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Objective The objective of this study is to clarify if admission to a specialist geriatric medicine ward leads to improvements in aspects of acute medical care for patients with dementia. Methods We analysed combined data involving 900 patients from the Irish and Northern Irish audits of dementia care. Data on baseline demographics, admission outcomes, clinical aspects of care, multidisciplinary assessment and discharge planning processes were collected. Results Less than one-fifth of patients received their inpatient care on a specialist geriatric medicine ward. Patients admitted to a geriatric medicine ward were less likely to undergo a formal assessment of mobility compared with those in non-geriatric wards (119/143 (83%) vs 635/708 (90%), odds ratio (OR) = 0.57 (0.35 to 0.94)) and were more likely to receive newly prescribed antipsychotic medication during the admission (27/54 (50%) vs 95/2809 (36%), OR = 1.95 (1.08 to 3.51)). Patients admitted to a geriatric medicine ward were more likely to have certain aspects of discharge planning initiated, including completion of a single plan for discharge (78/118 (66%) vs 275/611 (45%), OR = 2.38 (1.58 to 3.60)). Surgical wards performed more poorly on certain aspects including having a named discharge co-ordinator (32/71, 45%) and documentation of decisions regarding resuscitation status (18/95, 19%). Conclusion Relatively low numbers of patients with dementia received care on a specialist geriatric medicine ward. There appears to be a more streamlined discharge planning process in place on these wards, but they did not perform as well as one would expect in certain areas, such as compliance with multidisciplinary assessment and antipsychotic prescribing. Copyright © 2016 John Wiley & Sons, Ltd.

The objective of this study is to clarify if admission to a specialist geriatric medicine ward leads to improvements in aspects of acute medical care for patients with dementia.We analysed combined data involving 900 patients from the Irish and Northern Irish audits of dementia care. Data on baseline demographics, admission outcomes, clinical aspects of care, multidisciplinary assessment and discharge planning processes were collected.Less than one-fifth of patients received their inpatient care on a specialist geriatric medicine ward. Patients admitted to a geriatric medicine ward were less likely to undergo a formal assessment of mobility compared with those in non-geriatric wards (119/143 (83%) vs 635/708 (90%), odds ratio (OR) = 0.57 (0.35 to 0.94)) and were more likely to receive newly prescribed antipsychotic medication during the admission (27/54 (50%) vs 95/2809 (36%), OR = 1.95 (1.08 to 3.51)). Patients admitted to a geriatric medicine ward were more likely to have certain aspects of discharge planning initiated, including completion of a single plan for discharge (78/118 (66%) vs 275/611 (45%), OR = 2.38 (1.58 to 3.60)). Surgical wards performed more poorly on certain aspects including having a named discharge co-ordinator (32/71, 45%) and documentation of decisions regarding resuscitation status (18/95, 19%).Relatively low numbers of patients with dementia received care on a specialist geriatric medicine ward. There appears to be a more streamlined discharge planning process in place on these wards, but they did not perform as well as one would expect in certain areas, such as compliance with multidisciplinary assessment and antipsychotic prescribing. Copyright © 2016 John WileySons, Ltd.

Objectives Subjective memory complaints (SMC) are common. We aimed to characterize the relationship between psychiatric illness and white matter disease to SMC in a sample of healthy older people. Measurements Cognitively normal subjects between 55 and 90 years had age-adjusted and education-adjusted Consortium to Establish a Registry for Alzheimer's disease (CERAD) scores ≤1.5 SD from standard mean. ApoE genotyping was performed using polymerase chain reaction. Sixty subjects (30 SMC, 30 controls) underwent 3T MRI, which was rated by two raters blinded to the diagnosis, for periventricular (PVH) and deep white matter hyperintensities (DWMH) using the Fazekas scale. Subjective memory was assessed by asking the participant, Do you feel like your memory or thinking is becoming worse? Results Two hundred and fifteen volunteers were assessed. Ninety-six were cognitively normal (mean age 62.5 years). SMC were reported by 52/96 subjects (54%). These were compared with subjects who denied SMC. Participants with a history of depression or anxiety were more likely to have SMC (p = 0.02). The frequency distribution of ApoE4 allele and CERAD scores were similar. White matter load was similar (p ≤ 0.47), with a high prevalence of PVH and DWMH seen (100% and 88% of scans, respectively). Conclusion Both SMC and white matter disease were common. SMC were associated with a history of depression or anxiety but not with white matter disease. Evaluation for a history of depression and anxiety in people with SMC is supported by these findings. Copyright © 2011 John Wiley & Sons, Ltd.

Background Depression and anxiety are the most common mood symptoms and psychological consequences of stroke. This study aimed to examine the influence of acute depression and anxiety symptoms on functional recovery and health-related quality of life (HRQoL) one year after stroke. Methods At one month and one year after stroke, the prevalence and severity of depression and anxiety symptoms were examined in consecutively admitted patients, using the Hospital Anxiety and Depression Scale (HADS). Functional recovery was assessed using the Nottingham Extended Activities of Daily Living (NEADL) and HRQoL using the Stroke-Specific Quality of Life scale (SSQOL). Results In 107 patients, the prevalence of depression and anxiety symptoms was 35% at one month and 36% and 34%, respectively, at one year. Depression symptoms were significantly associated with functional ability (r = −0.19, p

A need exists for a simple screening instrument for depression in the elderly which may be applicable in mild to moderate dementia. The GDS is a simple 30-item instrument whose role in screening for depression in dementia is controversial. This may relate to problems with its use as a self-administered questionnaire with unclear guidelines as to which subjects may be aided by the rater. We assessed the GDS as a staff-administered and a self-administered instrument in 100 elderly medical patients. There was a significant difference between the mean scores for each mode of presentation. This may account in part for the discrepancies between published studies on the GDS in dementia. In the absence of strict guidelines for the original mixed mode of application, the GDS should be considered as a staff-administered questionnaire exclusively.

This study was undertaken to investigate whether it was possible to identify a 'cutoff' score on the Mini-Mental State Examination (MMSE) below which further cognitive assessment would be of little benefit for research or diagnostic purposes. Evaluation of cognitive assessments in 467 subjects, aged 31-92 (mean 71.4 years), in whom an MMSE score was also available revealed, for those patients scoring ≤5 out of 30, that the majority of a further battery of tasks testing amnesia, aphasia, visuospatial ability and intellectual processing were too difficult. Half of the subjects were too severely impaired to complete 16 of the 17 tasks. When the MMSE score was 8 out of 30 or less, there were eight tasks where a minimum of 50% of patients were untestable. In summary, subjects scoring 8 or less on the MMSE are unlikely to be able to cooperate meaningfully with further cognitive assessment, using psychometric test batteries such as that currently in use in our clinic, and similar batteries.

One hundred and eleven patients admitted to an acute medical geriatric assessment unit were screened for depression using the Geriatric Depression Scale questionnaire. All patients with high scores were further assessed by a consultant psychiatrist in a semistructured interview. Of the patients screened, 23.4% had depression of a clinically significant degree and 13.5% were judged to need specific antidepressant medication. 10.8% of the population had depressive illness superimposed on organic brain disease.