showed that higher conscientiousne...
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2008
The relationships between total serum cholesterol (TC) and dementia and between TC and cognitive ... more The relationships between total serum cholesterol (TC) and dementia and between TC and cognitive decline were investigated in a systematic review of 18 prospective studies. Follow-ups ranged from 3 to 29 years, and included a total of 14,331 participants evaluated for Alzheimer disease (AD), 9,458 participants evaluated for Vascular dementia (VaD), 1,893 participants evaluated for cognitive decline, and 4,793 participants evaluated for cognitive impairment. Compatible results were pooled using meta-analysis. Consistent associations between high midlife TC and increased risk of AD, and high midlife TC and increased risk of any dementia were found. There was no evidence supporting an association between late-life TC and AD, or between late-life TC and any dementia. No study reported a significant association between TC (measured in midlife or late-life) and VaD. An association between high midlife TC and cognitive impairment was found but there was only weak evidence for an associatio...
The public know little about risk factors for dementia. The aim of this study was to explore beli... more The public know little about risk factors for dementia. The aim of this study was to explore belief structures underlying how plausible risk factors for dementia appear to the general public. Two thousand members of the Australian public were surveyed by telephone on their beliefs regarding dementia risk factors. Factor analysis was performed on 17 modifiable behaviours that were rated by participants as increasing, not changing or decreasing the risk of dementia. Three factors were obtained - Health and Lifestyle, Activity, and Nutrition. Items loading on the Health and Lifestyle factor were management of cardiovascular risk factors, drinking more water, reducing stress, coffee and tea, and alcohol intake. Items loading on the Activity factor were mental, physical and social activity and getting out and about more. Items loading on the Nutrition factor were eating foods high in omega-3 fatty acids, antioxidants and estrogen, using non-aluminium cookware and taking vitamin and nutri...
Dementia behavior long-term care observational data a b s t r a c t Objectives: The objectives of... more Dementia behavior long-term care observational data a b s t r a c t Objectives: The objectives of the current research were (1) to test and evaluate the investigator-designed Behavior, Engagement, and Affect Measure (BEAM) touchpad direct observational data collection tool, and (2) to implement this tool to investigate residents' patterns of behavioral agitation, engagement, affect, behaviors associated with positive mood, general time-activity use, and social interactions within long-term care. Design: Raters collected cross-sectional observational data and conducted semistructured interviews with participants of the Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE) Study. Researchers tested the BEAM's reliability and validity and evaluated the instrument's discriminate validity for sampling resident behaviors. Setting: Data were collected in 36 long-term care homes. The sample included low-care hostels, high-care nursing homes, and residential facilities offering aging-in-place. Participants: Participants were 406 residents aged 52 to 105 years, with and without dementia. Measurements: Researchers collected direct observational data using the BEAM and operationalized behavioral domains based largely on concepts from Kitwood's model of person-centered care. Care staff reported on resident behavior using standardized measures of agitation, depression, quality of life, and social engagement. Results: The BEAM showed moderate-to-substantial interrater reliability and slight-to-moderate correlations with staff-report data gathered through standardized questionnaire measures. Observations showed that residents spent the greatest amount of time stationary and expressing little emotion, although actively engaged with their environment. Residents were observed to be coping adequately and experiencing a positive social and/or positive care interaction in approximately half of observations; however, close to a third of ratings identified "ill-being." Residents showed more positive behavior, appeared happier and less anxious, and exhibited higher "well-being" during structured activity than during free time or meals. Conclusion: The BEAM is a reliable and valid observational tool for measuring behavior in long-term care. Long-term care residents expressed little emotion and experienced limited positive social interaction in their daily routine. Increased provision of structured activities may increase resident experiences of positive behavior, affect, and well-being.
The Australian Government has commenced a two-year pilot of consumer-directed care (CDC) across 5... more The Australian Government has commenced a two-year pilot of consumer-directed care (CDC) across 500 home and community aged care packages. This policy paper discusses the model being trialled in Australia in light of the UK&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Individual Budgets&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; Pilot Programme and the USA&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Cash and Counselling Demonstration. The results of these randomised controlled studies suggest that older people vary in their preferences for consumer direction and that many find the administrative tasks of implementing CDC programs difficult. The relatively restricted model of CDC that the Australian Government is trialling may minimise the problems encountered in the overseas programs, but does not allow consumers to hire family or friends which they preferred to do overseas.
Australia or internationally about dementia in persons from culturally and linguistically diverse... more Australia or internationally about dementia in persons from culturally and linguistically diverse (CALD) backgrounds. This limits our ability to plan for and provide evidence-based medical care, social care and aged care services to persons from CALD backgrounds. This paper describes challenges to conducting CALD dementia research; these include sampling, having valid instruments and costs. Nine key research recommendations in the areas of epidemiology, community knowledge, carers, service delivery, screening and assessment, medical management, residential aged care and minority CALD reached by consensus by an expert group are presented. The paper closes with some strategies to encourage CALD research. The material presented here will provide guidance for future research endeavours. In 2007 there were an estimated 220 050 people with dementia in Australia [1]. By 2030 this figure will have more than doubled to 465 460 and by 2050 the figure will reach 731 030 [1]. In 2007, 18% of Australian residents aged 65 and over were born overseas [2].
I enjoy my current work situation' and 'Our work organisation is good'. There were significant di... more I enjoy my current work situation' and 'Our work organisation is good'. There were significant differences between homes in levels of strain related to dementia care that were not accounted for by the level of behavioural disturbance. Conclusions. Nursing home staff tended to perceive residents in more negative than positive ways. Staff were generally satisfied with their work. Factors other than resident behavioural disturbance are important influences in nursing staff strain.
Investigate factors associated with waiting times for home care packages and outcomes for care re... more Investigate factors associated with waiting times for home care packages and outcomes for care recipients and carers. Analyses of data collected every four months for 12 months from 55 community-dwelling older adults eligible for government-subsidised packaged care and their carers. Thirty of fifty-five participants were offered a package; they waited from one to 237 days. Baseline quality of life was higher for those offered a package than those not. Baseline care needs and unmet needs, neuropsychiatric symptoms, and cognitive decline did not predict offers. Package receipt compared to non-package receipt was associated with decreased carer burden over time but did not affect levels of unmet care needs, care needs or quality of life. Being offered a home care package was not based on waiting time or unmet care needs. Reforms should include a transparent system of wait listing and prioritisation.
Objectives: To determine whether humour therapy reduces depression ( primary outcome), agitation ... more Objectives: To determine whether humour therapy reduces depression ( primary outcome), agitation and behavioural disturbances and improves social engagement and quality-of-life in nursing home residents.
The American Journal of Geriatric Psychiatry, 2014
To examine the clinical utility of the Cornell Scale for Depression in Dementia (CSDD) in nursing... more To examine the clinical utility of the Cornell Scale for Depression in Dementia (CSDD) in nursing homes. 14 nursing homes in Sydney and Brisbane, Australia. 92 residents with a mean age of 85 years. Consenting residents were assessed by care staff for depression using the CSDD as part of their routine assessment. Specialist clinicians conducted assessment of depression using the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders for residents without dementia or the Provisional Diagnostic Criteria for Depression in Alzheimer Disease for residents with dementia to establish expert clinical diagnoses of depression. The diagnostic performance of the staff completed CSDD was analyzed against expert diagnosis using receiver operating characteristic (ROC) curves. The CSDD showed low diagnostic accuracy, with areas under the ROC curve being 0.69, 0.68 and 0.70 for the total sample, residents with dementia and residents without dementia, respectively. At the standard CSDD cutoff score, the sensitivity and specificity were 71% and 59% for the total sample, 69% and 57% for residents with dementia, and 75% and 61% for residents without dementia. The Youden index (for optimizing cut-points) suggested different depression cutoff scores for residents with and without dementia. When administered by nursing home staff the clinical utility of the CSDD is highly questionable in identifying depression. The complexity of the scale, the time required for collecting relevant information, and staff skills and knowledge of assessing depression in older people must be considered when using the CSDD in nursing homes.
Background: Depression is a common psychiatric disorder in older people. The study aimed to exami... more Background: Depression is a common psychiatric disorder in older people. The study aimed to examine the screening accuracy of the Geriatric Depression Scale (GDS) and the Collateral Source version of the Geriatric Depression Scale (CS-GDS) in the nursing home setting.
AFQT scores than MCI-discordant pairs; MCI-discordant pairs had lower scores than normal-concorda... more AFQT scores than MCI-discordant pairs; MCI-discordant pairs had lower scores than normal-concordant pairs. Within-pair AFQT differences were observed only in dizygotic discordant pairs; normal twins scored higher. Overall results were similar for age 55 AFQT even after adjusting for age 20 scores. Conclusions: Neuropsychologically-defined MCI is present in the sixth decade of life (50s) in non-clinically referred, community-dwelling adults. A unique feature of the discordant twin design enabled us to identify unobserved heterogeneity. The subgroups of normal twins are phenotypically the same, but differed in premorbid cognitive ability based on genetic risk (i.e., having a normal or MCI co-twin). Differences based on genetic risk for the MCI phenotypes followed the same pattern. Premorbid ability is not the entire story, however, because differences persist even after adjusting for premorbid ability. Finally, genetic influences cannot cause differences in genetically-identical monozygotic twins. Therefore, the fact that premorbid cognitive differences within discordant pairs were accounted for by only dizygotic twins suggests that the link between premorbid cognitive ability and MCI is due to some degree of shared genetic influences.
Uploads
Papers by Lee-fay Low